It’s time to recognize that like cholesterol levels (I’ve discussed the problem with our reliance on “good” and “bad” cholesterol before- there are four types and only one is deleterious, as determined by Dr. Robert Krauss), there are subtypes of obesity. It’s not just folks how have a body mass index (BMI) in excess of 30.
We do know that BMI of 30 to 35 is associated with type 2 diabetes- 5 times the risk than those with “normal” BMI. And, once the BMI is 40 to 45, the risk rises to 12X. (Please note ALL the subtypes really need to lose weight. And, yes- this is the pot calling the kettle black.)
Yet, many folks who are considered obese do not manifest any signs of disease, and are capable of maintaining long and healthy lives. And, it’s possible that obesity problems are more linked to other social determinants- poverty, access to healthy food, dementia, and maybe even discrimination.
It turns out where our body stores our excess fat may be more important than the fact that we have excess fat. Visceral fat- that which is stored in the abdomen- is more likely to lead to inflammation and organ fat buildup. Subcutaneous fat (that which is stored under the skin of the thighs, arms, and buttocks) may actually promote health, serving as energy storage and a cushion for our muscles and bones.
This follows the new research published under the direction of Dr. Ruth Loos (Mount Sinai) and Tuomas Kilpelainen (Novo Nordisk of Denmark and Mount Sinai, NY). [The other researchers- Drs. Lam Huang (Copenhagen Denmark), Alexander Ruach and Susanne Mandrup (Southern Denmark), Eugenia Mazzaferro and Marcel den Hoed (Uppsala, Denmark), Stefania Corobbio and Antonio Vidal-Puig (Wellcome Trust Sanger, UK), and Michael Preuss, Cigdem Bayrak, Nathalie Chami, Zhe Wang, Ursual Schick, Nancy Yang, Yuval Itan (all of Mount Sinai NY]. The article, Genome-wide discovery of genetic loci that uncouple excess adiposity from its comorbidities, was published in Nature Metabolism. The authors found 62 gene variants associated with higher body fat percentage and higher BMI, but a lower risk of cardiac and metabolic disorders. (The DNA involved control energy expenditure, insulin signaling, and inflammation.)
This finding is bolstered by research under the direction of Dr. Samuel Klein (Washington University, St Louis), with his team (Berekely- M. Shankaran, T. Field, M. Matthews, E. Nyangau, and M. Hellerstein; Washington University- J. Beals, G. Smith, A. Fuchs, G. Schweitzer, J. Yoshino, D. Morozov, שמג B. Mittendorfer(. Their research, published in American Association of Liver Diseases, was entitled Increased Adipose Tissue Fibrogenesis, Not Impaired Expendability, Is Associated With Nonalcoholic Fatty Liver Disease.
Their study included 45 metabolically healthy obese, 45 metabolically unhealthy obese, and 25 lean folks. Muscle and fat biopsies, blood samples, insulin regulation of glucose levels were the study parameters. Different diets (including the Mediterranean and plant-based) were also of issue.
Both studies indicate that being fat doesn’t mean one is unhealthy. But, the problem is – without the genetic testing- for whom that applies is absolutely unclear- even though up to 60% of the obese folks may so qualify.
Dr. Matthias Schulze (German Institute of Human Nutrition [GIHN]) (co-authors: A. Zembic, N. Eckel [both of GIHN], N. Stefan [German Center for Diabetes Research], and J. Baudry [Sorbonne]) proposed a new definition for metabolically healthy obese (MHO) individuals. (This study involved two cohorts of folks- 12000 from the US and 374000 from the UK.) The differentiation is based upon three criteria- those who maintain systolic blood pressure below 130 mm Hg [without medication], do not manifest diabetes, and relatively low waist-to-hip ratios (below 0.95 for women and 1.03 for men).
Only 40% of the US cohort and 20% of the UK cohort met this criteria- and during the 14 years of the data manifested no undue rates of heart disease, diabetes, stroke, or other metabolic diseases compared to non-obese subjects. However- the US group manifested an average after of 41; those from the UK had an average age of 56. (It is NOT known if this age should also be included as a criterion.)
(We will discuss a related issue- maybe even the same one, if it is combined with these data-but using different vernacular tomorrow.)
Years ago when I took water aerobics at our local “Y”, one of the instructors was an obese woman who was also a triathlete. I wonder what her “numbers” were like. My father was underweight and yet developed type 2 diabetes in his 40’s. I mentioned that to a doctor once and she told me her sister, who was of normal weight and very active, had also developed diabetes. There’s a lot we still don’t know about obesity and health. I applaud these studies.
Alana recently posted..Looking for Beauty
Today’s (Friday’s) blog may provide more of the answer, Alana.
A good friend of ours was diagnosed with Type 2 diabetes and started and has maintained a whole-food, plant-based lifestyle for almost two years now. Her BMI is now in the normal range. When I saw her for the first time in a while, I hardly recognized her due to her weight loss.
That is fantabulous, Rachel. It also means her kidneys are no longer at risk.
While my BMI is good, I know I need to work on my waist-to-hip ratio!! And your post is another reason for me to get moving more than I do now.. I do walk, but not enough me thinks!
vidya recently posted..No Rhyme Nor Reason Days Can Make a Difference
It’s 6 miles a week to be in good health, Vidya!