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.

14 Comments

  • Moira-Anne Somers says:

    Falling weight loss interest
    I often look at the very big ones and wonder how they feel. They often seem to look happy and content. That tells me a lot seem to feel very comfortable like that, they don’t know anything better so why change.
    It’s become a sad sight.
    MAS

  • Daren says:

    Very well written! Something my girlfriend and I have been talking about for a long time. This is particularly true in the black culture of “Big Boned” people. “I’m not Fat I’m Big Boned” is absurd and lazy. Black people eat a lot of refined carbs and processed sugars and exercise isn’t really cool (it’s not cool with too many cultures except western white). So it’s a behavioral systemic change that needs to happen from the ground (kids) up.

  • Jessie says:

    Hi,
    Just wanted to thank you all for the great work done on MAF.
    My husband and I have been following MAF method since Apr 16. Did the 2 weeks test, changed training to heart rate based, and diet to LCHF. Pace has since been improving and we no longer use energy gels. Just peanut butter and honey for runs above 25km. Carbs are mostly natural and low GI.
    Did our bloodwork recently. All looks well, low triglycerifes (96 mg/dL) , low gulcose level at fasting state (88 mg/dL) and high HDL (104 mg/dL). BUT LDL is off the charts! (202 mg/dL)… which gives a ratio of 3.1 (total/HDL) but still….
    I know Dr Phil says in his book that LDL itself is not a problem unless oxidation occurs, so should we be concerned at all?
    Also read somewhere that LCHF diet can cause high LDL for some, and one way to ‘treat’ that is to eat a very high fat diet just 3 days before blood test (meaning 5000 calories mainly from fat). We’re rather tempted to try it. Would you recommend it at all?
    Hope you can shed some light.
    Thanks!
    Jessie (from Singapore)

    • Hi Jessie:

      It would be good to know what the VLDL (very low density lipoprotein) is.

      I haven’t heard much about the benefits of eating a very high fat diet just before the blood test, but at face value it seems to me like the goal of it is more to hack the blood test than to improve health.

      Sorry if this is vague – have I helped at all?

      Ivan

      • Jessie says:

        Hi Ivan,

        Thanks for the quick response.
        The blood work didn’t include test for VLDL… I only have results from liver profile:
        Total protein 7.4 g/dL (ref. range 6-8.2)
        Albumin 4.4 g/dL (ref. range 3.5-5.0)
        Globulin 3 g/dL (ref. range 2.2-4.0) so I am within healthy range… supposedly 🙂
        And yes… the goal seems to be hacking the blood test result because the author also went on a LCHF diet, felt great but was totally blown away by his very high LDL level. He has a youtube video on this too, search Dave Feldman or cholesterolcode.com.
        I understand the topic is complex… just good to know if we’re on the right track.
        Thanks!

        • Daniel says:

          Hi Jessie, obviously you are referring to the Feldman protocol. Personally I think the your blood work is excellent; keep it up

        • Hi, Jessie –

          Unfortunately I can’t make any specific suggestions that might contradict what your doctor may say, but I can tell you that in recent years, the evidence has been building that VLDL is a better predictor of heart disease than LDL. It would also be good to test yourself for C-reactive protein.

          In my experience, a lot of individuals on a keto or LCHF diet who have no signs and symptoms of poor health have high cholesterol levels. I haven’t read any journal articles that study specifically why this may be, but I chalk it up to the fact that they have more fats going in and out. It is uncommon for there to be only one indicator of heart disease: usually there are a constellation of positive (bad) tests results indicating the presence of heart disease.

          What I would do is go to a nutritionist or cardiologist comfortable with LCHF/keto diets and have them explore your situation. Given the absence of any symptoms of poor health it is unlikely that you would have an issue, but the final word should be with a health professional who can address your particular situation in depth.

          • Jessie says:

            Hi Ivan,
            Thanks for the reply. We’ll include those 2 tests in the next round of blood work. Meanwhile we’re staying on with this.
            Keep great articles coming!

            And thanks to Daniel for the encouragement.

