Sensational headlines like these are designed to get your attention, and there have been a lot of them lately thanks to a new study by the University of Birmingham in England. Ever since the researchers announced—not published in a peer-reviewed journal, mind you, announced—their results at the European Congress on Obesity in May, media outlets all over the world have been tripping over themselves to declare an end to the decades-old "fat but fit" debate. The final word, according to most of them, as well as the study authors themselves: Healthy obesity isn't possible. (A claim that's especially troubling in light of recent evidence that more than 10 percent of the world's population qualifies as obese.)
To be fair, the study was pretty damning. It looked at the health records of 3.5 million adults during a 10-year period, making it the largest investigation of "healthy obesity" to date. The researchers found that individuals who were considered obese but metabolically healthy (i.e., having normal blood pressure and cholesterol levels, and no diabetes) were still 49 percent more likely to develop heart disease, seven percent more likely to suffer a stroke, and 96 percent more likely to have heart failure than healthy people of a normal weight.
It's hard to argue with those results, but I'm going to anyway. Or rather, I'm going to argue with everyone that uses them to conclude that you cannot be fat and fit, because that's absurd. And the study doesn't support that conclusion, anyway.
Before I explain why, I'd like to clarify what it means to be fit. Another author on this site defined fitness as "getting the fuck away from death," and I think that's a pretty good definition. Sure, it's nice to have a slim waist, fast feet, and muscles that stretch the limits of your shirtsleeves. It's also nice to be able to bench press one and half times your bodyweight, run a mile in less than eight minutes, and pass any number of other ridiculous tests that health magazines often proffer as benchmarks of being fit.
But you know what's nicer (not to mention a whole lot less subjective)? Not dying prematurely of shit you can likely prevent, like heart disease. And you don't need to be a fitness model to accomplish that. You just need to prioritize your health, and do it effectively enough to make a difference. So let's agree that minimizing your risk of death—and, I'd argue, maximizing your quality of life—makes you fit.
By that definition, the results of the British study are still pretty damning. As previously mentioned, simply having a body mass index (i.e., BMI—a ratio of height to weight) greater than 30 (the threshold for obesity) increases your risk of an early funeral by way of cardiovascular disease or failure, according to the authors. So that would seem to settle the debate: Healthy obesity is a myth—except, perhaps, if you exercise, which the study didn't take into account.
"We did not have access to data on physical activity, and therefore could not examine whether physical activity could modify the association between metabolically healthy obese and risk of cardiovascular disease events," says lead study author Rishi Caleyachetty, an epidemiologist at the Institute of Applied Health Research at the University of Birmingham.
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That's kind of a big deal (or "limitation," as researchers like to call it), and one that every other news story about the study seems to overlook. Most research—and by that I mean the vast weight of scientific evidence—shows that exercise has a distinctly beneficial effect on health regardless of where you land on a BMI chart. A 2011 study by researchers at Arizona State University, for example, found that a healthy diet and moderate exercise can reduce obese people's risk of cardiovascular disease and diabetes regardless of whether they lose weight or not. There was also a 2015 study of more than 11,000 adults at the University of Mississippi that found that "only those individuals that were inactive were at a signiﬁcantly increased risk for all-cause mortality." Translation: Being obese and physically active makes you less likely to die than being skinny and inactive.
To be fair, not every study agrees so resoundingly with the idea that exercise is the great equalizer in matters of death and bodyweight. Most notably, a 2015 study of 1.3 million Swedish men reached the opposite conclusion of the Ole Miss study: "Unfit normal weight [BMI less than 25] individuals had a 30 percent lower risk of death from any cause than did fit obese individuals."
It's tough to argue with that result as well, but allow me to call your attention to the last three words of it: "fit obese individuals." Even this massive study, which challenges the notion of healthy obesity, recognizes the "fat but fit" condition. It also found that even if exercise didn't level the mortality playing field for overweight and obese individuals, achieving a high degree of aerobic fitness (as measured by VO2 max) still reduced their risk of death by 28 percent and 30 percent, respectively.
In case all of that science made your eyes roll and mind wander, I'll sum it up for you: It is absolutely possible to be fat and fit. But like many things in life, fitness is a continuum, not a specific point, and there is always room for improvement. To that end, it's also important to keep in mind that, generally speaking, a person of normal weight who exercises regularly and eats healthfully will almost always be fitter than a similarly diligent overweight person.
So even if you're "fat but fit," you're not off the hook. Indeed, death is likely still closer on your heels than it is on those of the thin guy raining sweat on the treadmill next to you. But also know that every step you take moves you farther away from an untimely meeting with it—and makes you fitter as a result.
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