Today, I'm going to introduce a mini-series on "The Obesity Paradox: When
Thinner Means Sicker and Heavier Means Healthier" This is actually the cover
from a book by Carl La Vie. Carl - Dr. La Vie is a physician and he's not a
lightweight, emotionally-driven, "this is what I think of the world" kind of guy.
He's a heavyweight academically. He's written several articles on this issue.
He's an endocrinologist and this was a article that I'll cover, again, later in a
summary - a summary video. But this is in nature reviews for endocrinology. As you
see, he's the front author. Actually, let's go over a couple of items out of that -
out of that journal, and then we'll finish up with a couple of other
comments and even a bottom line on this issue which comes out of key points in
this article. So what we're talking about is that healthy obesity versus unhealthy
lean, it's - there's a paradox there. This was in, as I said nature journals
2015. He makes a couple of points. We're getting fatter in the US, as well as most
of the rest of the world, and controversy has surrounded the idea that some
individuals with obesity can be considered healthy with regards to their
metabolic and cardio respiratory fitness. That's been termed the "Obesity Paradox"
The - the controversies are reviewed in this article and they discuss programs
on patients with obesity who have no metabolic abnormalities and who have
preserved their fitness. Now, the article also suggests the greater emphasis
should be placed on improving fitness rather than weight loss per se in
primary and secondary prevention of cardiovascular disease. At least in
patients that are moderately overweight and have class one obesity - that is a BMI
30 to 35. The morbidly obese clearly need to focus priority
on weight loss. So that's part of the issue here. It's this whole question of
"which is more important: weight loss or getting in shape?" Now, if this sounds
weird, again, this is a - this is a big discussion. This article touches on it as
well and I'm just going to read a couple of points about this one. One of the
clues here is the journal that it came from and the name of the journal
- the Journal of Cachexia, Sarcopenia, and Muscle. Now, it's a - it's also a review and
facts and figures. I'm not going to go into details on that one but the reason
I said the title of the journal is a clue - sarcopenia and muscle, this isn't
that - if you've seen other videos of mine, this is not the first time you've heard
about sarcopenia and how - how dangerous it can be, especially for people over 65,
Well, wait a minute. What's sarcopenia? It's muscle loss and,
again, I'll put a - I'll put a reference to these articles, as well as this video in
the description below, and what you see here become - starts to become much
clearer. You remember in that series - basically, what we said is when people
lose muscle loss or lose muscle mass, they become unhealthier and so this
thing about "Oh, well. He's just a little old man." or "She's just a little old lady."
Especially talking about people 65 and older; that's not just a little problem.
In fact, I did another video where we talked about Docs tend to miss that
90% of the time. They just think "Well, you know - that's a little old
lady" That's not good. This is a problem and, again, this is - there is a major
overlap between this question of the obesity paradox and what's known
about the lethality of sarcopenia or muscle loss and, again, you see it
in this image here, where a 25 year old with mostly muscle in his thigh, versus a
63 year old with much less muscle and still the same thigh circumference but a
significant amount of fat there. Now, in other videos on this - on this topic, I'm gonna go into a thing called Mendelian
randomization studies and a meta-analysis of - is cardiovascular, I
mean, is obesity actually really linked to heart disease? Now, what does that mean?
what a we know what a systematic review is it's a meta-analysis it's the sort of
things that you review with Cochrane studies but Mendelian randomization -
Here's what Mendelian randomization is and we explain that further in the - in
that video. I think it'll come out next month. There are certain things that you
can't do. A randomized clinical trial on, for example - Does obesity actually cause
heart disease or does it - Is... is it - does the same thing -
is there something related to both of them? First of all, you're not going to do
a randomized trial where you have a study group that you make obese at
random, and another control group where you're not obese and here's the second
thing you just - you can't do that. Even if you could do that, which you can't do,
you're not gonna blind people to it either. I mean - you can't tell some - you
can't blind the patient or the subject to the fact that you've made them obese.
They'll know it. So will they die? So Mendelian randomization takes a - takes
advantage of the fact that genetics tends to be randomly distributed, whether
you get - if your mom has blue eyes, you and your dad has brown eyes; there's some
random component of which you're gonna get what eye color you're going to get but
as you can see, that can start getting really deep. That's not for this video.
We're just going to wrap up on this video to go back to La Vie study in
Nature Reviews endocrinology and he brought up some key points which I think
will help bottom line this issue of the obesity paradox. The prevalence of
obesity is increased in most of the world. Over the past few decades, patients
with obesity have more cardiovascular and metabolic risk factors than people
with normal weight and have increased risk of developing cardiovascular disease. Now,
data suggests that metabolically healthy obesity, especially when combined
with a high level of fitness, is associated with, at most, a minimal
increase in overall risk of cardiovascular diseases, and mortality;
And again, this gets much more important as we get older into our mid 60s and
beyond. In patients with established cardiovascular disease and other chronic
conditions such as kidney disease, severe arthritis, those with overweight and
class-one obesity have a better prognosis than lean patients that - that's
the obesity paradox that they're talking about. Now, many of us (myself included)
will automatically start thinking, when you read that point - Well, there's got -
there's clearly going to be an association with a severe disease like
kidney disease, severe arthritis as when that's coupled with cardiovascular
disease and clearly these are maybe the lower BMI - the thinner people are
selecting for people that have significant illness and yes, that's part
of this question as well. That's part of what happens when you start digging into
the studies and the data. Now, the last two points I think are very, very
important here. And, again, the last one itself is the bottom line. Fitness is
more important than fatness for long term prognosis. Again, especially for
older folks in the obesity paradox, fitness markedly alters the relationship
between adipose or how much fat you have and long-term
health outcomes so it's critical to exercise. High intensity intervals,
resistance training, and other things like some endurance training, but the
first two are most important - High intensity intervals and resistance
training. Despite that, here is the bottom line on
this entire obesity paradox so you can - those of you who say "Brewer, just
bottom-line it. Don't confuse me with all these facts." Here's the bottom line, guys,
despite accumulating evidence on the obesity paradox, the available data still
support purposeful weight loss for long-term health, particularly when
combined with increased physical activity, muscle strength, and fitness. So,
again, we'll get a little bit deeper and go into some interesting and maybe geeky
things like the Mendelian randomization but if you've made it this far, again, I
appreciate your interest.