Can you be Healthy and Obese?

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Health and Obesity Correlates

The state of obesity is definitely correlated with exacerbation of several disease states. Several systemic reviews and/or meta-analysis' noted that the state of obesity is associated with worsened symptoms and signs of Polycystic Ovarian Syndrome (PCOS),[1] Pulmonary Function and Cardiovascular Risk,[2][3] Asthma,[4][5] Obstructive Sleep Apnea,[6] Kidney function,[7] Schizophrenia,[8] Bipolar Disorder,[8] Alzheimer's,[9] worsened Breast Feeding potential[10] and heightened risk of Pregnancy complications[11] as well as preeclampsia,[12] and increased risk of Colorectal Adenocarcinoma.[13]

Several Meta-analysis' indicate that obesity is correlated with disease states and appears to be further correlated with worsened disease progression over time (when compared to leaner subjects with the same disease state)

Conversely, BMI appears to be inversely related to success of suicide attempts (although attempts in women only are positively correlated)[14] and the evidence of BMI influencing cancer survival during chemotherapy is mixed.[15][16]

The above studies establish a relationship between obesity and several disease states, but do not per se establish a causative link. However, unless the (obese/overweight) person being assessed is not the statistical norm it is possible these results would apply to them

Obesity and Activity

Sumo wrestlers tend to be a hot topic in regards to 'Health at Every Size®' due to their body mass exceeding the standards of obesity yet the strength and activity level of an average Rikishi exceeding most of the population.[17][18]

In sumo wrestlers, the large amount of daily physical activity conducted in accordance with a high calorie diet and state of obesity does not appear to be enough to normalize some health parameters; Type II diabetes, triglycerides, and hypertension are still higher in highly active sumo wrestlers when compared to age-matched controls of normal BMI status.[19] This study noted no significant differences in blood glucose or total cholesterol but worsened parameters otherwise, and it should be noted that the difference in average weight was a mere 12.2kg (88kg in control, 100.2kg in Rikishi) which is not the size many associate with a 'sumo wrestler'.[19]

The risk of premature death is higher in sumo wrestlers when comparing the heaviest weight class against lower weight cohorts;[20] an increase in risk of death was very significant when compared against age-matched controls, although it is hard to delineate if this is due to obesity or due to professional contact sports, some evidence towards it being weight related is an association between weight and premature cardiovascular death in NFL players of heavier weight but to a lesser extent in lighter weight NFL players.[21][22] Retired NFL players also appear to be at greater risk for metabolic syndrome if their BMI is greater,[23] and the state of obesity in athletes of this caliber is associated with hepatic damage, assessed by ALT levels.[24]

Sumo wrestlers do tend to have a more favorable body fat composition (more subcutaneous and less visceral, which is in accordance with biomarkers for reduced risk of cardiovascular disease[25]) but this same study also noted that it has yet to be shown that exercise interventions less than the heavily intense Sumo training confer this same theoretical protective benefit.[25]

Using sumo wrestlers and National League American Football players as models for 'High adiposity paired with High activity', there still appear to be risks associated with the state of obesity or the high calorie diet that activity cannot compensate for completely (some compensation does seem apparent, however)

Exercise does not appear to be potent enough to normalize all health biomarkers of an obese (BMI greater than 30) person if weight loss does not also occur; this may not hold for overweight persons where the state of health is inherently more favorable (than obese age-matched persons)

Health at Every Size® (HAES®)

According to a few studies, Health At Every Size® (HAES®) is a movement away from weight-centric thinking towards health-centric thinking, and "(addresses) the biological, psychological and sociocultural aspects of weight problem, to emphasize the importance of health and well-balanced life independently of body weight, and to improve lifestyle habits".[26]

Interventions

In overweight women who participate in HAES® intervention (support groups), it appears that a reduction in appetite precedes a reduction in calories.[26] This (appetite reduction) is a phenomena that has been noted previously with HAES® interventions in free-living conditions.[27][28] The success rate of size acceptance appears to be notable in persons who self-identify as 'chronic dieters',[29] especially when delivered via educational platforms such as a 13-week class[30] or Focus groups.[31]

These apparent benefits to appetite and weight control appear to be associated with normalization of eating behaviours and less stress/anxiety surrounding eating.[32][33]

Health At Every Size® interventions appear to be quite effective for normalizing eating habits and reducing subjective reports of appetite, which may be mediated through a reduction in anxiety and stress associated with eating; this effect is slightly more prominent in chronic dieters

