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PURPOSE OF REVIEW:
Obesity is associated with an increased risk of premature death and represents a fast growing worldwide health problem that is reaching epidemic proportions. Obesity significantly increases the risk of developing metabolic disorders, hypertension, coronary heart disease, stroke, and several types of cancer. However, a subgroup of 'healthy' obese patients seems to be protected against metabolic and cardiovascular obesity comorbidities. This review focuses on potential mechanisms underlying the healthy obese subphenotype.
RECENT FINDINGS:
Individuals with obesity typically develop type 2 diabetes, dyslipidemia, fatty liver disease, gout, hypertension, and cardiovascular disease. In the past years it became clear that up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy lean individuals, lower liver fat content, and lower intima media thickness of the carotid artery than the majority of metabolically 'unhealthy' obese patients. Recent studies suggest that protection against development of hepatic steatosis, ectopic fat deposition, inflammation of visceral adipose tissue, and adipose tissue dysfunction contributes to healthy obesity.
SUMMARY:
For the stratification of obesity treatment, definition of metabolically healthy or high-risk phenotypes will facilitate the identification of the obese person who will benefit the most from early lifestyle, bariatric surgery, or pharmacological interventions.
The negative effects of the sumo lifestyle become dangerously apparent later in life. Sumo wrestlers have a life expectancy of between 60 and 65, more than 10 years shorter than the average Japanese male. They often develop diabetes, high blood pressure, and are prone to heart attacks.... Recently, the standards of weight gain are becoming less strict, in an effort to improve the overall health of the wrestlers.[18][19]
The above extract from Wiki 'Sumo' seems to contradict the assertion re-healthy sumo wrestlers at least.
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The correct bibliographic citation for the definition is:
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
The Definition has not been amended since 1948.
Another definition that creates a different perspective with respect to orthotics and footwear is: 'Health is the ability to adapt.' In other words someone can appear to be healthy simply because they have not been put in a situation that challenges their physical, mental and social wellbeing.
Some people can wear any old thing on their feet and be happy. Others... things have to be just so, one millimetre here, another there or the pain is so great they have to sit down. When you finally get it right, are they then healthy?
__________________ Put on your red shoes and dance the blues away.
Thanks for the definitions Bill. The first one is good enough for me and the fact that it hasn't changed enhances its value as it suggests that they got it right first time and that the nature of health hasn't changed in the interim period and therefore they haven't needed to modify it? Of course it might be that no one has looked at the definition since 1946 and that in contemporary terms it's nonsense?
The answer to the question Are there still healthy obese patients is almost by definition NO. If they are patients they must be ill?
If the question was Are there still healthy obese people. My answer would be that they may not be manifesting disease but will be, because of their obesity, sooner and more severely than slim people. This is probably covered by the first of the definitions proposed by Bill B. The word 'still' in the question suggest that at sometime in the past there were healthy obese people. The most healthy response is that there never were and never will be healthy obese people, it's a contradiction in terms.
It would be better for the health of the world if the idea of healthy obesity is laid to rest here, once and for all but I bet it isn't.
The answer to the question Are there still healthy obese patients is almost by definition NO. If they are patients they must be ill?
If the question was Are there still healthy obese people. My answer would be that they may not be manifesting disease but will be, because of their obesity, sooner and more severely than slim people. This is probably covered by the first of the definitions proposed by Bill B. The word 'still' in the question suggest that at sometime in the past there were healthy obese people. The most healthy response is that there never were and never will be healthy obese people, it's a contradiction in terms.
It would be better for the health of the world if the idea of healthy obesity is laid to rest here, once and for all but I bet it isn't.
The definition of obesity as a BMI over 30 is problematic and I would disagree with the assertion it is unhealthy by defintion. In my training I was at the marine corp recruiting depot and they brought in this guy for a medical exam because he was "obese". From just looking at him, with his shirt off, you could tell that he was easily less than 10% body fat. So with the BMI definition, there will be people that are quite healthy and catagorized as obese.
I will agree that most people with a BMI over 30 have a problem, but the BMI is an imprecise instrument.
The definition of obesity as a BMI over 30 is problematic and I would disagree with the assertion it is unhealthy by defintion. In my training I was at the marine corp recruiting depot and they brought in this guy for a medical exam because he was "obese". From just looking at him, with his shirt off, you could tell that he was easily less than 10% body fat. So with the BMI definition, there will be people that are quite healthy and catagorized as obese.
I will agree that most people with a BMI over 30 have a problem, but the BMI is an imprecise instrument.
The above article looks at an alternative to the BMI the BAI (Body Adiposity index) which looks esentially at the hip circumference to height ratio and adjusts it so that can be read as a fat percentage.
The authors suggest it is better than the BMI. They describe it as 'reasonably accurate but not terribly accurate'.
Why are so many American baseball players obese? I am sure that in part if reflects increasing national obesity but is there something within the culture of baseball that makes being overweight a status symbol?
Why are so many American baseball players obese? I am sure that in part if reflects increasing national obesity but is there something within the culture of baseball that makes being overweight a status symbol?
What percentage are obese? By what measure? True, there are not many that look like marathoners. I'd bet that carying an extra 20 pounds doesn't effect their performance that much. A good question is how much does that slow you down when sprinting, or starting from a sprint. Being 20 pounds overweight might shave only a couple of points off of your batting average. The real skill is being able to hit a 90 MPH fastball. That's a skill where extra pounds probably don't matter. If you look at middle infielders, they tend to be more lean. Diving quickly to one side or the other, with quick accelerations, will be affected by body mass. Pitchers, especially with the designated hitter rule, rarely have to run at all. You could make the case that trowing fastballs might be easier if the body has more inertia. I guess the point is that they can perform at an elite level for their sport with some fat. Maybe the status symbol is that "I can be this good without being in shape." I don't see a lot of people saying they want to be like their idol because he's fat.
I agree with Eric. The BMI is neither a valid or reliable indicator for body fat percentage in a great number of individuals (Prentice AM, Jebb SA: Beyond body mass index. (Obesity Reviews, 2:1-7, 2001). I would imagine the Body Adiposity Index is just as poor of an indicator of actual body fat percentage. Measuring body fat percentage is best done using underwater weighing....BMI is basically a mediocre guesstimate of body fat percentage and, in my opinion, is much overused in today's medical world as an indicator of body fat percentage.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I am sure that you are right kevin, re- the validity and reliability of BMI but I don't think we should throw out the baby with the bathwater. The problem isn't so much the BMI but its use as the single factor leading to a possible diagnosis of obesity. As Eric said, 'From just looking at him with his shirt off, you could tell that he was easily less than 10% body fat.'
Add together BMI, Looking at the subject stripped to the waist (the subject of course and not the examiner although it might add an interesting dimension) and asking a few questions such as - What kind of work do you do? What kind of exercise do you take each week? As these are questions that could be asked at the same time as measuring the BMI there would be no extra time cost involved in doing so.
Are there any photos on the web showing people with different and the same BMIs?
There are some BMI visual graphs online including one which illustrates Eric's point, re-same bmi different body composition, nicely.
All the bmi visual graphs that I saw seem useful but they look as if they could be improved , at least by including a profile view as well as full face.
Are there still healthy obese patients?
Re: Are there still healthy obese patients?
Put on your red shoes and dance the blues away. 
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