Another "fit but fat" aticle

[Caincando1]

Here is an article based on women. I'm not sure if it's been posted before, but I thought I'd share it.

Exercise-heart study casts doubt on 'fit but fat' theory By LINDSEY TANNER, AP Medical Writer - Mon Apr 28, 6:13 PM PDT

CHICAGO - New research challenges the notion that you can be fat and fit, finding that being active can lower but not eliminate heart risks faced by heavy women. "It doesn't take away the risk entirely. Weight still matters," said Dr. Martha Gulati, a heart specialist at Northwestern Memorial Hospital.

Previous research has gone back and forth on whether exercise or weight has a greater influence on heart disease risks.

The new study involving nearly 39,000 women helps sort out the combined effects of physical activity and body mass on women's chances of developing heart disease, said Gulati, who wasn't involved in the research.

The study by Harvard-affiliated researchers appears in Monday's Archives of Internal Medicine.

Participants were women aged 54 on average who filled out a questionnaire at the study's start detailing their height, weight and amount of weekly physical activity in the past year, including walking, jogging, bicycling and swimming. They were then tracked for about 11 years. Overall 948 women developed heart disease.

Women were considered active if they followed government-recommended guidelines and got at least 30 minutes of moderate activity most days of the week, including brisk walking or jogging. Women who got less exercise than that were considered inactive.

Weight was evaluated by body mass index: A BMI between 25 and 29 is considered overweight, while obese is 30 and higher.

Compared with normal-weight active women, the risk for developing heart disease was 54 percent higher in overweight active women and 87 percent higher in obese active women. By contrast, it was 88 percent higher in overweight inactive women; and 2 1/2 times greater in obese inactive women.

About two in five U.S. women at age 50 will eventually develop heart attacks or other cardiovascular problems. Excess weight can raise those odds in many ways, including by increasing blood pressure and risks for diabetes, and by worsening cholesterol. Exercise counteracts all three.

"It is reassuring to see that physical activity really does make an impact," said lead author Dr. Amy Weinstein of Boston's Beth Israel Deaconess Medical Center. However, she added, "If you're overweight or obese, you can't really get back to that lower risk entirely with just physical activity alone."

University of South Carolina obesity expert Steven Blair, a leading proponent of the "fit and fat" theory, said the study is limited by relying on women's self-reporting their activity levels. That method is not as reliable as a more objective fitness evaluation including exercise treadmill tests, Blair said. These tests include heart-rate measures to see how the heart responds to and tolerates exercise.

In Blair's research, overweight people deemed 'fit' by treadmill tests did not face increased risks of dying from heart disease.

Dr. Laura Concannon, who specializes in treating overweight patients at Chicago's Advocate Illinois Masonic Medical Center, said the study's message that exercise can help reduce health risks isn't new, but it's important.

"Anything that can motivate the public is useful because heart disease is becoming a bigger and bigger problem as levels of obesity increase," Concannon said.

____

[JohnKScott]

Interesting.

I always have a skeptical eye on "easy way out" research results. It's just common sense to me, that for the most part, fit people are healthier and generally not considered fat or obese.

Other things I'm skeptical of...

Chocolate is good for you :D

[funrover]

Good reads I still think there is a point though where you can be bigger and be fit, not to say that this study is a waste but that there are some who have amazing abilities and are extremely active, healthy etc but are just bigger. Darn family genes! LOL

[Tom Stormcrowe]

Fit but Fat is a concept that even if overweight, your risks are REDUCED by daily activity and exercise. A "Fit but Fat" person is better off than a fat guy sitting on the couch in front of the TV. It's a matter of relativity. ;)

[edbikebabe]

Yes, but fit & not-fat is even better.....

[crtreedude]

I do believe as well, fat but fit is better than skinny but not active. Your body is meant to be used.

[shog]

Lou Schuler has a nice piece on this over at Male Pattern Fitness http://www.malepatternfitness.com/

Personally I have a lot of trouble with these self reported studies. There wasn't any actual measurement of the fitnesse level of the women involved so I'm not sure the conclusions being drawn are as accurate as they could be. I certainly won't argue the point fit and skinny is better than fit and fat obviously that is true. What I worry about in studies like this is that it possible doesn't convey the message that being fit and fat is better than sedentary and fat.

