The mantra “fat but fit” is a myth that doctors should no longer perpetuate, scientists have said.
Research involving more than 500,000 people across Europe suggests that carrying too much weight is a cardiovascular problem in its own right and doctors should recognise it as such.
Nearly two thirds of adults in Britain are overweight or obese. About a third of them show no obvious sign of ill health, such as high blood pressure or insulin resistance, leading some experts to call them “metabolically healthy”.
Advocates of the theory include the singer Adele, who said that she “would lose weight only if it affected my health or sex life, which it doesn’t”, to the UK medical regulator, which tells GPs there is no need to instruct people to diet or exercise more unless they exhibit serious warning signs.
An international team of researchers has found, however, that overweight people face a greater chance of developing coronary heart disease (CHD), which kills 73,000 people a year in Britain, more than any other condition.
The researchers tracked 366,000 women and 153,000 men between the ages of 35 and 70 in ten European countries, including the UK, for an average of just over 12 years.
During that period there were 7,637 cases of CHD. After stripping out other risk factors such as smoking, diet and exercise, the overweight but ostensibly healthy people were still 26 per cent more likely to have developed the disease than those of normal weight.
Camille Lassale, who led the study while at Imperial College London but who is now based at University College London, called on the National Institute for Health and Care Excellence (Nice) to overhaul its guidance. She said: “Regardless of the measurements of blood pressure, blood glucose or cholesterol and so on, if you have a patient who is overweight or obese it is always wise to tell them to lose weight. It’s particularly relevant here because the UK has a greater prevalence of overweight [people] and obesity than other European countries.”
The study, which is published in the European Heart Journal, also shows that even though the “fat but fit” did not necessarily meet the clinical criteria for health problems such as high cholesterol or triglycerides, they still had higher concentrations of these chemicals than people of normal weight. This led Dr Lassale and her colleagues to believe that the effects of being overweight catch up with most people eventually. “We think what happens is when you classify these people as metabolically healthy obese they are on their way to developing metabolic abnormalities,” she said.
Metin Avkiran, professor of molecular cardiology at King’s College London and associate medical director at the British Heart Foundation, which funded part of the research, said: “This study conclusively shows that being obese increases a person’s risk of developing heart disease, even if they are otherwise healthy.”
A spokesman for Nice said it regularly reviewed its guidance in the light of the latest scientific evidence.
•Only one in five GPs is familiar with the national guidelines on how much exercise people should do, according to a study in the British Journal of General Practice. The poll of 1,000 family doctors also found that only two fifths had made use of the 2011 recommendations for physical activity, which state that adults need at least 150 minutes of moderate intensity exercise a week.
Published in The Times on 15/08/17