The ‘Fat But Fit’ Myth Debunked

On the train to New York for Thanksgiving, we sat next to a family with a very chubby girl. She was about 9, with lovely red hair and a pretty moon-shaped face. But I could see her belly bulging and her chunky arms as she played with her iPad, and I imagined some tough teenage years ahead.

While her mother slept, her dad headed to the cafe car and returned with a box of chocolate chip cookies and peanut M&M’s. “Quiet,” he said, handing the treats to the girl. “Eat them before Mom wakes up.” Then he gave her a Mountain Dew to wash it all down. It was 10 am on Thanksgiving.

“Child abuse,” I thought, but kept my mouth shut.

I imagined the little red-haired girl again today, in light of this headline in MedPage Today “Fat But Fit — Is It Just A Myth?”

Remember the concept of “benign obesity” — the idea that as long as you’re exercising and relatively fit, being a little fat probably won’t hurt you. Well, think again. A new study published in the Annals of Internal Medicine suggests there is no healthy obesity. According to the news report:

Metabolically healthy obese people have a long-term increased risk for death and cardiovascular events compared with their normal-weight counterparts, suggesting there is no such thing as benign obesity, according to a meta-analysis.

(Yale Rudd Center for Food Policy & Obesity)

(Yale Rudd Center for Food Policy & Obesity)

When studies with follow-ups of a decade or more were considered, obese people with no metabolic abnormalities had a 24% increased risk for these events compared with metabolically healthy, normal-weight people (relative risk 1.24; 95% CI 1.02-1.55), reported Caroline K. Kramer, MD, PhD, of Mount Sinai Hospital in Toronto, and colleagues.

All metabolically unhealthy people had a similar elevated risk for the events compared with metabolically healthy, normal-weight study participants, they wrote in the Annals of Internal Medicine, specifically an RR of 3.14 for normal weight (95% CI 2.36-3.93), 2.70 for overweight (95% CI 2.08-3.30), and 2.65 for obese (95% CI 2.18-3.12).

“Our results do not support this concept of ‘benign obesity’ and demonstrate that there is no ‘healthy’ pattern of obesity,” Kramer and colleagues wrote. “Even within the same category of metabolic status (healthy or unhealthy) we show that certain cardiovascular risk factors (blood pressure, waist circumference, low high-density lipoprotein cholesterol level, insulin resistance) progressively increase from normal weight to overweight to obese.”

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  • Ashley Rafter

    A good article busting the myth of being fat and fit at the same time …
    http://www.christopherdavidsonmd.com

  • Meira

    While I hate the shaming inherent in much of this article, I’m completely on board with shaming the dad at the beginning. There is no reason on earth that a CHILD needs a Mountain Dew — the corn syrup, the carbonation, the fake dyes, the massive number of calories. Everybody deserves some chocolate and at least there’s a teeny bit of nutrients in there somewhere, but soda? No.
    Secondly — “Quiet, eat them before Mom wakes up.”?
    Presenting a picture of partnership wherein it’s acceptable to lie & hide from one’s partner? Encouraging one’s child to secretly and quickly eat ‘bad’ things? Encouraging one’s child to lie to their other parent? I don’t know what her arteries will look like in 10 years, but I can bet her relationships — to her body, to her body’s need for fuel, to food, to romantic partners — those will be unhealthy.

  • 10 miles a day

    Sounds like a lot of fat people are reacting to legitimate health concerns by being angry and pointing fingers.

  • Lily G.

    The only thing about this article that constitutes as “child abuse” is using someone else’s child as an example. What if they got into a car and heard this broadcast? The child would be absolutely humiliated. Also, just because you see a parent feed their child junk food once doesn’t account for all of the feedings. What if the girl has some kind of health problem that makes her have a propensity for being overweight? There could be a million different reasons, none of which are your business, why a parent would treat their child, and not everyone is on a schedule which you deem appropriate.

    I understand your point about how people who have claimed to be overweight and fit might be kidding themselves, absolutely, I’m even inclined to agree. I know from personal experience I am a much happier, healthier person when my weight is within an appropriate BMI range, however you could have used a much better, less invasive anecdote than a child.

    • Rick

      Your concern is reasonable, considering the high likelihood that a 9-year old girl will read this blog and recognize herself.

  • Mr. Salad

    Mountain dew, cookies, and M&Ms. Nice! No wonder Americans are so healthy… I understand that there are many factors underlying obesity, some of which are very hard/impossible for individuals to control, but personal choices (i.e., actually exercising and eating well, etc.) definitely plays a big role in staying healthy. Too many Americans don’t do enough in this regard, and it is having a negative impact on our economy and society that we need to fix before it is too late.

