Thursday, October 16, 2008

Fat & Healthy

Fat & Healthy

OK, be honest, if you see a chubby person do you think “hey, you look sensational” or “don’t collapse near me please, I ain’t done CPR training in years”? It is difficult not to think that a person with a greater width than you dines on pastries and wouldn’t be wise to plan past the weekend.

There are two (unexpected) types of people
A US report on 5440 adults found there are two types of people we do not normally acknowledge. One group of adults (or phenotype) were healthy, overweight people who did not have the cluster of expected risk factors for early demise, such as high blood pressure, blood glucose and blood cholesterol. Another phenotype is the physically lean person who did have a cluster of risk factors for heart disease and early death.

The study revealed that one in four lean adults were just around the corner from their first heart attack, while a half of overweight adults (yes, half) were healthy on the inside, or “metabolically healthy” in their words. That is, all things being equal, they would live a long and healthy life. Even one in three obese adults were metabolically healthy.

Are thin health professionals too smug?
We are frequently told of the prevalence of overweight and obesity (67% men; 52% women), with the implied assumption that all of these people are going to die young unless they see the error of their habits and start taking better care of themselves. That some people classed as overweight could be healthy will not suit the socially-sanctioned and health professional-endorsed view that all overweight people are, or likely to be, a health burden. And it is easier to make every fat person feel guilty rather than admit that some of them are pretty fit and healthy.

Why is it that we assume that a lean person is a healthy person? It seems that plenty of trim folk have high cholesterol and blood pressure, although they are not publicly admonished as they look healthy. Go to the gym and see the people aiming to get the right look, the “approved look”. Is this self-obsession healthy? When a solid looking guy tells you that he hates Good Friday and Christmas Day because the gyms are closed, you wonder if we haven’t missed something in our list of risk factors for health. I recall a conversation with one 25 year old lady who had decided not to have children. Why? Because she would look fat for five months or so!

Is health just based on measurements?
I wonder whether health is measured solely by what is measurable? We can measure your blood pressure, but there isn’t a simple test for happiness. You won’t find it in the textbooks, but I think that health includes an appreciation of a normal body; for example, pregnancy is normal, being able to bench press 150kg (330lb) is not. Healthy habits also include volunteering, mentoring, giving to charity, hugging your kids, and buying Girl Guide biscuits even if they go to the dog.

The salient point
That point is that you cannot assume that every fat person is a walking heart attack and that every lean person should plan for a long life. A better measure of your health will come from a knowledge of what is happening on the inside, such as blood cholesterol, blood pressure, fitness levels and Prostate Specific Antigen in men. On a different level, it would be wise to meet with your friends each time assuming it could be the last, independent of their size. Morbid, I know, but that thought could get you to appreciate them more each time you do see them.

Reference: Archives of Internal Medicine 2008; 168 (15): 1617-1624


David Beard said...
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David Beard said...

This highlights the importance of focusing on fitness not fatness.

For years I've been telling people to throw out their scales and just try and get fit. Weight, body fat levels and the internal health markers will take care of themselves if you get fit.

Perhaps if models focused on being fit rather than thin we wouldn't have issues with their health either!