Plot Thickens in Ongoing Debate of 'Healthy Obese'(Weight Loss Not for Everyone, Says Specialist)

One of Canada's top obesity doctors says it's time to stop recommending weight loss for everyone who meets official criteria for obesity.

Dr. Arya Sharma says being obese doesn't necessarily doom people to poor health and that weight loss recommendations should be targeted at those most at risk because of medical problems.

Many people who meet the body mass index criteria for obesity "are really not that sick at all," says Sharma, chairman for cardiovascular obesity research and management at the University of Alberta and scientific director of the Canadian Obesity Network.

"It's not unusual to find someone come into your practice whose BMI is 30 or 32 (technically obese). This might be someone who is physically active, who is eating a good healthy diet. If you followed the guidelines to the letter you would be prescribing obesity treatment when there's really no reason to do that, because they're not medically obese."

"It's not enough to just know how big someone is. In order to make medical decisions, you need to know how sick someone is."

His appeal comes as evidence begins to mount that a significant proportion of fat people are metabolically healthy. One in every three people who are obese -- and half of those who are overweight -- may be resistant to fat-related abnormalities that increase their risk of cardiovascular disease, according to new research from Albert Einstein College of Medicine in New York.

The concept of "benign obesity" has been known for more than 20 years. Only now are researchers discovering the scope of the phenomenon.

"Obesity was far less common when it was identified, and then obesity became this gigantic epidemic, with just the assumed outcome that everyone is going to be at risk for vascular disease and a whole bunch of other things," says Rachel Wildman, an assistant professor of epidemiology and population health at Albert Einstein College.

"As it turns out, it seems not to be the case. There is at least a proportion of obese individuals who at this point don't seem to be at elevated cardiovascular risk." Not only is their risk fairly minimal, "in some instances it's better than individuals who are normal weight."

Hardly a week passes without a headline warning the overweight are eating their way toward a premature death, and there's a huge amount of money to be made by encouraging hysteria around the issue. The weight-loss industry is worth $50-billion in the U.S. alone. But there's growing recognition that the risks associated with obesity are not uniform.

In Wildman's study, nearly 17% of obese men and women possessed not one of the heart or metabolic abnormalities the researchers considered.

"What's very clear is that people in the range of 25 to 30 BMI -- the 'overweight' category -- live longer than lighter people," says Paul Ernsberger, an associate professor of nutrition at Case Western Reserve University School of Medicine in Cleveland, Ohio.

Researchers have shown that while overweight people are more likely to have a heart attack and heart failure, they're also more likely to survive it.

One theory is that high blood pressure, a leading cause of heart disease, is less dangerous for fat people than for lean: Obese people with high blood pressure tend to have higher blood volume and higher cardiac output. Lean people, on the other hand, have high blood pressure because of increased resistance -- that is, their blood vessels are clamped down more tightly.

Having more blood circulating isn't as harmful as having blood vessel changes, Ernsberger says.

He and others believe the concept of "overweight" should be abandoned, "because that implies that you are over the ideal, that there is some magical weight you shouldn't be over." He says a person's weight begins to affect their health at around a BMI of 30.

Wildman, of Albert Einstein School of Medicine, agrees that it may be time to deal with the obesity epidemic in a more nuanced way.

Her team's analysis of a sample of 5,400 American adults 20 and older found 23.5% of normal-weight adults were metabolically abnormal, whereas 51.3% of overweight adults and 31.7% of obese adults were metabolically healthy, at least when it comes to their risk for heart disease.

One theory is that some obese people are less sensitive to the hormones and inflammatory chemicals secreted by fat tissue. Another is where the fat is stored. It may be that the healthy obese have less visceral fat -- the kind of fat that wraps around the intestines, liver and other organs that's more metabolically active than peripheral fat.

To answer that question, Ernsberger took genetically obese and genetically thin rodents and made the thin ones fat by feeding them a high-sugar, high-fat diet. "They both had obesity related problems, but the one that has a poor diet is much less healthy -- they have worse blood sugar, worse blood pressure and worse cholesterol.

"So all risk factors are worse off, even though they may not nearly be as heavy as the genetically obese." He says some people are naturally obese and other people are naturally thin but that they force their bodies to become obese by over-eating and under-exercising. "And that's probably the unhealthy obese."

Public health recommendations tend to lump everyone together. "It's like saying not everybody who smokes dies of a heart attack or develops lung cancer and yet we recommend to everybody not to smoke," says Dr. Andreas Wielgosz, an Ottawa cardiologist and spokesman for the Heart and Stroke Foundation.

A BMI of 25 to less than 30 is considered overweight. A BMI of 30 and over is obese. Someone who is five-foot-10 who weighs 174 to 208 pounds would be considered overweight, according to their BMI. More than that, and they're obese.

when my mom hit middle age she got a really good full physical.. she had every test known to man and everything came back perfect. Then the doc says “ but i want you to lose some weight”.....”.um, did you ever stop to think it was all that good food that made me so healthy?” she says.

That’s not surprising. Personally, I’ve qualified as ‘dangerously underweight’ for most of my life, and despite eating most everything in sight and getting lots of exercise and doing weightlifting to try and build muscle mass, gaining weight was almost impossible. Therefore, it makes perfect sense to me that there would be people in the opposite situation, who have a high BMI and can diet and exercise and be healthy all they want, but can’t lose weight for whatever reason. Not to mention that muscle mass weighs more than fat, so almost all professional athletes, even ones who aren’t bodybuilders or football players, fall into the ‘overweight/obese’ category.

When my grandfather turned 80, he went in for his usual checkups. Doc told him to quit drinking Scotch, because it was bad for him.

Grandpa fired the doctor. :-) Quote: "What did this guy think, that it was going to stunt my growth?"

Grandpa lived to the ripe old age of 89, and enjoyed his Scotch thoroughly right up to the end.

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