  • CB

    The intro to this article is truly offensive. Fat shaming, concern trolling, totally presumptuous. How disappointing to see it here on Commonhealth.

    • Rick

      Don’t see how this is “fat shaming” unless one isn’t allowed to even criticize obesity as a general phenomenon. Let’s be clear about what the anecdote illustrates: a child learning unhealthy eating habits from a parent who is deliberately keeping his spouse ignorant of the decision.

  • gobbledygook

    ‘Child abuse,’ you thought, but you kept your ‘fat mouth’ shut, eh? Good for you! Child ABUSE would be if that little girl comes home from school every day to a mom who tells her she’s worthless because she’s not skinny, who refuses to give her more than a meal a day until she ‘slims down’ or who slaps her every time she sees her eat a cookie. Child abuse is not a man giving candy and soda to his daughter, although I’m sure you have some magical powers that let you see into the lives of families and immediately know everything about how one person parents their child by witnessing a mere five minutes of interaction between them.

    I suppose I should call my mother up for the first time in over a decade to tell her, ‘Gosh, I know you used to physically and verbally abuse me almost every day for my entire childhood but when you did feed me, you gave me HEALTHY food, so it turns out you were a great parent! And as a bonus, I’m skinny now, which is obviously a hell of a lot more important that mental health or intelligence or personal satisfaction with myself as a human being! We should hang out!’

    You, my dear, are an imbecile.

    • Mark

      Boy, did you ever miss the meaning of this story.

    • Therese Didelot

      Wow. That became rapidly about something else. Hit a nerve? If your mother overfed you, blame her. Don’t argue with a stranger.

  • Dara Crawley

    So you resisted fat shaming a little girl? congrats on being a decent human being. You’re no different than the woman who refused to give out Halloween candy to heavy kids, and instead gave them notes saying they had terrible parents. You just assume that little girl eats like that everyday? So do you assume a thinner little girl would eat the same way everyday in the exact situation?

    Fact is this, some people will always be overweight. How are you helping anyone by writing this article and wagging your finger at overweight people? How about writing about the lack of affordable fruits and vegetables? Or the fact that an eggplant costs as much as two bags of off brand chips in some places, or the same price as low quality ground beef? OR the lack of access in rural and inner city areas? The study does not address causes of weight gain or obesity beyond inactivity such as genetics and environment. This is kind of the problem with a macro study it doesn’t take into account factors within individual studies and often uses averages which can influence results in odd ways. To really come to this conclusion you’d have to compare it against other macro studies and individual study results.Another study came out last week that did the same exact macro level study. except with more than a sample of eight studies, and actually contradicts some of the findings. I can find it for you if you like.. Not to mention the fact that you misread some of the study, which indicates that if a person continues to increase their BMI instead of naturally balancing out that causes the issue:

    “As BMI increased, levels of HDL cholesterol, thought to protect against heart attack and stroke, decreased.” While participants who were either overweight or obese “may not yet have reached the points that define metabolic illness, they appeared to be on that road as their weight” increased.”

    • peterlake

      I’m guessing this writer is overweight.

      • Rick

        I’m guessing you’re chronically presumptuous.

        • peterlake

          Maybe, but you didn’t deny my presumption, so we can assume I was correct.

    • J__o__h__n

      M&Ms and cookies on a train aren’t cheap.

    • Mark

      I don’t see the opening scene as finger-wagging. I see it as a reasonable introduction for the information stated after it. The author saw a fat kid, and a parent seemingly not helping this child’s situation (however she got that way). I hear concern in the author’s words: She’s about to give you stats which indicate that this kid is in for trouble health-wise. The author wanted to point out studies that show there’s no healthy way to be obese. It doesn’t matter, for the author’s purpose for writing this, *why* someone is overweight, nor was it the purpose of the studies she quotes from. That’s a topic for a different conversation.

    • Rick

      “Fact is this, some people will always be overweight. ”

      Is this supposed to be some kind of scientific fact? Or is this some kind of demographic truism like “some people will always be in jail” which absolves parents of the need to teach their children to obey the law?
      Seemed to me that the point of the anecdote was to illustrate how children learn unhealthy eating habits. Isn’t that something we should target? Or is the mere specter of addressing the malpractice of teaching a child to overeat morally equivalent to “fat-shaming”?

      • Therese Didelot

        Some people was never nearly half od the adults and children in this country. You fat activists are so willfully ignorant.

  • Reasonable?

    We need to start measuring density (Mass/Volume).
    Weight is not go enough.
    BMI is not good enough.
    My BMI is 27.5, I’m 6ft and 205 pounds.
    Without knowing my density it would be impossible to guess whether I am fit or moderately overweight.
    When I read about overweight and obesity and metabolic syndrome, I want to the know the density of the people we’re talking about.