Two recent studies on obesity yielded some concerning findings regarding its impacts on life expectancy and heart disease.

Let’s take a look at each.

Obesity and Longevity

In April, researchers from the Cleveland Clinic and New York University School of Medicine found that obesity resulted in as much as 47 percent more life-years lost than tobacco, and tobacco caused similar life-years lost as high blood pressure.

The research team found the greatest number of preventable life-years lost were due to (in order from greatest to least) obesity, diabetes, tobacco use, high blood pressure, and high cholesterol.

Of the five top causes of death, three (diabetes, hypertension, and high cholesterol) are treatable with medications and lifestyle changes. Obesity and tobacco use are more challenging issues to resolve: both involve complex psychological factors.

From the press release:

To estimate the number of life-years lost to each modifiable risk factor, researchers examined the change in mortality for a series of hypothetical U.S. populations that each eliminated a single risk factor. They compared the results with the change in life-years lost for an “optimal” population that eliminated all modifiable risk factors. Recognizing that some less common factors might place substantial burden on small population subgroups, they also estimated life expectancy gained in individuals with each modifiable risk factor.

The reality is, while we may know the proximate cause of a patient’s death, for example, breast cancer or heart attack, we don’t always know the contributing factor(s), such as tobacco use, obesity, alcohol and family history. For each major cause of death, we identified a root cause to understand whether there was a way a person could have lived longer.

Glen Taksler, Ph.D., internal medicine researcher from Cleveland Clinic and lead author of the study, said of the findings,

“Modifiable behavioral risk factors pose a substantial mortality burden in the U.S. These preliminary results continue to highlight the importance of weight loss, diabetes management and healthy eating in the U.S. population.”

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Busting the “Fat but Fit” Myth

Storing too much fat in the body is associated with a number of metabolic changes, including increased blood pressure, high blood sugar, and altered cholesterol levels, which have been linked to numerous health problems and diseases.

However, some studies have revealed a subset of overweight people who appear to lack the adverse health effects of excess weight, leading to them being classified as “metabolically healthy obese” in the medical literature (referred to “fat but fit” in the media).

In August, researchers from Imperial College London, University College London, and other institutions across Europe found that being overweight or obese increases a person’s risk of coronary heart disease (CHD) by up to 28 percent compared to those with a healthy bodyweight – even if they have healthy blood pressure, blood sugar, and cholesterol levels.

For this study – the largest of its kind to date – scientists used data from more than half a million people in 10 European countries – taken from the European Prospective Investigation into Cancer and Nutrition (EPIC). They found that excess weight is linked with an increased risk of heart disease, even when people have a healthy metabolic profile. Researchers focused on weight and signs of heart disease. Then, they looked at more than 7,637 people who had cardiovascular events such as death from heart attack, and compared them to more than 10,000 people who didn’t have heart problems.

Being metabolically unhealthy or having metabolic syndrome was defined as having three or more of the following at baseline:

• high blood pressure, use of blood pressure medications, or self-reported history
• high triglycerides (a type of fat) or use of lipid-lowering medication like statins
• low HDL (good) cholesterol
• high blood sugar, use of diabetes medications, or self-reported history
• high waist circumference

Researchers looked for the new development of heart disease during follow-up, either self-reported or through data from GP and hospital registers and mortality records. The last follow-up ranged from 2003- 2010, with an average of 12.2 years.

They looked at the link between body fat, metabolic markers, and developing heart disease, adjusting for baseline variables of country, gender, age, education, smoking status, alcohol intake, diet, and physical activity.

After those adjustments and considerations, the scientists found that people with three or more heart risk factors like high blood pressure, high cholesterol, or large waist sizes (more than 37 inches for men and 31 inches for women) were more than twice as likely to have heart disease, regardless of whether their weight was normal or above normal.

But those who were considered overweight yet healthy were still 26 percent more likely to develop heart disease than their normal-weight peers. Those considered healthy but obese had a 28 percent higher risk, the study found.

The findings, which were published in the European Heart Journal, add to a growing body of evidence that suggests being “fat but fit” is a myth, and that people should aim to maintain a body weight within a healthy range.

The excess weight itself may not be increasing the risk of heart disease directly, but rather indirectly through mechanisms such as increased blood pressure and high glucose, the researchers said.

Lead author Dr. Camille Lassale explained,

“Our findings suggest that if a patient is overweight or obese, all efforts should be made to help them get back to a healthy weight, regardless of other factors. Even if their blood pressure, blood sugar and cholesterol appear within the normal range, excess weight is still a risk factor.”

Dr. Ioanna Tzoulaki, from Imperial’s School of Public Health, added,

“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.”

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Additional Resources:

Secrets from the Eating Lab: The Science of Weight Loss, the Myth of Willpower, and Why You Should Never Diet Again by Traci Mann, PhD

Diet Anarchy: Are You Sabotaging Yourself?

Diet Anarchy: The More Things Are Forbidden…

Why You Should Ditch Your Scale

Diet Anarchy: Are You Eating Enough?

Diet Anarchy: Should You Count Calories or Eat Intuitively?

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