PROFESSOR ROB GALLOWAY: I thought I didn’t have to worry about my weight since I’m ‘fat but fit’… I was wrong

I’ve just finished another typical emergency department shift, but although I left feeling like we were providing great care, there were still eighteen patients in the hallway – at a time when older patients spend more than two days in a hospital. ward bed can wait.

It is not only because resources are under pressure, but because we as a population are becoming increasingly unhealthy and need more and more care.

And of all the lifestyle factors that influence our health, obesity has the greatest impact. In fact, I estimate that at least two-thirds of patients waiting on trolleys and in corridors for a bed had obesity-related conditions.

There was a patient who required an amputation, a complication of type 2 diabetes caused by obesity. In the next cart in the hallway lay a patient who had suffered a stroke caused by high blood pressure, partly the result of being overweight.

There was also a patient who couldn’t walk because of knee pain, due to osteoarthritis – caused by, yes, obesity.

Another patient had a postoperative infection, a complication that is much more common with obesity.

Others required hospitalization due to worsening dementia or complications from treatment for their cancer; obesity is a major risk factor for both conditions. Then there was the patient who was admitted with kidney failure – again partly due to obesity.

Finally, two patients with Covid were admitted: due to their excess weight, they did not have the respiratory reserve to cope with the infection and were seriously ill.

As I looked down the hallway, I saw that, on the one hand, these patients had a longer life expectancy than their parents, thanks to advances in modern medicine. But on the other hand, we spent many of those years in poor health – and obesity was to blame.

The latest figures from the Health Survey for England (an official report that monitors the country’s health and care) show that 25.9 percent of adults are obese and a further 37.9 percent are overweight but not obese. (I fall into this category, despite many failed attempts to continue my weight loss journey: I have lost about 10 kg in the last year, but need to lose another 5-6 kg to reach a ‘healthy’ body mass index , BMI.)

Obesity is generally defined as a BMI of 30 or higher and ‘overweight’ as a BMI between 25 and 30.

There’s been a lot of talk lately about BMI not being all that useful as a measure of healthy weight – and there’s certainly some truth to that.

BMI was actually devised in the 19th century by a Belgian mathematician, Lambert Adolphe Jacques Quetelet, to provide a quick and easy way to measure the level of obesity in the general population and thus aid in government health planning.

But the man who spurred its widespread use in more modern times was Professor Philip James, a British nutritionist at the London School of Hygiene and Tropical Medicine.

He looked at data from American health insurers and saw that people with a higher BMI died earlier on average.

It was Professor James who set the thresholds for the ‘overweight’ and ‘obesity’ categories and these are now international benchmarks. Sadly, he recently passed away at the age of 85, but his thresholds have played an important role in the medical community’s ability to track obesity across generations and regions, looking at the causes of obesity and ways to treat the condition to take.

But, as Professor James himself acknowledged, BMI is a very crude measurement tool and does not distinguish between muscle and fat.

The example we hear so often is how healthy, muscular rugby players are laughably ‘obese’ just because of their BMI. Meanwhile, BMI has not prevented obesity from exploding in prevalence and severity.

In its simplest form, the cause is consuming more calories than we burn. That’s actually what I was taught in medical school and it’s what most people still think.

In fact, we know so much more now. Exercise is good for you, but contrary to what most people think, it won’t help you lose weight. That’s because the body adapts to the number of calories you burn through exercise and reduces energy expenditure in other areas, for example by reducing inflammatory responses. .

We also eat too much of the wrong things: highly processed foods that are packed with sugar and fat and “empty calories.”

This is the more complex cause: it is not just about blaming the individual, but requires social and political changes around the way food is produced and marketed.

But it is also true that as individuals we must take responsibility, no matter how difficult this is.

The problem is that many of us – and I include myself in this – are not making all the changes that are needed. One reason for this is that we look around us and see that we are normal for the population, or perhaps even thinner than the average.

That may very well be true, but that is because more than two-thirds of the population is now overweight. However, if the average person were teleported 50 years into the past, they would be one of the most overweight people. The fact is that obesity has been normalized.

And even if we acknowledge that we are a little overweight, we can fall into the trap of the misunderstood phenomenon of ‘healthy but overweight’.

Professor Matthias Bluher, from the University of Leipzig in Germany, is a world expert on obesity and type 2 diabetes, and a few weeks ago he gave a major lecture at an international convention discussing the latest research.

This showed that there is a large subsection of people who would be ‘obese’ according to the BMI definition, but who are ‘metabolically healthy’, that is, they do not have blood markers that indicate poor health.

Their excess weight is around their legs and buttocks, rather than around their abdomen and internal organs. They do not have insulin resistance (a precursor to type 2 diabetes, in which the cells cannot absorb all the sugar from the blood), or type 2 diabetes, high blood fats or cholesterol.

They also have normal blood pressure. In other words, they are fat but fit. Just like me!

I am overweight according to the BMI definition (28), but I walk every day, my blood pressure is fine, I have no evidence of type 2 diabetes or pre-diabetes and my blood fat and cholesterol levels are normal. So I’m overweight, but metabolically healthy.

So I thought this meant I didn’t have to worry about my weight because I’m much healthier than other people who weigh the same but aren’t as metabolically and physically fit as I am.

That may be true, but what I didn’t realize was that my “metabolically healthy” excess weight was actually a risk factor for poor health.

Professor Bluher’s presentation blew away my confidence and assumptions. First, being metabolically healthy but obese is often just a transient state and you quickly end up metabolically unhealthy.

A little-read 2013 article in the Journal of Clinical Endocrinology and Metabolism found that 30 percent of obese but metabolically healthy people become metabolically unhealthy within six years.

But the research that really blew my complacency out of the water was a study published in 2019 in the Journal of the American College of Cardiology.

Researchers from the University of Birmingham looked at the health records of 3.5 million patients and found that obese people with no metabolic abnormalities (including healthy, overweight people like me) had a 49 percent higher risk of heart disease over almost five and a half years, a seven percent higher risk of stroke and a 96 percent increased risk of heart failure compared to people of normal weight.

What causes this switch from fat but healthy to fat and unhealthy? The underlying reason is that excess fat cells cause chronic, harmful inflammation.

So where does this leave me and you? By delving into this ‘fat but fit’ concept, I have come to realize that it is indeed better to be ‘fat but fit’ than ‘fat and not fit’. But obesity itself – regardless of your body’s metabolic state – is a risk you cannot afford.

Do I really need it?

This week: Ultimate Performance Advanced Back Support, £38, 1000mile.co.uk

Made from neoprene – a rubber material used in wetsuits – ‘this is a brilliant product’ to support your back ‘during physical exertion or lifting’, says physiotherapist Tim Allardyce of Surrey Physio.

‘That’s because the lower back is a weak area, especially in people who lack strength in their spine. A brace like this provides more stability in the spine and abdominal core.

‘This product pulls you in with the front tension strap and can be worn under or over clothing when lifting something heavy to stabilize and support your spine, reducing the strain on your back.

‘I would recommend using this if you are doing physical work for short periods of time – no more than ten minutes at a time – rather than all day, which could promote dependence or weaken your core and muscle stability.

“I have one of those back supports in my office for when I have to lift something heavy.”