Shog

[heckler]

I dislike studies like this... "active" isn't really defined very well and BMI is the biggest BS out there meant to compare couch potatos...

all i know is if i lose all the body fat on me i am still overweight. I find it hard to believe that burning muscle will make me a healthier person. for all we know the obesse women in this study are "active" with 30 % body fat and the "normal" women have 12%, which would make sense to me as far as increased risk.

I would like a study where obesse women and normanl women with the same body fat were compared

[jimbobborg]

Wow, I'm 5'9", 205 lbs, and according to the BMI calculator, I am obese at 30.3. ??? I'm at 20% body fat. And just because you are skinny does not mean you are fit. When I weighed 50 pounds less, I wore the same size pants as I do now, but I was in worse "shape" than I am now. Bah.

Jim

[superslomo]

If you have a lot of muscle mass the BMI is crap. But outside of that, as body fat increases, so does BMI (all else being equal.)

Not sure what body fat %age I'm at, but since I'm 6'3" and around 215, I think the crapola Tanita scale might not be quite right about the number. I find it hard to believe that I'm at 24%, but who knows...

[jimbobborg]

It's great, I have real shoulders now, so my head doesn't look like it's on the top of a hill. And the pants I'm wearing are 34x30. I haven't fit into pants that size since the 8th grade and weighed 160. According to several articles I have read, men need to be under 20% bf to be in the acceptable range. Over 25% is obese.

Jim

[unixpro]

Count me in the BMI is crap group. I'm obese by BMI standards, but I just had my annual physical and my doctor said that, while I could still drop a few pounds, I'm one of his healthiest patients of any age (I'm 49). My heart is steady and slow, my BP is excellent, my cholesterols are all in the "excellent" range, and I can actually touch my toes.

If they're going to do studies like this, they need to use body fat percentage, a documented and graduated set of levels of activity, an estimate (or recording) of the HR for exercise periods, etc. As far as I'm concerned, this is just more junk science.

2 weekends ago I did a full century. My average HR over a 9.5 hour riding time was 124 and max was 151. I think that's pretty fit.

[Black Bud]

Some things that indicate this study that should sound some alarms and bring the conclusions into serious question:

Participants were women aged 54 on average who filled out a questionnaire at the study's start detailing their height, weight and amount of weekly physical activity in the past year, including walking, jogging, bicycling and swimming. They were then tracked for about 11 years. Overall 948 women developed heart disease.

The age of the women being studied averaged 54 years old, old enough for age to be a factor. The probability of heart disease rises with age, and these women were almost certainly postmenopausal, another risk factor for heart disease in females.

The total study population was 39,000; only 948 developed heart disease over the 11 year study period.
A tiny percentage. Also, did this study population include women who have chronic illness or disease? That can affect the rate of heart disease even independent of obesity.

Now, what was the definition of "activity":

Women were considered active if they followed government-recommended guidelines and got at least 30 minutes of moderate activity most days of the week, including brisk walking or jogging. Women who got less exercise than that were considered inactive.

The term "active" in these studies is defined--unless otherwise stated--as leisure time recreational activity and/or athletic training. A woman who works one or more physically-demanding jobs--or even a lot of heavy housework or commutes by bicycle (our favorite commute method! :D )--and does not engage in leisure time physical activity (exhaustion and or simple lack of time)? She is considered "inactive". That is ludicrous; the body does not care how it's made to move, just that it is.

The definition used also discriminates against the old, ill, and poor since it favors the "hamster wheel" model of physical conditioning which is exercise for entertainment, which, in turn, is usually something only the wealthy can afford to do and have the time to spend on such activities.

Weight was evaluated by body mass index: A BMI between 25 and 29 is considered overweight, while obese is 30 and higher.

Uh, the BMI is not a sound method to evaluate how much fat a body has on it! Developed by Adolphe Quetelet (http://www.morris.umn.edu/~sungurea/introstat/history/w98/Quetelet.html) of Belgium in the 1800's, it was intended to be used as a tool for purposes we would consider to be statistical analysis of a population for sociological and census purposes. The BMI (http://www.nhlbisupport.com/bmi/) NEVER was intended to be used as a diagnostic tool for the medical profession. Not only is this method unable to distinguish between "fat" and "lean" tissues, but it does not indicate WHERE the fat is: Fat located in the body cavity of the torso (belly fat) has been correlated with a higher risk of metabolic diseases--including heart disease--than fat that is subcutaneous (beneath the skin). Subcutaneous fat might be ugly to some people, but it has not been successfully correlated with any risk factor for heart disease (and neither type of fat has been proven to CAUSE any disease).

