Metabolically Healthy Obesity Not Associated with Higher CVD Risk
In my review of Part 1 of “The Weight of the Nation,” I raised a subject not discussed in the documentary: the existence of metabolically healthy obese people. Now that I’ve seen the entire documentary, I’m still somewhat unsatisfied with the writers’/producers’ “black/white” view of obesity: if your BMI is >30, you’re a ticking time bomb. Your increased risk for diabetes and/or heart disease was simply assumed.
According to this report relayed by bariatrician Arya Sharma, however, things may not be quite so dire…
In a study by Mark Hamer and Emmanuel Stamatakis from University College London, published in the Journal of Clinical Epidemiology, the researchers show that ‘metabolically’ healthy obese individuals have minimally (if at all) increased risk of cardiovascular mortality.
Their study looked at mortality records in 22,203 men and women community-dwelling adults from the general population in Scotland and England without known history of cardiovascular disease (CVD) at baseline.
…Compared with metabolically healthy nonobese participants, metabolically ‘healthy’ obese individuals were not at elevated risk of CVD over the seven year observation period.
In contrast both metabolically ‘unhealthy’ nonobese and obese participants were were at a significantly elevated risk for heart disease.
In addition, metabolically ‘unhealthy’ obese participants were also at elevated risk of all-cause mortality compared with their metabolically healthy obese counterparts.
Dr. Sharma comments: “Clearly treatment recommendations based on BMI alone should be now considered obsolete and perhaps best relegated to history books.”
May 27, 2012
I also noted this in the parts of the series I have seen. It did seem like an “all or nothing” frame of mind. You were either at the correct weight and “healthy”, or obese and ready for death.
This could have partly been do to the fact that they were trying to get people to loose weight and not give them the belief they could be heavy and healthy.
I do agree with Dr. Sharma. I think there are people out there that are overweight but still are metabolically healthy. The use of BMI is a terrible way to judge health.
May 27, 2012
From a larger public health frame, obesity is an issue: the aggregate numbers don’t lie.
The problem with “The Weight of the Nation,” however, is that it consistently blurred the distinction between the “big picture” of public health and the risk to specific individuals. This attitude can complicate the lives of obese people who need medical treatment for various ailments – as I mentioned in my review of Part 3, doctors and other medical personnel often can’t see beyond “fat” and prescribe weight loss as a sort of cure-all. In light of the fact (ably discussed in Part 2), that maintaining major weight loss is difficult for many obese people, IMHO, the medical focus should be less on weight loss, per se, and more on getting patients to adopt healthier habits – regardless of whether major weight loss occurs. Actually digging deeper to assess a patient’s actual risk factors is part of treating obese patients as individuals, rather than walking statistics.