Overfat and Healthy?

One big myth in modern society is that you can be both.

Embracing excess body fat as socially acceptable or even a healthy condition has been popular for years. We often see this in television ads that seem to validate or even glorify the the overfat condition.

Of course with up to 91 percent of the adult population being overfat, it pays to pander to target audiences when advertising unhealthy products.

From the social climate that brought specialty clothing sizes and the notion that any discussion on the topic is “fat-shaming,” to the clinical notion that obesity might even be a healthy condition, especially in older persons, what’s the real story?

It’s true that body fat is healthy, and is actually an endocrine organ. It serves many important functions, including support for organs, glands and bones, and as fuel for increased energy and endurance, as well as other metabolic needs.

But when body fat levels rise to excessive levels, things change. Fat cells become abnormal, driving poor health. This can lead to two serious conditions: chronic body-wide inflammation and carbohydrate intolerance (insulin resistance). Muscle dysfunction quickly follows, leading to poor exercise recovery and even injury.

Over time, these conditions cause a variety of cardiovascular and metabolic risks. These may include high LDL cholesterol, low HDL cholesterol, high triglycerides, increased blood sugar, and rising blood pressure. This pattern results in common diseases, from diabetes, cancer and arthritis, to Alzheimer’s and cardiovascular disease among others.

Also common conditions among those who are overfat include sleep apnea, polycystic ovary, fatty liver, gallbladder and pulmonary diseases, and others.

Treating symptoms instead of causes has become commonplace in today’s healthcare world. Eliminating an existing overfat condition should be a priority. Most other signs and symptoms are only secondary, despite being the focus of many primary therapies, including pharmaceutical drugs.

Falling interest in fat loss?

Yes. Studies show that fewer people are actively trying to reduce excess body fat. Between 1994 and 2008, the percentage of adults trying to reduce dropped from 56 to 49. Even primary care doctors have downplayed counseling and evaluation/diagnosis of overfat patients. Of course, there are many success stories, but these are few and those that last long-term are among people who made the right lifestyle changes.

An adipose paradox?

While it’s well-accepted that younger adults with excess body fat are at high risk of the many associated illnesses noted above, overfat adults in their 60s and older appeared to have paradoxical associations with reduced mortality, like those with normal levels of body fat. This ongoing idea just won’t die, fueled by studies showing obesity may improve post-op outcomes, especially in older persons. But who wants to have a surgery anyway?

These early studies have largely proven both deceptive and wrong. A recent study in the American Journal of Clinical Nutrition (2017) showed that even normal-weight non-obese people with increased body fat (most had increased belly fat), had “substantial excess mortality.”

Is there such a thing as ‘healthy obese?’

Not really.

Long called metabolically healthy obese (MHO), these individuals are technically obese with a BMI over 30, but appear less carbohydrate intolerant with few or no metabolic abnormalities such as blood fats or glucose, or blood pressure. Their global prevalence is estimated at 7 percent. But being overfat still renders these individuals at high risk for diabetes, cardiovascular disease and other problems. A closer look reveals that MHO people are younger, usually under 40, and as they age begin developing the conditions more commonly seen in overfat people at younger ages. MHO individuals may have subclinical disease, and are in the process of becoming unhealthy. They share the same long-term risks with others who carry excess body fat.

As discussed elsewhere, the waist-to-height ratio is a great monthly indicator of overfat risk. Your waist should measure less than half your height. While a common assessment of bone density known as DXA is also accurate for determining body fat, it’s impractical for regular use.

The most common cause of excess body fat — the consumption of refined carbohydrates, including sugar, and sometimes the overconsumption of natural carbohydrates — is also discussed elsewhere. Exercise plays a lesser role in the buildup or reduction in body fat.

Just because an abnormal, unhealthy condition becomes common should not make it normal or acceptable. It’s bad enough our society allows people to give up, and come up with sayings like, “there’s more to love” or excess abdominal fat “is sexy.” It’s not. Health is much more sexy than illness and dysfunction.

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