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Study Debunks Notion of 'Healthy Obese' Man

Heart risks may take years to show up, but they're there, study finds

MONDAY, Dec. 28 (HealthDay News) -- No man who is fat is truly healthy over the long term, a new study finds.

"There appears to be no such thing as metabolically healthy obesity," said a statement by Dr. Johan Arnlov, an associate professor of cardiovascular epidemiology at Uppsala University, and lead author of a report published online Dec. 28 in the journal Circulation.

That assessment is based on a study that has followed almost 1,800 Swedish men, starting at age 50, for an unusually long time, 30 years, recording those who died or had a cardiovascular problem such as a heart attack or stroke.

Arnlov and his colleagues measured not only obesity, but also the prevalence of metabolic syndrome, a cluster of cardiovascular risk factors -- high blood sugar, high blood pressure, high blood triglycerides (fats), low HDL ("good") cholesterol and a broad waist size (40 inches for men, 35 for women). Metabolic syndrome is the presence of three or more of these risk factors.

Previous studies have found no increased cardiovascular risk in obese men who did not have the metabolic syndrome, giving rise to the notion that there was a "healthy obesity."

But the new report indicates that those studies didn't follow the participants long enough. Problems only become more evident after 15 years or so, the researchers found.

Using the body-mass index, which matches height and weight and lists a score of 30 as obese and 25 to 30 as overweight, the study found that over the 30-year period, the risk of cardiovascular disease was 63 percent higher in men of normal weight who had metabolic syndrome, compared to normal-weight men who did not have metabolic syndrome. It was 52 percent higher in overweight men without metabolic syndrome, 74 percent higher in overweight men with metabolic syndrome, 95 percent higher in obese men without metabolic syndrome and 155 percent higher in obese men with metabolic syndrome.

"The findings weren't all that surprising to me," said Barry Franklin, director of cardiovascular rehabilitation and exercise laboratories at the William Beaumont Hospital in Royal Oak, Mich., and chairman of the American Heart Association council on nutrition, physical activity and metabolism. "But they had a phenomenal follow-up, 30 years, and the take-home message is that overweight and obese men are at higher risk of cardiovascular risk even if they don't have metabolic syndrome."

A shortcoming of the study is that while it measured other factors such as smoking, it did not look at levels of physical activity, Franklin said.

"We have unequivocal evidence that being physically fit, whether you are overweight or obese, has a beneficial effect," he said. "So, if you are overweight or obese, it is all the more important to emphasize your fitness."

The endpoint results seen in the study -- 681 cardiovascular events, 386 cardiovascular deaths -- were similar to those seen in the United States, said Dr. Richard A. Stein, director of urban community cardiology at New York University.

And so the message of the study is that an American man "can't say 'my weight is a social or psychological issue, [but] it's not a cardiovascular risk factor,'" Stein said.

More information

The metabolic syndrome is described by the American Heart Association.

SOURCES: Barry Franklin, Ph.D, director, cardiovascular rehabilitation laboratories, William Beaumont Hospital, Royal Oak, Mich., chairman, American Heart Association council on nutrition, physical activity and metabolism; Richard A. Stein, professor, medicine, and director, urban community cardiology, New York University, New York City; Dec. 28, 2009, Circulation, online

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