The Fat-but-Fit Debate Rages On

What does it mean to be healthy? What if you’re rail-thin, but sedentary? Or how about if the scales say you’re overweight, or even obese, but you eat well and exercise? These questions, which essentially make up the “fat-but-fit” debate, have been controversial for a long time, especially when it comes to the question of whether you can be overweight and still healthy. And, unfortunately, there are still conflicting studies surrounding this issue, meaning it doesn’t look like the arguments are going to stop anytime soon. So maybe it’s time to reframe the debate anyway.

Conventional Wisdom on Obesity

the back of 3 obese women walking in the street
Obesity increases your risk of chronic diseases and can double your risk of developing coronary heart disease.

Mainstream opinion seems to be that being overweight, or especially obese, automatically means being less healthy than being thinner. If we were going to boil down the conventional wisdom on the topic, we’d probably cite the research that finds strong associations between overweight and obesity and negative health effects, which is what most people think of. And it is true: there are a lot of high quality studies out there that have shown that obesity increases your risk of chronic diseases, such as heart disease, type 2 diabetes, cancer, premature death, breathing difficulties, nonalcoholic fatty liver disease, and mobility issues.

You might even be vaguely familiar with findings like the ones from one retrospective study including 103,218 people that observed a 1.5–2.7-fold greater risk of death among people with obesity, compared with those with “normal” weight statuses. Or you might have heard that excess belly fat can be a real killer – literally, since it leads to the highest rates of cardiovascular disease and metabolic syndrome.

How about a huge study from 2017, published in the Journal of the American College of Cardiology, that according to the lead author, found that “The bottom line is that metabolically healthy obesity doesn’t exist…Obesity is not a benign condition”? This study suggests that even when overweight or obese people are free from health complications, they are still more likely to develop heart disease than people who aren’t overweight, even if they don’t have conditions like diabetes, high blood pressure or high cholesterol (in other words, are “metabolically healthy obese”). 

In this study, as long as they were in the obese weight category, participants had a higher risk for having a stroke, a nearly 50% greater risk of developing coronary heart disease, and had nearly double the risk of developing heart failure than people who were not overweight and in similar metabolic health. And if they were just overweight? They still had a 30% higher chance of developing coronary heart disease than other people.

But you know what? There’s always a “but.” So let’s take a look at some of the controversies in this debate, and the challenges to this conventional wisdom.

The Controversy

These studies are concerning, but the thing is they don’t actually always tell the whole story, both for better or for worse. First, let’s look at some of the caveats that are fueling the fat-but-fit controversy, and then at what might be the real reason that even being metabolically healthy but overweight could be problematic.

First of all, to take the study above as an example, it’s important to note that this major study that followed 3.5 million British people from 1995-2015 left a few important things out. It didn’t look at lifestyle, meaning that it fails to account for the effects of diet. Not only that, but as many studies do that look at weight, it classified weight status by using body mass index (BMI), a formula based on height and weight that doesn’t distinguish muscle from fat. 

But here’s where we get to the real controversy. This study, like many others, didn’t take fitness level or physical activity into account. So yes, there is strong evidence that obese individuals have a higher rate of heart failure, but when it comes to coronary heart disease outcomes, studies that take both weight and physical fitness into account have concluded that “fitness is more important than fatness.”

Let’s take a look at another study from even more recently. It analyzed 527,662 people, and found that despite being regularly active, those with obesity had two, four, and fivefold greater risks of developing diabetes and high cholesterol and blood pressure than people with “normal” weight statuses. 

Those scary stats are what most media outlets ran with, but there were other aspects to the study that were important, too. First, it found a reduced risk of chronic disease across all BMI categories in those who were more physically active, leading the authors to conclude that physical activity does, in fact, provide health benefits across all BMI categories. Second, it did not look at cardiorespiratory fitness, or diet, both of which are pretty important when it comes to assessing heart disease risk. 

Now add to all of this these studies:heart beat with a heart in the middle

  • 2 studies from 1999 that found that obese men could possibly reduce their risk of dying from heart disease more than threefold with regular exercise, even if they didn’t lose a single pound.
  • A recent meta-analysis from 2014 that found that individuals with normal, overweight, and obese weight statuses with equal cardiorespiratory fitness levels had the same risk of all-cause mortality. Those who were unfit, regardless of their BMI, had a twofold greater risk of all-cause mortality.
  • A 30-year follow-up study including 3,307 people that showed a 36% decreased risk of heart-disease-related mortality in those that remained physically active, with weight loss providing no additional risk reduction.

