The Obesity Paradox

We all know that being fat is unhealthy. And that the more overweight you are, the sicker you are more likely to become. Right?

Wrong.

Amidst the overwhelming tide of warnings about the obesity epidemic in America, the outcries that sugar is toxic, and the medical advice given by healthcare providers everywhere to “just lose weight”, is a steadily growing group of researchers in opposition to the fear of obesity. Researchers looking at risk factors related to diabetes, heart failure, and atherosclerosis are discovering some unusual findings.  

In a research study conducted at Northwestern University, Dr. Mercedes Carthenon found that diabetes patients of normal weight are twice as likely to die as overweight or obese diabetes patients. Other researchers are finding these same types of trends when looking at patients with heart failure, and patients on dialysis.

There are many possible theories to explain the paradoxical effect that weight may have on mortality. One idea is that as the body develops a chronic disease, it requires more energy and calories to deal with the disease effects.  Another theory proposes that genetics plays a role: Perhaps thinner people have genes making them more susceptible to chronic diseases.

And yet a third theory asserts that we are measuring overweight and obesity with the wrong yardstick. BMI—body mass index—is actually an arbitrary table that only takes into account height and weight to calculate a number by which all healthcare providers and researchers base their obesity data on. This simple measurement tool does not allow inclusion of other important factors, such as age, gender, and muscle mass. So perhaps our definition of obesity is originating in a faulty system to begin with, which could then be causing us to look in the wrong place for risk factors relating to chronic diseases.

With this growing research beginning to confound the culturally prevalent concept that obesity is unhealthy, researchers are going back to the drawing board to emphasize fitness. Our own Dr. Glenn Gaesser (author of Big Fat Lies) at ASU’s Healthy Lifestyles Research Center has devoted his research efforts to evaluating the effects of different types of exercise programs with overweight and obese individuals on a variety of cardiac risk factors, including insulin resistance, visceral fat, and endothelial function. The results have yet to be determined.

So what can healthcare providers take from this idea of an obesity paradox? Perhaps it is time to rethink obesity as the main concern when promoting healthy lifestyle behaviors. Let’s keep our eyes peeled for the most current literature in this field, and in the meantime, encourage our patients to get fit instead of get thin.

**This post is based on a recent article by Harriet Brown in the NY Times and can be found here. (Further note: Glenn Gaesser is my husband's PhD mentor!)