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Obesity is a scourge on society. Fat people are such a burden on our healthcare system that it is not coping. Fat people are simply lazy. Obesity is the fault of the person. Fair call? It certainly seems that way if you open any health magazine or watch the news these days. Apparently, all fat people are a burden on society and an eyesore to boot.

 

Well guess what. It’s not always true and it’s a horrible message to be sending out. It puts anyone who is overweight or obese into a societal subclass and it needs to stop. I’m absolutely fed up with society’s fake image of health. I want to start seeing a more positive message going out about health that is not just limited to the size of someone’s waist and the perkiness of their glutes.

 

First it’s well worth pointing out that the definition of a healthy weight is a contentious one. It is a man-made concept that does not have universal agreement. Currently, a healthy weight is considered to be a body mass index (BMI) between 18.5 and 24.9 kg.m-2. However, keep in mind that using BMI as a means of assessing a healthy weight is somewhat flawed due its inability to distinguish between fat and lean tissue and it’s inability to determine where fat is located on the body. It’s well known that where fat is placed on the body is far more important than how much fat there is in total. So using BMI as a determinant of health therefore is going to be problematic and the research is backing this up. More specifically, in terms of cardiovascular disease (CVD) risk it’s been shown to have low correlation. It’s worth mentioning here that cardiovascular disease is Australia’s biggest killer with approximately 33% of all deaths being due to CVD. So surely we need to work out what is a more useful way of assessing risk and poor health. The Journal of Clinical Epidemiology (2008) had this to say, “Statistical evidence supports the superiority of measures of centralized obesity, especially WHtR, over BMI, for detecting cardiovascular risk factors in both men and women.” So there you have it – centralised obesity is far more problematic than overall weight and we should be using waist to hip ratio over BMI as a better determinant for disease risk. This makes a lot of sense really.

 

I’ve talked about health a lot, so what is it? To be honest it’s a bit of an arbitrary and ambiguous term. The World Health Organisation (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” But herein lies the problem – how do we measure these things? How do you measure physical, mental and social well-being? They’re not easy to define let alone measure.

 

So here’s some truth. You can be overweight or obese and still be healthy. This may surprise a lot of people but the research does not lie. A recent study published in the Archives of International Medicine found that people who are overweight have a 50-50 chance of developing high blood pressure, high cholesterol or elevated blood glucose. This is not as good as people in the healthy weight range who have a 75% chance of not developing any of the above and it was significantly better than those who are obese who only had a 30% chance of not developing any of them. So what this means that not all people who are overweight/obese are unhealthy but by being overweight/obese you do increase your risk for developing certain conditions. If you are overweight/obese and are free from medical conditions, have normal cholesterol (depending on your view of cholesterol), normal blood pressure, normal blood glucose, psychologically and mentally sound, then I would suggest that you, my friend, are healthy. What I would also suggest to ensure you stay healthy, is that we try and reduce your abdominal fat as much as possible. It would be likely that in doing this, you would lose weight from all of your body. How good is that?!

 

Still don’t believe me? Well here’s another study by a researcher from our own backyard (which means he has to be good). Professor Jeff Coombes and his team have found that the greatest risk factor for all cause mortality (which basically means for any cause of death) is low cardiovascular fitness (research paper to be published in The New England Journal of Medicine). Consider the following table:

 

Table 1: Physical fitness as a predictor of risk for all-cause mortality

Physical Fitness and body composition Relative Risk
Healthy weight and fit 1.0
Healthy weight and unfit 2.2
 
Overweight and fit 1.1
Overweight and unfit 2.5
 
Obese and fit 1.1
Obese and unfit 3.2

The ideal is clearly to be within the healthy weight range and physically fit which gives us the reference point of 1. However if you’re fit, then it doesn’t matter if you’re obese or overweight, your risk only increases to 1.1. Over on the other side of the table we have a completely different story. Even if you’re a healthy weight, if you’re unfit, your relative risk for all-cause-mortality more than DOUBLES. If you are also overweight and unfit it slightly increases to 2 .5 times the risk of the reference point and not surprisingly if you’re obese and unfit, your risk than triples than if you were fit. These results are simply staggering. There is nothing more protective than physical fitness in reducing our all cause mortality. This is what our focus should be. We need to be looking at the inside not the outside (there’s a lesson in that isn’t there). Our cellular health is so much more important than our physical appearance.

 

So how do we improve our physical fitness? Well high intensity interval training (HIIT) training has been shown to have overwhelming success both in healthy and diseased populations. I will write specifically on how to undertake a HIIT session during the week and make a program available on my website.