  • Gregg says:

    Our society has adjusted so much towards the heavy side of the spectrum that we’ve convinced ourselves that we’re healthy on that side. Now when we see BMIs of 23 or less we think that they have some serious issues. Dadbods are the new craze. Why not get gratitudes and praise for essentially giving up?

  • Daniel says:

    I hear what you are saying but explain this. I have a brother who is past his mid sixties who has a bmi of around 30. He is strong and indeed has thicker bones then I do. And yet, his blood numbers are fantastic – cholesterol, blood pressure, sugar levels you name it and he is medication free. He eats really well but also indulge in eating deserts and enjoying beer etc. Then there’s me. I’ve been active most of my life and still is (I also served as a paratrooper for 3 years while he served a none combat task) and my weight today is pretty much the same as in my twenties. I was always aweare of what I eat and have been following the primal diet for a number of years before switching to very high fat diet – keto basically.. and yet, I am the one who has hasimoto, I had my gallbladder removed ( maybe because in the past I followed the guidelines and try to eat low-fat), my blood pressure is rising, my ferritin’s are high due to g6pd insufficiency, my cholesterol numbers are higher but ratios good but fluctuate and I takes me a while to heal from breaks caused by my adventures activitie, whether mounting biking or barefoot running. I had multi stress fractures over a year ago and I just started hitting the pavement again but my ankle still doesn’t feel a 100%. There’s one factor that distinguish us ,I am more tense then he is and the past years have been a struggle for me, but that surely can’t account for all the differences between our health statue (I am 60).

    I would love to hear your take on this

  • Gregg says:

    Daniel I feel for you. Sorry to hear things aren’t working exactly right for you. However, this whole discussion is based more on the population and not the individual. How many times have we heard “but my uncle smoked all his life and he lived to be 100” or “my friend Joe can eat and drink anything he wants and he never gains a pound”? Since a population in this case is based on 100s of millions of people there’s always going to be a large number of people that fit in those little curves at either end of the distribution curve. Since life is an interplay of so many different variables (activity, nutrition, genes, sleep and stress to name a few of the key players) it’s just too hard to know why some people react different then other people given the same circumstances.

    • Daniel says:

      Gregg, I hear you. I very aware that some are exception to the rule no matter what the do. The difference between your friend Joe to the example I gave, lies in the the fact that my brother way of eating does effect his girth and may lead to issues in the future; and make that 32 BMI not 30. The other difference is that unlike you and joe we share genes. Having said that, I won’t switch places with him and I like the fact that at my age, I can still run circles around some that are far younger then I am. My Mom lived to 99 and was in excellent health and I hope I got some of her good genes. (-:

  • Ulrik pridal says:

    Hi
    Just started MAF a week ago, so very new here.
    I have a question which has been bothering me for a few years.

    Most diets uses the simpel math of Kcal taken in and Kcal burned, so 100Kcal in then you burn 110Kcal and you lost 10Kcal.
    But is it that simple can the human body really use 100% of the Kcal in whatever we eat?
    Most animals leave a lot of energy in their waste, look at elephant waste that can be used for firewood.
    Do we do the same, if I eat a Marsbar 500Kcal and then work out for 1000Kcal did I lose 500Kcal? or did my body “waste” some of the 500Kcal Marsbar and only really turn 80% into energy and expel the rest? I can see its a win win if I´m right so I lost 600Kcal in the above example.
    Does anybody know? I can´t find any study’s which explains this.

    • Hi Ulrik

      Great question. You’re exactly on the right track and in fact I want to add that it’s even more complex than that: for example, when your body burns calories, it does so by stressing muscles, bones, organs, nerves, etc. to an important degree. So in order to produce any real informative numbers, you would have to be able to calculate the amount of muscle, bone, organ, nerve (etc.) mass broken down—which requires repair and improvement. Furthermore, to speak directly to your example, some people waste 20%, others 25%, all based on the food itself, how well they chewed it, what their intestinal flora happens to be like at that point, etc.

      In short, it’s nearly impossible to calculate “calories in, calories out” in any real way. All you can do is track long-term trends and see what your muscle, bone, fat (etc) mass is like, and how your health and energy levels are like. That’s really the best way to know if you are getting enough calories (of what) in your meals.

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