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Obese But “Healthy” May Still Kill You?



Recently, I blogged about Jennifer Kuk’s study showing that even so called “metabolically healthy” obese folks may have an increased risk of premature death. This study certainly supported the notion that the term “healthy obese” may well be an oxymoron.

Now, a new study Johan Ärnlöv and colleagues from Uppsala University, Sweden, published online in Circulation, provides further support for the idea that obesity may still kill you even if you have no other apparent metabolic risk factors.

The researchers looked at deaths in 1758 fifty-year old male participants without diabetes in the community-based Uppsala Longitudinal Study of Adult Men (ULSAM).

After adjustment for age, smoking, and LDL cholesterol, as expected, an increased risk for cardiovascular disease was observed in normal-weight (hazard ratio 1.63), overweight (HR 1.74), and obese (HR 2.55) participants with metabolic syndrome (MetS).

However, even in participants without MetS, overweight (HR 1.52) and obesity (HR 1.92) were associated with a significantly greater risk for cardiovascular disease.

Thus, as in the previous study by Kuk and colleagues, it again appears that excess weight is a significant predictor of heart disease even in people who appear to be metabolically healthy.

Clearly, taken together, these studies challenge the notion of so-called “healthy” or “benign” obesity.

What does this mean for clinical practice and weight-loss recommendations?

As blogged before, unfortunately losing weight and keeping it off is by no means easy and most people will tend to regain any weight they lose. For this reason alone, prevention of further weight gain is a far more achievable and realistic goal than losing weight and keeping it off.

For practical reasons, I have therefore previously recommended that we focus our expensive and limited weight-loss treatments on people with apparent obesity related complications (EOSS Stage 2 and 3). 

But let us not kid ourselves into believing that excess weight can be a benign condition and that simply continuing to gain weight can be OK as long as medical check ups show no sign of obesity-related illness.

It is always the right time to stop the gain!

AMS
Edmonton, Alberta

2 Comments

  1. I haven’t been able to see if this appears in the Ärnlöv study, but I think it’s important to note that in the Kuk study and another similar one (Ewertz on breast cancer and BMI), some portion of the mortality risk is not due to the excess weight per se, but is due to later diagnosis of disease.

    Why is that important? Because some of this may well come from the patient avoiding the doctor, and some may well be from the doctor’s bias wrt overweight patients.

    So, I’m not saying that excess weight is benign. In fact, I like the way Taubes puts it: what makes us fat makes us sick. So I think that getting people off crappy diets is as important if not more so than weight loss. But I also think we need to look past whether or not fat is inert or not and look at other reasons that excess weight can be a risk for people!

    See Brownell and Puhl for more: http://xnet.kp.org/permanentejournal/sum03/stigma.html

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  2. QUOTE:

    Why is that important? Because some of this may well come from the patient avoiding the doctor, and some may well be from the doctor’s bias wrt overweight patients.

    that being said.

    Education of DRs is very important.. Not just drs who deal with obesety.

    I for one feel that any doctor who practices ( GP OR OTHER) should have to take a course from Dr Sharma. or someone who has knowledge. ( Knowledge is Power )….

    . Most drs who see Overweight patients ” give up”, close the door on communication before they even have an opportunity to talk to the patient.. I am one who it took almost dieing to have a dr care enough to help me. I don’t have high colestoral, I dont have diebeties. . But I was over 390 lbs and needed someone to help me help myself..

    I have lost almost 9 precent of my BW due to the care and support of the Team. I do the work. They incourage me and let me know what I need to change .

    This program that Dr Sharma Runs is something that is needed Canada Wide.. Each Province Needs to help . Not only the Medically ill Obese but the Non Medically.. I for one hated going to the dr cus their way of dealing with it was ” what can I prescribe ???”..

    Weight loss is not an over night ,over the counter fix. it’s a life time ,life style change. Mostly comes from the willingness of ourselves …

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