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Overweight increases the risk of cardiovascular disease by 28 percent. Even in people who are considered “healthy” based on their current blood pressure, blood sugar, and cholesterol. These are the findings of a recent British study. Their conclusion: “Healthy overweight does not exist”.
“Overweight”
Some time ago, I wrote an article about plus-size model Ashley Graham. It didn’t sit well with everyone. I expected criticism regarding terms like “just fat.” However, I didn’t anticipate criticism for linking overweight to health risks. “Were there concrete indications, symptoms showing that her weight posed a danger to her health?” Others pointed out that it’s not necessarily the overweight itself, but the yo-yo effect in weight that poses a risk.
However, the reason I wrote the article wasn’t necessarily to suggest that Ashley should lose weight. The goal was to ask whether overweight should be considered an ideal. In other words, “Is overweight desirable?”. Should we be concerned about the increase in the number of overweight people [1], or should we adjust the “ideal” image, both medically and culturally, to the current reality?
Large fluctuations in weight, such as typical yo-yo dieting, are indeed undesirable. But that assumes that someone has already reached an undesirable weight. You can have long and interesting discussions about the role of motivation in determining your weight. Whatever the role of motivation, it starts with having a goal, a norm, an ideal.
I can understand that there are cases where the physical and mental consequences of losing weight (and gaining it back) are greater than the consequences of overweight itself. However, I’m concerned when I see cases where overweight has become the norm and there’s no awareness of what a ‘healthy’ weight is.
Terms like “undesirable,” “norm,” and “ideal” can again be subjective or objective (in medical terms). In both respects, there was discussion following the article about what is “desirable.” As mentioned, I was also accused of assuming that her weight might pose a risk to her health. Again, I must emphasize that my main concern was the role model function. The fact that she doesn’t show symptoms of deteriorating health doesn’t mean that someone else with ‘comparable’ overweight wouldn’t experience complaints. In terms of content, I also thought, “Should you then wait for symptoms?” Overweight is a risk factor like many other things. Some people smoke incessantly and live to be 100, while others lead saintly lives and don’t make it to 30. Or does this comparison not hold because smoking always leads to symptoms and overweight doesn’t?
“Healthy overweight”
In this context, I came across the recent study led by researchers from Imperial College London and the University of Cambridge [2]. Their research shows that people with obesity have a 28 percent higher risk of cardiovascular disease. However, the interesting aspect here is that this difference was found in a test group considered “healthy” based on blood pressure, blood sugar, cholesterol, triglycerides, and waist circumference. This led the researchers to question the concept of “healthy overweight”. Personally, I question what they consider “healthy”. Therefore, I can’t, waving this research, say: “See!”
Excessive fat storage is usually associated with certain changes such as increased blood pressure, blood sugar, and altered cholesterol profile. However, the researchers refer to previous studies where some participants with overweight were spared these consequences.
They used data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study for their research. This gave them access to data from more than half a million people in 10 European countries, including the Netherlands. They wanted to investigate the relationship between overweight and the risk of CHD (coronary heart disease), plaque formation in the coronary arteries, which can lead to a heart attack, among other things. In the 12-year follow-up, 7,637 participants in the study had experienced the consequences of CHD, including death from a heart attack. Subsequently, the researchers selected a representative group of more than 10,000 people as a control group.
Weight was classified according to the definitions of the World Health Organization. People with a BMI higher than 30 were classified as ‘obese,’ those with a BMI between 25 and 30 as “overweight,” and those with a BMI between 18.5 and 25 as “normal.”
Groups were then categorized as “healthy” or “unhealthy.” Participants fell into the “unhealthy” group if three or more of the mentioned measurements showed undesirable values. For example, if they had high blood pressure in combination with elevated triglycerides and blood sugar, decreased HDL cholesterol, or a waist circumference greater than 94 cm for men and 80 cm for women.
When the researchers then compared the “healthy” group with the “unhealthy” group, they found that the risk of CHD was twice as high in the latter group, regardless of weight. This was after adjustment for lifestyle factors such as smoking, drinking, and exercise, and for socioeconomic factors.
However, when they then compared within the “healthy” group, weight did indeed influence the risk of CHD. Compared to people with a normal weight, people with ‘overweight’ had a 26 percent higher risk of CHD. For those classified as “obese,” the risk was 28 percent higher than in those with a “normal” weight.
I think there is no longer this concept of healthy obese. If anything, our study shows that people with excess weight who might be classed as ‘healthy’ haven’t yet developed an unhealthy metabolic profile. That comes later in the timeline, then they have an event, such as a heart attack.
Dr Ioanna T
zoulaki, Imperial’s School of Public Health. Science Daily
“Fat is bad”
The researchers therefore argue that overweight should continue to be seen as a risk factor despite certain values being normal. The fact that someone doesn’t show symptoms now doesn’t mean that overweight won’t have consequences in the long term. However, I wonder how logical it is to classify people with ‘only’ one or two elevated risk factors such as high blood pressure or deteriorated cholesterol in the “healthy” group. If someone with obesity, for example, has high blood pressure and elevated blood sugar, I don’t think the average doctor would say, “There’s nothing indicating that your weight might have an unhealthy effect.”
People in the “healthy with overweight is possible” camp probably won’t see their mistake in this study. I can’t blame them for that. It would be more interesting to see what the result would be if you were only placed in the “healthy” group if you didn’t show any of the elevated risk factors.
Since there was no interim follow-up, the researchers didn’t have insight into changes in health since the first measurement and twelve years later. We don’t know if some of the people with overweight, for example, were constantly yo-yo dieting, let alone whether this effect was more positive or negative than constant overweight.
It’s also important to realize that CHD is just one possible effect of overweight. Possible consequences like diabetes weren’t included in this study.
References
- Volksgezondheidenzorg.info/onderwerp/overgewicht/cijfers-context/trends#node-trend-overgewicht-volwassenen
- Camille Lassale, Ioanna Tzoulaki, Karel G.M. Moons, Michael Sweeting, Jolanda Boer, Laura Johnson, José María Huerta, Claudia Agnoli, Heinz Freisling, Elisabete Weiderpass, Patrik Wennberg, Daphne L. van der A, Larraitz Arriola, Vassiliki Benetou, Heiner Boeing, Fabrice Bonnet, Sandra M. Colorado-Yohar, Gunnar Engström, Anne K. Eriksen, Pietro Ferrari, Sara Grioni, Matthias Johansson, Rudolf Kaaks, Michail Katsoulis, Verena Katzke, Timothy J. Key, Giuseppe Matullo, Olle Melander, Elena Molina-Portillo, Concepción Moreno-Iribas, Margareta Norberg, Kim Overvad, Salvatore Panico, J. Ramón Quirós, Calogero Saieva, Guri Skeie, Annika Steffen, Magdalena Stepien, Anne Tjønneland, Antonia Trichopoulou, Rosario Tumino, Yvonne T. van der Schouw, W.M. Monique Verschuren, Claudia Langenberg, Emanuele Di Angelantonio, Elio Riboli, Nicholas J. Wareham, John Danesh, Adam S. Butterworth. Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. European Heart Journal, 2017; DOI: 10.1093/eurheartj/ehx448
