Experts Debate The Validity Of ‘Healthy Obesity’ Studies, Claims
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ATLANTA (CBS Atlanta) – According to the Centers for Disease Control and Prevention, over a third of all American adults are considered obese.
CDC researchers have traditionally expressed concern on the matter, noting that the 35.7 percent of adults in the U.S. struggling with obesity are at risk of “heart disease, stroke, type 2 diabetes and certain types of cancer.”
The issue of obesity in America is frequently discussed at medical conferences and in news reports alike, especially as the amount of people grappling with their weight increases.
Members of the obese community have continued the conversation not in defense, but by attempting to both refute stereotypes that cast overweight and obese people as inherently lazy and unmotivated while also negating the idea that all obese people are plagued with serious health issues.
Recently, the latter notion seemingly earned some scientific credibility in the form of studies and articles on the concept of “metabolically healthy obesity.”
Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health, addressed the subset of the obese population that does not suffer from afflictions such as diabetes.
“Obesity isn’t a homogeneous condition,” Hu was quoted as saying on the Harvard Health Blog. “It appears that it doesn’t affect everyone in the same ways.”
Along with three colleagues, Hu penned an article for The Lancet Diabetes and Endocrinology. In a summary of the article, the team of experts stated that “a proportion of obese individuals might not be at an increased risk for metabolic complications of obesity and, therefore, their phenotype can be referred to as metabolically healthy obesity.”
Not everyone agreed, including a group of experts at Mount Sinai Hospital in Toronto who released the results of an analysis of studies spanning 63 years which indicate that obese people could – and likely will – suffer from long-term consequences of their excessive weight.
“The idea that we don’t need to target health care resources toward obese people whose lab tests are ‘normal’ turns out to be false,” lead author Dr. Catherine Kramer, a postdoctoral fellow in endocrinology at Mount Sinai, said in a statement obtained by CBS News. “If they can start to lose weight, that’s a benefit.”
She added, “Maybe they are still healthy now, but in five, 10 years, maybe [the weight] will have an effect on metabolic health.”
Due to the recent attention both sides of the argument have received from various news outlets, the concept of metabolically healthy obesity has become a controversial topic for medical, health and nutrition experts.
Dr. Kathy Shadle James, an associate professor of nursing at the University of San Diego’s Hahn School of Nursing as well as a fellow in both the American Academy of Nurses and the International Association for the Study of Obesity, told CBS Atlanta that initial reports of metabolically healthy obesity were “incomplete.”
“I see … young, 30-year-old women who are about 50-100 pounds overweight who are healthy with no complaints,” she said. “I also see women 20-30 years later who are now on meds for cholesterol, high blood pressure, depression and arthritis and who are borderline diabetic.”
She added, “Here is the real story – there is a window period before we pay a price.”
For those who have yet to exhibit the sort of health problems that are linked to obesity despite years of struggling with their weight, other experts offered possible reasons.
The Obesity Society’s past secretary-treasurer Dr. Dale A. Schoeller, who is also a professor of Nutritional Sciences at the University of Wisconsin, said there are two potential explanations for the phenomenon.
“It may be something else in their lifestyle that is protective, such as physical activity that reduces risks,” he told CBS Atlanta. “It could also be genetics. Some people have a higher risk of developing obesity-related diseases than others due to their genetic make-up.”
He additionally observed of the possible differences between those whose obesity either does or does not manifest itself in health complications, “When we’re talking about metabolic disorders, obesity is what we call a risk factor. It is not an on-off switch.”
Another theory offered to CBS Atlanta by Dr. Judith S. Stern, a co-founder of the American Obesity Association who serves as a distinguished professor emerita for the University of California Davis’ nutrition department, touched upon the role of fat distribution on the body.
“If a person has upper body fat distribution, the fat tends to accumulate in the liver more,” Stern said. “People with lower body fat distribution don’t appear to suffer the same effect. But if you’re fat enough – with a body mass index of 50 or more – the risk increases for everyone, because you have upper body fat anyway.”
Schoeller also discussed the same possibility, adding that taking note of such factors may even help identify obesity better than body mass index, which uses height and weight to calculate body fat.
“A better indicator of obesity, one that is more strongly related to the unhealthy aspects of obesity, is percent body fat, in particular where that fat is located – upper, lower, and more important, intraperitoneal, or in and around vital organs,” he said.
Experts agreed that, no matter what tests might indicate, overweight and obese persons would be better off maintaining a healthy lifestyle and trying to rid themselves of excess fat in order to reduce the likelihood of complications caused by obesity later in life – though hypotheses on potential solutions also differed.
Some focused on the lack of emphasis on exercise in the U.S.
“There is a genetic, behavioral and cultural component that is a contributor [to obesity] but when you consider that since 1980, obesity prevalence among children and adolescents has almost tripled, that can’t all be blamed on genes. Children are mirroring their parents,” she said of societal attitudes toward physical fitness. “I see over 400 patients a week at my weight clinics. Patients who increase their fruits and vegetables in their diets and develop an active lifestyle have success. Those who don’t, struggle.”
She continued, “Move it and lose it – and eat your greens.”
Others highlighted gastric bypass surgeries or support networks and smartphone applications such as Weight Watchers as possible solutions, but stressed that a longer-term investigation of the matter is needed “because even scientists don’t understand it.”
“More research is needed, because we don’t know the answers. I can name one thing that isn’t the solution, though – blaming the obese person,” Stern said, adding that there could be biological or genetic reasons for their obesity, and that “obese people feel guilty enough because society already looks at them as ugly.”
She also stated, “We should be sympathetic and helpful toward obese people.”
Schoeller said that while the differences between scientific and psychological reasons for weight gain exist on a continuum of sorts – which complicates the search for a solution to weight gain and subsequent difficulties with weight loss – people should all the same make attempts to rectify the situation.
He noted, “[Complications] may not happen at age 28, or 38, but somewhere during their lifetime, it’s going to lead to that.”