Newly Published Study Debunking the Idea of HAES

I take it this is the study I heard about on the news this morning while I was foam rolling? The one that supposedly debunks the myth of fit but fat or "perfect bloodwork"?

I too await hearing from people who know how to dig into the data better than I do.

That's consistent with the link in the OP:

* we defined obesity and overweight using body mass index (BMI)
* metabolic dysfunction (‘unhealthy’) was defined as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference.

Compared with metabolically healthy normal weight people (reference), hazard ratios were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.

The first thing that strikes me is using BMI for obesity/overweight, as we know that many people who are technically a healthy BMI are technically overweight by body fat, so I'd be curious to know what percentage of those with healthy weight/not metabolically healthy fall into that category. With such a large study you need to use BMI, though.

I'd also like to know how the numbers change with physical activity.

My own thoughts are:

1. Get thinner - this should improve your metabolic health. Plus, the usual things that people do (controlling diet, eating less, exercise) tend to improve metabolic health.
2. At the same time, increase physical activity/exercise if you can, at least if you are not already active. From other studies I've seen, this also should help.
3. If there are other things you are aware of (diet, for example) that could improve the specific issues with your metabolic health, try them too. This will somewhat depend on the test results (the waist one suggests overweight/obesity at a normal BMI).
4. If you are normal weight but inactive, a huge help might be increasing activity.

It's sad we have to spend the time and money to debunk HAES

It actually seems to confirm it. Only slightly higher risk at higher worked with healthy markers, but significantly higher risk at low weight with unhealthy markers.

A the athletes BMI statement back again - Yes there are some Most often mentioend are the top Rugby players. (See the All Blacks often mentioned in NZ for that)
Sure they are outliers for BMI, but also outliers for endurance, training intensity, support teams and mental health. Thre are not many general guidelines that apply to these people That does not mean that the guidelines are inaccurate. It means that thee people are special athletes that do not follow the general population guidelines. Otherwise all the general guidelines would result in a world population of All Blacks and they don't

In my job I get to see the coronary arteries of lots of different people.

Many overweight people have minor to critical disease.

Many 'healthy' looking people have minor to critical disease.

Obesity is just one cardiac risk factor, albeit a modifiable one along with smoking, cholesterol, oxidative stress etc.

Non modifiable factors such as age, gender, genetics play a big part too.

............

One thing I do find interesting from the imaging I see is that many people with no known history of high blood pressure who are sure their blood pressure is 'fine' have curly twisty coronary arteries typical of chronic hypertension.

Angel49kitty wrote: »

Gallowmere1984 wrote: »

https://academic.oup.com/eurheartj/article-abstract/doi/10.1093/eurheartj/ehx448/4081012/Separate-and-combined-associations-of-obesity-and

It's becoming more and more clear all of the time, that there's no such thing as "health at every size", but of course, this will not deter the most hardcore zealots.

That said, I'm not the greatest at reading population based information, so does anyone here find flaws in this particular study's methods?

The summary of the study results is that, regardless of body mass index (a calculation to estimate someone's body fat), people who were metabolically unhealthy (metabolism being the chemical processes in your body that maintain your life) were much more likely to have heart disease, but those who were overweight were much more susceptible as their bodies are working too hard to maintain them. ie Even if you have a strong metabolism, those who are overweight are still more likely to get heart disease -- but the most important factor is your metabolism.
The concept of 'fit but fat' is basically BS.

Metabolically unhealthy does not mean weak metabolism.

It means varies indicators (such as IR, high cholesterol, high blood pressure, fat around the middle) that are identified in the article.

Being fat without these indicators is slightly more risky than not being fat without them.

Having the indicators and not being fat is quite a bit more risky than not being fat without them.

So to the extent that lifestyle affects your propensity to get metabolic syndrome (which it probably does) you ARE far better off to be fit (i.e., exercise, eat a better diet) while still fat than not to, but of course it's better to also lose weight and doing those things tends to result in weight loss anyway if you also pay attention to how much you eat.