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“The take-home message would be pay more attention to your weight even if you don’t have an unhealthy risk factor profile yet.” Lijing L. Yan, PhD, MPH, Northwestern University Researcher (Associated Press)

 “Healthy” Fat People at Risk

“Devastating” is the word my friend Drew Parkhill used to describe a recent study by researchers at Northwestern University linking obesity and mortality. “Certainly provides serious motivation to exercise and lose weight,” he added. After reading the study, reported by AP medical writer Lindsey Tanner and published in the Journal of the American Medical Association (January 11, 2006), I agree that it’s an important wake-up call for those inclined to downplay the dangers of being overweight.

Not long ago I wrote about a Harvard study which found that being fit does not overcome the hazard of being overweight or obese (Fit But Fat Risky, # 142, Health & Fitness category). Exercise helps, but does not overcome the increased risk of death associated with being fat. The new study investigates whether having normal blood pressure (120/80 or lower) and normal cholesterol (<200) negate the dangers of being overweight or obese. Apparently they don’t.

The researchers analyzed data on 17,643 Chicago-area men and women who were examined between 1967 and 1973, and then followed through 2002, an average of 32 years. The participants, mid-40s on average and free of heart disease or diabetes at the beginning of the study, were initially checked for height, weight, blood pressure and total cholesterol. Beginnings at age 65, Medicare records were used to determine whether participants had been hospitalized or died as a result of heart disease or diabetes.

Abundant evidence shows a strong association between being overweight and well-established coronary risk factors, such as high blood pressure and high cholesterol. Many doctors, however, haven’t been sure what to tell patients who ask whether it’s okay to be overweight as long as their blood pressure and cholesterol are normal. Using the data from the Chicago-area study, Dr. Lijing L. Yan and her colleagues undertook to assess the relationship, if any, between midlife body mass (based on height and weight) and illness or death after age 65.

The statistical analysis is more complicated than it sounds, because different levels of body mass (normal, overweight and obese) and risk (low, moderate and high) create a checkerboard of sub-groups. After sorting all this out, the researchers concluded: “For individuals with no cardiovascular risk factors as well as for those with 1 or more risk factors, those who are obese in middle age have a higher risk of hospitalization and mortality from coronary heart disease, cardiovascular disease, and diabetes in older age than those who are normal weight.”

More specifically, obese participants with normal blood pressure and cholesterol were 43% more likely to die of heart disease than those with normal body mass. Obese participants with moderate risk (BP 121-139/81-89 or total cholesterol 200-239) were more than two times as likely to die. As you would expect, hospitalization figures were worse. Obese participants with normal BP and cholesterol where hospitalized four times as often as normal-weight participants.

Significantly, participants who where overweight (but not obese) with low risk factors also had a higher risk of hospitalization or death than those with normal weight.

“The take-home message would be pay more attention to your weight even if you don’t have an unhealthy risk factor profile yet,” lead researcher Lijing L. Yan told AP medical writer Lindsey Tanner. Yan said it is possible that some overweight participants developed high blood pressure and cholesterol during the study (before turning 65), which could have contributed to their hospitalization or death. “But she said researchers increasingly believe that being too fat causes other cardiovascular problems, too,” Tanner reported.

My friend Drew was especially impressed by the explanation offered by Dr. JoAnn Manson, chief of preventive medicine at Harvard’s Brigham and Women’s Hospital: Fat tissue is more than a storage depot. It is “a very dynamic organ that is actually producing hormones and chemical messengers.” These substances can damage blood vessels, increase the risk of blood clots and cause insulin resistance that makes people prone to diabetes—all without elevating blood pressure or cholesterol, she told the AP writer

Clearly, excess fat can be a major health problem—separate and apart from other risk factors.

Take a clue from my friend Drew. Don’t wait. If you’re carrying excess fat--lose it and keep it off!

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