 

In the meantime, if you’re overweight or obese and struggling to lose weight but doing all the right things, maybe it’s time you looked in low carb high fat (LCHF) and HIIT training. LCHF is all about eating the right fat – saturated fat. You may think that’s a typo but it’s not. Saturated fat is superior to all other fats because unlike unsaturated fats, saturated fats are almost always the right chain length to be used by the body rather than stored as adipose. Saturated fats are almost always short and medium chain fatty acids. Scientifically speaking, medium chain fatty acids are more completely oxidised than long chain fatty acids and medium chain fatty acids are also able to passively diffuse across the mitochondrial membrane. Basically this means they are used more completely and readily which means there will be very little left over for love handles. Medium chain triacylglycerols (MCTs) have been found to reduce central adiposity and assist in weight reduction. It makes sense really – when you switch from long chains (which tend to be stored as fat) to short chains (which tend to be used up) you’re bound to start losing body fat.

 

So what foods are high in MCTs? Animal products are a great source of MCTs as is coconut oil. You can eat any meat you like (the fattier the better) but I would recommend grass fed (organic) meat and meat products (if you can afford to do so). Butter is a super food as far as I’m concerned and cream is a staple in my house (I have it in my coffee and just about every dinner). We go through eggs at the speed of knots and every meal is all about getting as much fat into the meal as possible. Essentially if you just about flipped what mainstream dietetics would have us do, you’ll be onto a winner.

 

If you’ve been struggling to lose weight I’m pretty sure I can tell you why. Low fat diets ultimately turn us into fat forming machines via a nifty little hormone called insulin. Insulin is used to control our blood glucose levels but it’s also able to stop the body using fat as a fuel source (lipolysis) and instead gets the body to start storing fat. The issue with low fat diets is they ultimately become either high carbohydrate or high protein diets. Why is this an issue? Well carbohydrate ultimately gets broken down into glucose. If you eat a grain based diet you are eating mostly carbohydrate i.e. glucose. This means you are getting the insulin message over and over again all day every day. You may eat very little dietary fat but the research indicates that a high carbohydrate diet is the ideal situation for carbohydrate metabolic conversion to fat. You might be thinking, well I did low carb and high protein. Unfortunately for you, in this situation, your body is very cleverly turning your protein into glucose via a process called gluconeogenesis. This means your blood glucose levels are still rising and you’re still producing insulin. Add to this, the fact that your body is also able to convert excess protein into fat, internally you’re getting a fat-forming storm. The only macronutrient that will not affect your blood glucose levels (unless in absolute dire straits) is fat. The recommendation to cut it from our diets was the worst nutritional error of the 20th century.

 

If you’re struggling with your weight, don’t be disheartened. We live in an image obsessed society where skinny is in and therefore must be healthy. I’ve been in the industry long enough to see that the way in which someone looks has very little bearing on their health status. If someone has to take diet pills, take thermogenics, undergo extreme dietary regimes and exercise their butts off to maintain their physique, I would suggest that’s not healthy at all. Weight loss is a funny beast and it’s a mystery as to why some people can lose it straight away whilst others take much longer. Genetics ultimately play a huge part in our shape but so do hormones and some research is indicating that inflammation is a factor worth considering. So don’t give up and hold your heads high. The world is full of skinny people who are killing themselves (literally) to stay that way (there’s also lots of skinny people who are perfectly healthy). If you’re eating well and exercising and you are in good health then I say embrace who you are. There is no-one in this world who can take your place. You are an individual and a unique creation. That is worth celebrating.

 

References:

 

R.P. Wildman, PhD; P. Muntner, PhD; K. Reynolds, PhD; A. P. McGinn, PhD; S. Rajpathak, MD, DrPH; Ju. Wylie-Rosett, EdD; M. R. Sowers, PhD; “The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering.” Arch Intern Med. 2008;168(15):1617-1624.

 

Lee, C.M.Y.; Huxley, R.; Wildman, R.P.; Woodward, M. “Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis.” Journ Clin Epid. 2008; 61(7):646-653

 

  1. Stefan, MD; K. Kantartzis, MD; J. Machann, PhD; F. Schick, PhD; C. Thamer, MD; K. Rittig, MD; B. Balletshofer, MD; F. Machicao, PhD; A. Fritsche, MD; H. Haring, MD; “Identification and Characterization of Metabolically Benign Obesity in Humans.” Arch Intern Med. 2008;168(15):1609-1616.

 

W.C. Willet, MD, Dr.P.H; W.H. Dietz, MD, Ph.D; G.A. Colditz, MD, Dr.P.H. “Guidelines for healthy weight.” NEJM. 1999; 341:427-434.

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