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   Is "fat but fit" a myth or true? The results of this study suggest that it is a myth. That there is a higher risk of coronary heart disease, and even if everything looks OK initially, it is associated with an eventual metabolic changes (and problems). Just wait a while - as can be seen in the results of this study that followed people from 8 European countries over many years (about 12.2 years). The study found that being normal weight and fit is best, and that "metabolically healthy" obese people were more likely to go on to develop metabolic abnormalities (and become metabolically unhealthy obese people) over the years. Metabolically unhealthy signs included high blood pressure, low HDL-cholesterol, and hyperglycemia (high blood sugar).

Bottom line: aim for normal weight for a lower risk of heart disease (and of course, be physically active and eat a healthy diet - fewer processed foods, and more fruits, vegetables, whole grains, seeds, nuts, and legumes). From Science Daily:

'Fat but fit' are at increased risk of heart disease

Carrying extra weight could raise your risk of heart attack by more than a quarter, even if you are otherwise healthy.Researchers have found that being overweight or obese increases a person's risk of coronary heart disease (CHD) by up to 28 per cent compared to those with a healthy body weight, even if they have healthy blood pressure, blood sugar and cholesterol levels.The findings add to a growing body of evidence that suggests being 'fat but fit' is a myth, and that people should aim to maintain a body weight within a healthy range.

Storing too much fat in the body is associated with a number of metabolic changes, including increased blood pressure, high blood sugar and altered cholesterol levels, which can lead to disease and poor health. However, previous studies have revealed a subset of overweight people who appear to lack the adverse health effects of excess weight, leading to them being classified as 'metabolically healthy obese' in the medical literature, and 'fat but fit' in the media.

Now, a group led by researchers at Imperial College London and the University of Cambridge has shown that despite an apparent clean bill of health, this overweight group is still at increased risk compared to those with a healthy weight. In the largest study of its kind to date, scientists used data from more than half a million people in 10 European countries -- taken from the European Prospective Investigation into Cancer and Nutrition (EPIC) -- to show that excess weight is linked with an increased risk of heart disease, even when people have a healthy metabolic profile.

In the study, published in the European Heart Journal, researchers looked at the link between excess weight and risk of CHD, a condition where not enough blood gets through to the heart due to clogged arteries, leading to heart attacks. After a follow-up period of more than 12 years, a total of 7,637 people in the EPIC cohort experienced CHD events, such as death from heart attack. Researchers then selected a representative group of more than 10,000 individuals as controls, for analysis. Body weight was classified according to definitions from the World Health Organization. Those with a body mass index (BMI) over 30 were classed as obese, while those with a BMI of 25-30 were classed as overweight, and 18.5-25 as normal weight. More than half of the control group (63 per cent) were female, with an average age of 53.6 and an average BMI of 26.1.

Participants were categorised as 'unhealthy' if they had three or more of a number of metabolic markers, including high blood pressure, blood glucose, or triglyceride levels, low levels of HDL cholesterol, or a waist size of more than 37" (94 cm) for men and 31" (80 cm) for women. .... the researchers found that compared to the healthy normal weight group, those classed as unhealthy had more than double the risk of CHD, whether they were normal weight, overweight or obeseHowever, analysis also revealed that within the apparently healthy group there was a significant difference in outcomes for people depending on their weight. The research found that compared to those at normal weight, people who were classified as healthy but were overweight had an increased CHD risk of 1.26 (26 per cent), while those who were healthy but obese had an increased risk of 1.28 (28 per cent). [Original study.]

 Remember all the medical advice for years about not eating eggs frequently (high cholesterol! heart disease!) and to instead eat egg white omelettes if one absolutely wanted to eat eggs? Remember the obsession with dietary cholesterol? Well, this recent research followed 1032 men for 21 years and found that a relatively high intake of dietary cholesterol, or eating one egg every day, was not associated with an elevated risk of incident coronary heart disease - not in the entire study population nor in those with the APOE4 phenotype. Also, the study did not establish a link between dietary cholesterol or eating eggs with thickening of the common carotid artery walls. Time to enjoy eggs again! From Science Daily:

High-cholesterol diet, eating eggs do not increase risk of heart attack, not even in persons genetically predisposed, study finds

A new study from the University of Eastern Finland shows that a relatively high intake of dietary cholesterol, or eating one egg every day, are not associated with an elevated risk of incident coronary heart disease. Furthermore, no association was found among those with the APOE4 phenotype, which affects cholesterol metabolism and is common among the Finnish population. 

In the majority of population, dietary cholesterol affects serum cholesterol levels only a little, and few studies have linked the intake of dietary cholesterol to an elevated risk of cardiovascular diseases. Globally, many nutrition recommendations no longer set limitations to the intake of dietary cholesterol. However, in carriers of the apolipoprotein E type 4 allele -- which significantly impacts cholesterol metabolism -- the effect of dietary cholesterol on serum cholesterol levels is greater. In Finland, the prevalence of the APOE4 allele, which is a hereditary variant, is exceptionally high and approximately one third of the population are carriers.

The dietary habits of 1,032 men aged between 42 and 60 years and with no baseline diagnosis of a cardiovascular disease were assessed at the onset the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, in 1984-1989 at the University of Eastern Finland. During a follow-up of 21 years, 230 men had a myocardial infarction, and 32.5 per cent of the study participants were carriers of APOE4.

The study found that a high intake of dietary cholesterol was not associated with the risk of incident coronary heart disease -- not in the entire study population nor in those with the APOE4 phenotype. Moreover, the consumption of eggs, which are a significant source of dietary cholesterol, was not associated with the risk of incident coronary heart disease. The study did not establish a link between dietary cholesterol or eating eggs with thickening of the common carotid artery walls, either.

The findings suggest that a high-cholesterol diet or frequent consumption of eggs do not increase the risk of cardiovascular diseases even in persons who are genetically predisposed to a greater effect of dietary cholesterol on serum cholesterol levels. In the highest control group, the study participants had an average daily dietary cholesterol intake of 520 mg and they consumed an average of one egg per day, which means that the findings cannot be generalised beyond these levels.