Wednesday, December 18, 2013

Idea of Healthy Obesity Is Tested

The idea that there are obese people who are nonetheless healthy may be a myth.
December 13, 2013

Although some overweight or obese people have normal cholesterol, glucose levels and blood pressure – elements of so-called metabolic health – a new study suggests that obesity itself increases the risk for heart disease, stroke, diabetes and death.

Last week the Annals of Internal Medicine published a report that followed more than 61,000 adults, most for at least 10 years. About 9 percent of the subjects were obese and metabolically healthy – that is, they had normal LDL, HDL and total cholesterol, along with healthy blood pressure and blood sugar levels.

Compared with metabolically healthy people of normal weight, the obese group had a 24 percent increase in risk for total and nonfatal cardiovascular events like heart attack and stroke, and death by any cause.

Increased weight, waist circumference, blood pressure, and insulin resistance all rose together. However, increases in triglycerides, glucose, or LDL cholesterol were not associated.

“The message here is pretty clear,” said the lead author, Dr. Caroline K. Kramer, a researcher at the University of Toronto. “The results are very consistent. It’s not O.K. to be obese. There is no such thing as healthy obesity.”

The study appears to be pretty obvious – if you are overweight, your health suffers. However, if you look more closely, it says something more profound – They found no correlation between high triglycerides, high glucose, or high LDL cholesterol and increased cardiovascular events. Waist circumference was a better indicator of health risk! Please note they did see a correlation between insulin resistance and cardiovascular events.

More than 50 percent of Americans having their first heart attack have normal or even low cholesterol. We don’t need to put statin drugs in the drinking water; we need to focus on the real risk factors of metabolic syndrome – central obesity (weight around the middle), insulin resistance, and low thyroid function.

What is the difference between insulin resistance and fasting blood glucose? The fasting glucose tells you how well your body controls blood sugar levels without the stress of eating (adding more sugar) for at least 8 hours. That’s like an open book test, setting the bar too low. By the time the fasting glucose is high, insulin resistance is out of control and you are a full blown diabetic.

The glycohemoglobin A1c is a simple test that measures insulin resistance. It actually measures the percentage of red blood cells (RBCs) that are saturated with glucose. Normal is below 5.7 percent. Because RBCs live about 120 days, this test measures your average blood glucose over the course of the past two months.

Watch your weight, especially your waist line. Have yearly laboratory tests, but insist on a glycohemoglobin A1c and don’t be too concerned with the serum lipids. If you want to see if your cholesterol is really a risk factor, have an L(p)a run. It is the only lipid test that really correlates with increased risk of cardiovascular events.