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Breaking down the ‘fat but fit’ phenomenon

If you’re overweight but eat a good diet and exercise often, it’s natural to think that you’re a healthy person — and you probably are. But new research has found that being overweight or obese can still affect your future health, including raising your risk of heart disease.

The study, which is published in the European Heart Journal, analyzed data from 520,000 people who participated in the European Prospective Investigation into Cancer and Nutrition study and found that people who were overweight or obese had a nearly 30 percent increased risk of coronary heart disease compared with those with a normal BMI. That was true even when people had healthy blood pressure, blood sugar, and cholesterol levels.

For the study, researchers followed up after 12 years and found that more than 7,600 people experienced coronary heart disease, which is what happens when not enough blood gets through to the heart due to clogged arteries, and can lead to a heart attack. People were classified as “unhealthy” in the study if they had three or more certain metabolic markers, such as high blood pressure, low levels of HDL cholesterol (aka “good cholesterol”), or a waist size of more than 37 inches for men and 31 inches for women.

The researchers adjusted for lifestyle factors like smoking, diet, exercise, and socioeconomic status, and found that, compared with people in the healthy normal weight group, those who were deemed unhealthy had more than double the risk of coronary heart disease — no matter their weight. But the researchers also found that those who were healthy but overweight had a 26 percent increased risk of coronary heart disease, while people who were healthy but obese had a 28 percent greater risk.

Previous research has found that there is a group of overweight people who appear to be healthy despite their weight — and these people have been dubbed “metabolically healthy obese” by doctors and “fat but fit” by everyone else. The concept has been controversial, but researchers in the latest study say that the concept of being “fat but fit” is a myth, and that people should still strive to have a healthy body weight, if possible. “These findings challenge the concept of ‘metabolically healthy obesity,’ encouraging population-wide strategies to tackle obesity,” they wrote in the conclusion.

Here’s why: When you have too much fat in your body, it can cause several metabolic changes, such as increasing your blood pressure, creating insulin resistance, and increasing cholesterol levels, Vinh Nguyen, MD, a family medicine physician at Orange Coast Memorial Medical Center in Fountain Valley, Calif., tells Yahoo Beauty. “In the future, that can make a person very unhealthy,” he says.

Obviously, weight is a complicated issue that can be caused by a number of factors, some of which are out of a person’s control, and weight loss is easier for some people than others. It’s also worth pointing out that BMI isn’t always the most accurate indicator of whether a person is overweight (by BMI standards, the Rock is considered obese, for example) — but it’s generally thought to be a decent diagnostic tool.

If you’re overweight, Nguyen says it’s a good idea to think about whether there’s any room for improvement in your diet or exercise habits, or both. “We’re not perfect, so there is always some kind of opportunity for improvement,” he says. For example, it’s possible you’re not getting enough fiber or are eating too many carbs, which can be converted in your body to fat. If you feel like you’re doing a good job with your diet and are already exercising regularly, he recommends trying to step up the intensity of your exercise.

And, if all of that fails, it may be time to see an obesity medicine specialist who can help advise you on next steps. There may be an underlying condition that’s causing you to struggle to lose weight, and a doctor can help you reach a diagnosis.

Again, it’s possible to be healthy and overweight now, but it’s unlikely that will be the case down the road. “I ask my overweight patients, ‘Do you see any 80-year-old people in your community who are extremely overweight and thriving?’ The answer is usually no,” Nguyen says. “Keeping a healthy weight is the key to longevity and having a better quality of life.”

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