Are YOU one of the lucky few 'healthy obese' people?

Are YOU one of the lucky few who is ‘healthy’ AND obese? Study finds phenomenon is becoming more common in the US

  • The fat that appears on the surface is not as bad at what is hiding deep inside
  • Visceral fat, which lines the organs in the abdomen, is more harmful
  • READ MORE: More than half the world’s population will be obese in 2035 

A growing number of Americans are medically obese but physically healthy, research has shown.

The ‘healthy fat’ phenomenon is causing doctors to rethink their view on weight as an overall barometer of health. 

In the study published this week, researchers in China found 10 percent of the obese US population were ‘healthy’ in 2002, meaning they did not suffer conditions usually associated with excess fat such as diabetes and high blood pressure. Now, 15 percent of obese people are healthy, according to the study.

Subcutaneous fat (left) is more visible outside of the body, padding the outer layers of muscle just underneath the skin. People with more of this fat will have a ‘pear-shaped’ body. People with more visceral fat (right), which is more dangerous but less noticeable, are at an increased risk of many metabolic diseases 

The research adds to the growing idea that body mass index, or BMI, is too crude a measurement of obesity, with very tall or muscly people falling into overweight categories because they carry more mass.

They point to improved technology, treatment and awareness for high blood pressure and heart disease, preventing the issues from arising in as many people.

But, many other experts also point to the evidence showing that the type of fat a person has on their body is more important than how much of it they have. 

Scientists have described body types as either apple or pear-shaped – with the former looking more healthy but potentially hiding dangerous underlying fat. 

Experts warn that people who weigh less but carry more fat in their midsection could be ‘metabolically obese’ – meaning they carry many of the risks to organ, brain and heart health associated with the condition even though they are skinny.

This is because of key difference’s in the type of fat a person puts on. 

A majority of the visible fat on a person’s body is subcutaneous fat, which lies just beneath the skin. The more dangerous, visceral fat, lies unseen deep in the abdomen – but is linked to all types of health issues.

While a person’s weight can be a good barometer for their overall health in some cases, it is not the only determining factor.

Obesity has been linked to chronic diseases such as diabetes, heart disease, some types of cancer, Alzheimer’s and more.

But, these issues are not caused by the high number on the scale, but instead by what an increased weight usually means.

People who are obese are usually eating unhealthier diets and not getting enough exercise each day.

Some people suffer these same issues at a lower weight, though, and experience the same risks.

A larger focus has been placed on the phenomena of ‘skinny-fat’ in recent years. 

This is the body type of people who are not visibly fat when wearing clothing, but have a ‘beer belly’ or ‘pot belly’ hiding underneath.

A ‘skinny-fat’ person will often have a BMI considered healthy, but have lingering issues beneath their skin’s surface.

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Dr Nitin Kapoor, a endocrinologist at the University of Melbourne in Australia, wrote extensively about it in 2021, saying: ‘Though this concept was described about 15 years ago, further evidence… and implications for policy change are still emerging.’

‘The thin-fat phenotype is known by several other names in the scientific literature including normal weight obesity, metabolic obesity, metabolically unhealthy non-obese, etc. It is defined as an individual who has normal body weight but a disproportionately high body fat percentage.’

Much of this fat is visceral. This fat is buried deep within a person’s abdomen and lines their organs. Visceral fat usually makes up around 10 percent of all a person’s fat.

It has been described as ‘active fat’, with experts finding that visceral fat secretes hormones and molecules which have far-reaching impacts on the body.

The fat releases fatty acids into the bloodstream and liver that boosts production of cholesterol in the body.

Visceral fat also creates cytokines, immune proteins in the body that trigger inflammation and boost the risk of heart disease. 

Meanwhile a person who is more visibly fat may not suffer from these same risks.

Much of the visible fat on a person’s body – like what can be pinched and pulled from the arm and leg – is subcutaneous fat.

This fat can pile pounds onto a person’s body, and accounts for a vast majority of a person’s fat makeup.

It is not nearly as harmful as visceral fat and even has some benefit for the body.

The fat acts as padding and insulation for the body. It guards the muscle and bones from the impact of bumps and bruises.

Subcutaneous fat is also what leads to the development of cellulite, a harmless but visible skin condition that causes dimpling on the legs, thighs and buttocks. 

It usually affects women, and while it may have a bad reputation, doctors say that the appearance of cellulite has no bearing on a person’s health.

Having high levels of subcutaneous fat is not healthy either, though.

More subcutaneous fat often signals a person is carrying more visceral fat.

By itself, the fat is also linked to cancer, issues with the liver, kidney and gallbladder, heart disease, high blood pressure and more.

People with high levels of fat also usually reach that point because of poor diet and exercise habits, which come with a host of health issues themselves.

These people also often have a higher BMI. But while that is linked to a host of other health issues, excess weight does not always signal health problems. 

Rates of obesity have sharply risen in the US since the turn of the century. Two-in-five Americans are now obese (blue), up from just under 30 percent in 1999. The number of people considered healthy obese (gray) has doubled over that time, though

Chinese researchers found that while obesity rates rose in America, so did the share of obese people that reached that threshold with good health. In 2018, 40 percent of Americans were obese, but 15 percent of obese people were considered to be in good metabolic health

To further explore the differences between BMI and overall health, researchers from Huazhong University, in Wuhan, China, gathered data from over 20,000 Americans over the past two decades.

They gathered data from the National Health and Nutrition Examination Survey, biannual data from the US Centers for Disease Control and Prevention (CDC) on the state of American health.

For the research, published in JAMA Network Open, the Chinese team used survey data from 1999 to 2018. In total, 20,430 participants were included.

Using BMI, which generates a score using a person’s height and weight, they measured how many participants in the survey were obese.

A person who scores between 18 and 24 on the scale is considered to have a healthy weight.

For the average American man, who is 5’9, this is a weight between 120 and 160 pounds.

The average US woman is 5’4, and a healthy weight for her would be 110 to 140 pounds.

A score of 30 or higher is considered obese. This would be 200 pounds for the average man, and 180 pounds for the average woman.

They found that 28.6 percent of the population was obese, with 3.2 percent considered healthy obese. In total, 10.6 percent of obese people were healthy. 

Researchers then gathered available data on levels of blood pressure, cholesterol, triglyceride and blood sugar levels.

If a person maintained healthy levels of each of these despite having a BMI over 30, the researchers categorized them as having ‘metabolically healthy obesity’.

From 1999 to 2002, researchers found that 28.6 percent of the population was obese, with 3.2 percent considered healthy obese. In total, 10.6 percent of obese people were healthy.

America’s obesity rates massively rose over the 20-year study period, reaching 40.9 percent from 2015 to 2018.

But, the share of obese people who reached that threshold healthily increased too. 

Now, 15 percent of obese people are healthy, making up 6.6 percent of the total US population.

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