References
1.^Lim SS, Norman RJ, Davies MJ, Moran LJThe effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysisObes Rev.(2012 Oct 31)
2.^Friedemann C, Heneghan C, Mahtani K, Thompson M, Perera R, Ward AMCardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysisBMJ.(2012 Sep 25)
3.^Wehrmeister FC, Menezes AM, Muniz LC, Martínez-Mesa J, Domingues MR, Horta BLWaist circumference and pulmonary function: a systematic review and meta-analysisSyst Rev.(2012 Nov 16)
4.^Juel CT, Ali Z, Nilas L, Ulrik CSAsthma and obesity: does weight loss improve asthma control? a systematic reviewJ Asthma Allergy.(2012)
5.^Adeniyi FB, Young TWeight loss interventions for chronic asthmaCochrane Database Syst Rev.(2012 Jul 11)
6.^Wall H, Smith C, Hubbard RBMI and obstructive sleep apnoea in the UK: a crosssectional study of the over-50sPrim Care Respir J.(2012 Jun 29)
7.^Mongkolsomlit S, Patumanond J, Tawichasril C, Komoltri C, Rawdaree PMeta-regression of risk factors for microalbuminuria in type 2 diabetesSoutheast Asian J Trop Med Public Health.(2012 Mar)
10.^Turcksin R, Bel S, Galjaard S, Devlieger RMaternal obesity and breastfeeding intention, initiation, intensity and duration: a systematic reviewMatern Child Nutr.(2012 Aug 20)
11.^Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Duda W, Borowiack E, Roseboom T, Tomlinson J, Walczak J, Kunz R, Mol BW, Coomarasamy A, Khan KSInterventions to reduce or prevent obesity in pregnant women: a systematic reviewHealth Technol Assess.(2012 Jul)
12.^Salihu HM, De La Cruz C, Rahman S, August EMDoes maternal obesity cause preeclampsia? A systematic review of the evidenceMinerva Ginecol.(2012 Aug)
13.^Okabayashi K, Ashrafian H, Hasegawa H, Yoo JH, Patel VM, Harling L, Rowland SP, Ali M, Kitagawa Y, Darzi A, Athanasiou TBody mass index category as a risk factor for colorectal adenomas: a systematic review and meta-analysisAm J Gastroenterol.(2012 Aug)
14.^Zhang J, Yan F, Li Y, McKeown REBody mass index and suicidal behaviors: A critical review of epidemiological evidenceJ Affect Disord.(2012 Sep 20)
15.^Arem H, Irwin MLObesity and endometrial cancer survival: a systematic reviewInt J Obes (Lond).(2012 Jun 19)
16.^Parekh N, Chandran U, Bandera EVObesity in cancer survivalAnnu Rev Nutr.(2012 Aug 21)
17.^Kanehisa H, Kondo M, Ikegawa S, Fukunaga TBody composition and isokinetic strength of professional Sumo wrestlersEur J Appl Physiol Occup Physiol.(1998 Mar)
18.^Kanehisa H, Kondo M, Ikegawa S, Fukunaga TCharacteristics of body composition and muscle strength in college Sumo wrestlersInt J Sports Med.(1997 Oct)
19.^Nishizawa T, Akaoka I, Nishida Y, Kawaguchi Y, Hayashi ESome factors related to obesity in the Japanese sumo wrestlerAm J Clin Nutr.(1976 Oct)
21.^Selden MA, Helzberg JH, Waeckerle JFEarly cardiovascular mortality in professional football players: fact or fictionAm J Med.(2009 Sep)
22.^Croft LB, Belanger A, Miller MA, Roberts A, Goldman MEComparison of National Football League linemen versus nonlinemen of left ventricular mass and left atrial sizeAm J Cardiol.(2008 Aug 1)
23.^Miller MA, Croft LB, Belanger AR, Romero-Corral A, Somers VK, Roberts AJ, Goldman MEPrevalence of metabolic syndrome in retired National Football League playersAm J Cardiol.(2008 May 1)
24.^Selden MA, Helzberg JH, Waeckerle JF, Browne JE, Brewer JH, Monaco ME, Tang F, O'Keefe JHElevated alanine aminotransferase in current national football league players: correlation with cardiometabolic syndrome markers, obesity, and insulin resistanceSouth Med J.(2009 Oct)
27.^Bacon L, Keim NL, Van Loan MD, Derricote M, Gale B, Kazaks A, Stern JSEvaluating a 'non-diet' wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviorsInt J Obes Relat Metab Disord.(2002 Jun)
28.^Provencher V, Bégin C, Tremblay A, Mongeau L, Corneau L, Dodin S, Boivin S, Lemieux SHealth-At-Every-Size and eating behaviors: 1-year follow-up results of a size acceptance interventionJ Am Diet Assoc.(2009 Nov)
29.^Bacon L, Stern JS, Van Loan MD, Keim NLSize acceptance and intuitive eating improve health for obese, female chronic dietersJ Am Diet Assoc.(2005 Jun)
30.^Jackson EGEating order: a 13-week trust model class for dieting casualtiesJ Nutr Educ Behav.(2008 Jan-Feb)
31.^Greaney ML, Lees FD, Lynch B, Sebelia L, Greene GWUsing focus groups to identify factors affecting healthful weight maintenance in Latino immigrantsJ Nutr Educ Behav.(2012 Sep-Oct)
32.^Provencher V, Bégin C, Tremblay A, Mongeau L, Boivin S, Lemieux SShort-term effects of a "health-at-every-size" approach on eating behaviors and appetite ratingsObesity (Silver Spring).(2007 Apr)