As for the cutoffs? Those have been lowered over the years...without sound science to back them up! In fact, recent studies indicate that merely being fat DOES NOT necessarily mean higher risk of disease; the merely "overweight" by the BMI may, in fact , have lower disease risk and overall all-cause mortality rates than the thin. The risk only rises with "morbidly obese" BMIs; in women, even the morbidly obese have lesser risk of disease and death than a normal-weight man!

Compared with normal-weight active women, the risk for developing heart disease was 54 percent higher in overweight active women and 87 percent higher in obese active women. By contrast, it was 88 percent higher in overweight inactive women; and 2 1/2 times greater in obese inactive women.

Relative risk figures are good for medical propaganda and causing panic...but tell one nothing at all! What this story does not report--and needed to--is the absolute risk data. The real numbers.

Why? For example (these figures are only for illustration and are not actual figures) let's say a woman who is not fat has a 1% absolute chance of developing heart disease over that 11-year period. So, her fat counterpart might have about a 1.5-1.9% chance of doing the same. That would produce the absolute risk figures given in the story, BUT the real risk for the 'obese' a.k.a "Bertha the Amazing Land Whale" :p developing heart disease is, in reality, no worse than less than 2 in 100 people (as versus 1 in 100). If she is not in love with the gym, that is.

Also, since almost all of the relative risk figures are less than 200% difference, most statisticians and good researchers would consider the figures as being insignificant and liable to be reflective of bias in the study method or simply the results of chance, not existing in real life and indicative of, at best, a null result (no difference).

All in all, the percentages seem to be hardly worth fussing about.

About two in five U.S. women at age 50 will eventually develop heart attacks or other cardiovascular problems. Excess weight can raise those odds in many ways, including by increasing blood pressure and risks for diabetes, and by worsening cholesterol. Exercise counteracts all three.

"Exercise counteracts all three [risk factors/surrogate end points, measures]." That is true.

As for the risk factors mentioned? These are all genetic in origin, with any disease resulting being exacerbated by chronic stress, aging, and possibly poor diet and/or lack of fitness. Of those, only aging is not modifiable, BUT changing the other two will NOT prevent any disease or sign of disease (associated with aging and doing a lousy job of choosing one's parents :) ) from showing up or getting worse. All that happens is remission or symptom relief.

Exercise can relieve symptoms and improve physical functioning as fitness increases.

The odds of women getting heart disease--again--are given as relative odds. Those increase primarily with aging and underlying chronic disease. Aging cannot be modified; chronic disease can only be managed with weight loss really not proving to help much in the long run since the body will fight starvation all the way.

My view--as a lay person--is not simply me shouting off, but does have support:

University of South Carolina obesity expert Steven Blair, a leading proponent of the "fit and fat" theory, said the study is limited by relying on women's self-reporting their activity levels. That method is not as reliable as a more objective fitness evaluation including exercise treadmill tests, Blair said. These tests include heart-rate measures to see how the heart responds to and tolerates exercise.

In Blair's research, overweight people deemed 'fit' by treadmill tests did not face increased risks of dying from heart disease.

Another point: Self-reporting is considered to NOT be reliable for research purposes because of recall bias, social pressure to say the "right" thing...and simple interpretation (or misinterpretation) by the subjects as to the information the researcher wants.

"Use it or lose it" is NOT a diet plan, but a prescription to "get off the butt and move period".

[damnable]

It's good that the information is there. It's also good that people here are taking it with a grain of salt and seeing the weaknesses of the data.

Presuming the women are accurate in their recording of exercise I would say the biggest pitfall in the recording is saying how hard they push themselves in each session. All they say it 'moderate' and they include walking in that. Juding by the criteria of the study, I would be one of the fit and fat women as I definitely get 30 mins of exercise most days of the week. If I don't I turn into an junkie waiting to get a fix. My co workers ask me what's wrong when I try to gnaw their arms off as a form of activity while still in my office chair.

Saying that, while I haven't seen a big difference on the scales, I feel a lot better and am definitely fitter and stronger. So there is something going on.