Can You be Healthy and Obese?

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Obese but Fit?

Can you be substantially overweight and still healthy? The answer is no–according to a large study published in the European Journal of Preventive Cardiology (January 2021). The study notes physical activity does not undo the negative effects of excess body weight on heart health. The journal is part of the European Society of Cardiology (ESC).

“One cannot be ‘fat but healthy,’” study author Dr. Alejandro Lucia of the European University, Madrid, Spain, says. “This was the first nationwide analysis to show that being regularly active is not likely to eliminate the detrimental health effects of excess body fat.” Above all, the study’s findings refute the notion that a physically active lifestyle can completely negate the harmful effects of being obese.

Using data from 527,662 working adults in Spain, the participants were placed into different weight categories based on their BMI: normal, overweight, or obese. Additionally, they were grouped by activity level. Regularly active (the minimum recommended for adults by the World Health Organization which is 150–300 minutes of moderate-intensity aerobic physical activity); insufficiently active (some modern to vigorous physical activity every week but less than The WHO minimum); and inactive (no exercise). Cardiovascular health was determined according to three major risk factors for heart attack and stroke. These factors include diabetes, high cholesterol, and high blood pressure.

Approximately 42% of participants were normal weight, 41% were overweight, and 18% were obese. The majority were inactive (63.5%), while 12.3% were insufficiently active, and 24.2% were regularly active. Some 30% had high cholesterol, 15% had high blood pressure, and 3% had diabetes.

The researchers investigated the associations between each BMI and activity group and the three risk factors. At all BMI levels, any activity (whether it met the WHO minimum or not) was linked with a lower likelihood of diabetes, high blood pressure or high cholesterol compared to no exercise at all. Dr. Lucia said: “This tells us that everyone, irrespective of their body weight, should be physically active to safeguard their health.” In fact, at all weights, the odds of diabetes and hypertension decreased as physical activity rose. “More activity is better, so walking 30 minutes per day is better than walking 15 minutes a day,” Dr. Lucia says.

However, overweight and obese participants were at greater cardiovascular risk than their peers with normal weight, irrespective of activity levels. As an example, compared to inactive normal weight individuals, active obese people were approximately twice as likely to have high cholesterol, four times more likely to have diabetes, and five times more likely to have high blood pressure. “Exercise does not seem to compensate for the negative effects of excess weight,” Dr. Lucia says.

He concludes, “Fighting obesity and inactivity is equally important; it should be a joint battle. Weight loss should remain a primary target for health policies together with promoting active lifestyles.”

Obesity and COVID-19

Having certain underlying medical conditions puts adults, of any age, at greater risk from severe illness or death from COVID-19. These conditions include cancer, chronic kidney disease, COPD, heart conditions, diabetes, smoking, immunocompromised immune systems, and being obese. But why does obesity put someone at higher risk for serious complications from COVID-19?  According to the CDC, being severely overweight can:

  • Increase the risk of severe illness from Covid-19;
  • Triple the risk of hospitalization from Covid-19;
  • Impair and weaken immune function;
  • Decrease lung capacity and can make ventilation more difficult;
  • Increase the risk of death from COVID-19;
  • Lower vaccine responses for numerous diseases.


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