Is it better to be skinny vs fit? If you’re a couch potato but thin is that okay? Or is being in good shape, even if you have a few extra pounds better for you?
Of course the ideal situation is to be in great shape and be thin. These people have the lowest risk, or chances, of getting a number of diseases and having an early death. But it’s not as easy as it sounds. It’s not like we can wake up and decide today we’re going to be fit when we’re not. Or thin when we’re not.
Sure we probably all know someone who doesn’t do anything at all and is skinny. Meanwhile, you might be exercising daily and you still can’t shed those last few pounds. So even though you can run or walk ten minutes faster than you did a few months ago, are you really benefiting from it?
Let’s start off by clarifying that obesity is defined as excess body fat, not excess weight. Weight is a simple measure but it also includes the weight of your bones and muscles, in addition to fat. And as I’ve written, your weight alone doesn’t determine your health. Likewise, just because someone is thin, doesn’t mean they’re healthy.
The Battle Between Fit and Skinny
Early research would suggest it’s better to be thin than active. Compared to women who were thin and active, lean inactive women had a 55% greater chance or early death, while obese active women had a 91% greater chance. But that study looked at physical activity and not fitness. And while the two are related, they’re not exactly the same thing.
When taking fitness into account measured in a lab, the story seems to be quite different. In people who were unfit, increasing body size was associated with greater chance of early death. However, in people who were fit, it didn’t seem to matter what size the person was. Effectively, being fit reduced the negative effect of being overweight or obese.
And this finding also applies to more than just early death. While overweight and obesity are associated with depression, being fit was more important. Those people who were fit but obese had a lower chance of being depressed than people who were unfit and lean.
What about people who are an ideal body shape but aren’t active or physically fit? A review of a variety of studies concluded a) increasing body fat results in increased chances of early death, b) higher fitness levels are associated with a lower chance of early death, and c) people who are obese and fit may actually be healthier than people who are lean but unfit.
Can you be obese and healthy?
So how is it that obesity can increase chances of disease and early death, yet being in good shape can remove this risk? Is there such a thing as being healthy obese? When it comes to risk for conditions like diabetes and heart disease, it may be the case.
As a result, scientists have created the term metabolically healthy obese (MHO). These people may be obese but do not have risk factors for heart disease like high cholesterol, high blood sugar and high blood pressure. It’s likely that being active and in good shape has worked to reduce, or eliminate, these risk factors in these people.
While people who are considered MHO may have a lower risk for disease than people with obesity and risk factors, being MHO is not without concern. Compared to people at ideal body size, MHO people had a 50% greater risk for heart disease.
So while being MHO is better than being obese with risk factors, it is not better than being ideal body size with no risk factors. However, the focus on metabolic health also misses other concerns. Obesity is also associated with arthritis, back pain, as well as psychological and social issues.
On the other hand, it’s also possible to be lean but at high risk for disease. These people are referred to by terms such as thin on the outside but fat on in the inside (TOFI) and metabolically obese but normal weight (MONW). These people tend to have a number of risk factors for diabetes and heart disease, and are in poor shape. They also have more fat around their waist. Together, this puts them at greater risk for heart disease and early death.
The Bottom Line
Both obesity and being physically inactive (or out of shape) increases your chances for a number of diseases and early death. However, the person who is lean but doesn’t exercise regularly may not be in such good shape after all.
Therefore, being active and in shape at any size is good for you. And given the challenge of weight loss, focusing on regular activity is a sure way to improve your health make you feel good.
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