The Obesity Paradox

Are We Fit or Fat, or Fit AND Fat?

If you've heard it once you've heard it a thousand times: eat right and live longer, you are what you eat, garbage in garbage out. You know what I'm talking about, fat bad, sugar bad, salt bad, etc. But what happened when the diet experts put their healthy eating programs and advice to the test. Not on rats or mice in labs, but on real people in the real world eating real food.

Enter the Women's Health Initiative (WHI) Dietary Modification Trial. 48,835 postmenopausal women were randomly assigned to either their regular unrestricted diet or to a healthy low-fat, high fiber diet. Though starting at more stringent levels, by the end of the study, the dieters were eating 29% fat, compared to 37% in the control group, and ate about 25% more fruits and vegetables, grains and fiber than the group on your typical American diet.

After eight years this is what they discovered: There was no difference in the incidence of breast cancer, colon cancer, heart attacks or strokes among those who ate "healthy" and those who ate whatever they pleased.

The researchers concluded: "A dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD (coronary heart disease), stroke, or CVD (cardio-vascular disease) in postmenopausal women." Not only that, but among the women who had heart disease symptoms at the beginning of the study, the low-fat diet slightly increased their risks for heart disease.

They added: "We found no evidence that lower intake of total fat or specific major types of fat was associated with a decreased risk of breast cancer." Also, the women who'd been on low-fat diets before the study began had slightly higher risks for breast cancer than women who'd been eating the most fat. At the same time women who had managed the most reduced fat diets had the highest risk for breast cancer. Lastly they wrote: "A low-fat eating pattern does not result in weight gain in postmenopausal women."

Did you get that? They didn't claim the low-fat diet made you thinner, rather it didn't make you fatter. Subjects lost some weight at the start, but regained it before the end of the trial, despite eating 361 fewer calories a day than at the start of the study. At the end, the researchers found weight change differences between the intervention and control group of only about a pound and a half.

There's also this from the INVEST trial, a prospective, randomized international study of some 22,000 patients with hypertension and coronary artery disease age 50 and up. The patients got cardiovascular workups including BMI (body mass index) calculations, and were followed for an average of 2.7 years.

The INVEST findings: Compared to normal weight patients, thin patients had 74% higher risk of both death and having a heart attack or stroke, and overweight patients had 29% lower risk. But the obese had the lowest risks of all, nearly half that of normal weight patients.

Adjusted for diseases, such as kidney disease and congestive heart failure, and health risk factors the researchers found being overweight and obese was associated with lower risks, 1/3 to 1/4 that of patients of normal weight. Interestingly, being thin had a 52% higher risk; advancing age a 63% higher risk; smoking rendered a 40% higher risk. They concluded: "Our study is in agreement with previous studies that observed an obesity paradox in patients with previous cardiovascular disease... Our results suggest a protective effect of obesity in [these] patients."

Then there's the Growing Up Today Study (GUTS), led by Allison Field at Brigham and Women's Hospital and Harvard Medical School examining the health and lifestyles of more than 16,000 children, ages 9 to 14.

The study found, regardless of overweight status, dieting children gained more weight compared to children who didn't. This confirms another study by these same researchers finding girls who were frequent dieters were nearly 4 BMI points higher versus never or rarely dieting kids. This after accounting for other factors, including physical activity, television watching, etc. Neither could the researchers find a connection between soda or snack (so-called junk food) consumption and weight among these kids after 3 years. The bottom line, fat kids didn't eat more sweets than the thin ones.

David Garner, Ph.D. and Susan Wooley, Ph.D., reviewed 500 studies on weight in Clinical Psychology Review and concluded: "Multiple researchers, using a variety of methodologies, have failed to find any meaningful or replicable differences in the caloric intake or eating patterns of the obese compared to the non-obese to explain obesity."

Here are a few more tidbits:

UCLA researchers analyzed the Acute Decompensated Heart Failure National Registry and the more than 108,000 cases of acute heart failure in hospitals nationwide from October 2001 through December 2004. Adjusting for every contributing factor, they found for every 5 unit increase in BMI (body mass index) the risk of dying dropped by 10 percent.

Among men with symptoms of heart disease, the overweight tend to live longer than their normal-weight counterparts. Researchers found that among nearly 6,900 male veterans assessed for symptoms of heart disease, those who were overweight were less likely to die over the next 7.5 years compared with normal-weight men.

The National Institutes of Health conducted an expert review showing weight gain with age for both men and women reduces death rates; while dieting, weight loss or fluctuating weights (yo-yoing), increases the risk of actual death, cardiovascular diseases, type 2 diabetes and cancers.

All this seems completely contrary to the popular wisdom and is often called the "obesity paradox." Study after study showing fat people living longer and no connection between fat laden diets and poor health nor between so-called "healthy diets" and better health. But you wouldn't know that listening to the media reports. Aren't we killing ourselves with out fatty, sugar-filled foods? Isn't there an obesity epidemic? That's what we keep hearing. The facts are as obesity rates increase in the U.S., heart disease death rates have been dropping for more than five decades -- 22% between 1993 and 2003 alone.

Of course, this is only a paradox if we believe being thin is healthier than being fat, especially as we age. This is only a paradox if we believe a low-fat, low-salt, low-sugar or whatever the experts regard as a healthy diet really is healthier. But what if those beliefs are overstated or, as some evidence suggests, wrong? In that case you have to wonder...

Paradox or not?