So what do we have? A recipe for a debate that doesn’t feel like it’s going to be wrapped up definitively anytime soon. But with that being said, there is, as we mentioned above, one more part of the debate that might tie these two sides together. The effect of remaining obese throughout your life, and not making lifestyle changes that could improve your health.

Time Takes Its Toll

According to a study on obesity and cardiovascular diseases published in the journal Minerva Medica, “The most effective therapies at reversing CVD [cardiovascular disease] risk factors associated with obesity have been dietary changes with exercise.” That simple sentence says a lot. The answer to the debate (if there is one) could be that being fat-but-fit is possible for a period in your life, but, like most good things, that state of being will eventually come to an end. 

Remember that study published in the Journal of the American College of Cardiology, the one that left out a few things? It had another interesting finding, one that maybe wasn’t as widely publicized as its findings shattering the idea that you can be fat and fit. It found that, according to lead study author Joshua Bell, time was actually the most important factor in the participants’ health.

For example, 66 of the participants were considered “healthy obese adults” at the beginning of the study, but after 20 years, about half had progressed to unhealthy metabolic levels, even without any changes in weight. To these researchers, that meant that being currently healthy doesn’t guarantee being healthy down the road. The authors of the study suggest this is because excess fat is biologically active, messing with hormone balance and pumping out inflammatory chemicals, which can cause insulin resistance (a precursor to diabetes), cancer, and a lot of other bad things in between.

Interesting. So this could mean that yes, you can be fat but fit, but that designation is only a snapshot in time, and making healthy lifestyle changes now could mean avoiding all of those possible negative effects of obesity down the road. Is it time, then, to reframe the fat-but-fit debate?

Reframing the Debate

What’s the takeaway here? What’s most important? Probably not that researchers are arguing over whether it’s actually possible to be fat and fit at the same time, although keeping on top of the latest findings is a good idea. What’s really important is how you can be your healthiest self, now and in the future, and that could mean simply moving your body more, along with other healthy habits. 

After all, focusing too much on someone’s weight takes away from other positive actions they’ve taken toward good health, like getting more exercise, managing stress, eating a nutritious diet, and sleeping more. In fact, making weight loss your goal can also be unhelpful: it’s much easier to set a goal to be more physically active than it is to set a goal for how many pounds you want to lose. For example, you can set a goal to get in a brisk 30 minute walk, three times a week, which feels much more doable than telling yourself you need to lose 20 pounds by a certain date.  

What’s more, getting regular exercise is beneficial to everybody, regardless of weight, and increasing your cardiorespiratory fitness, strength, endurance, and flexibility is more important than focusing on aesthetic weight loss. You’ll get all of the benefits of moving your body more, including: black and white picture of the back of a man with his arms up showing off muscles

  • Stronger muscles and bones
  • Lower risk of injury
  • Reduced pain
  • Better mood and brain health
  • Improved sleep and energy levels
  • Increased self-confidence and self-efficacy
  • Improved productivity and creativity
  • Reduced risk of chronic disease (e.g., heart disease, type 2 diabetes, and cancer)
  • Lower risk of early death
  • A healthier immune system
  • A healthier heart
  • Better quality of life

And once you get a taste of all that, you’ll want more! That means, no matter how much you weigh right now, you’ll be on the road to better health.

Confirmation That Portion Sizes Are Supersizing Us

There are a few things that aren’t a secret to any of us living in the U.S. One: our obesity rate is high, and is only getting higher. Two: we tend to live by the motto “go big or go home,” and that includes how we dish out our food. A lot of us have suspected for a long time that these two things are related, although many people have been stuck on the idea that it’s our supposedly sedentary lifestyles that’s caused the skyrocketing obesity rate in our country. But now, a recent report has charted how increasing obesity rates and increasing portion sizes in this country have run parallel to each other, and many frankly aren’t all that surprised.

The Skyrocketing Obesity Rate

It’s been said before, the obesity rate in this country has been rising for a long time, and it doesn’t seem to be slowing down, so it’s worth taking a good look at the numbers. According to the CDC, from 1999-2000 through 2017-2018, the percentage of people in the U.S. who were obese increased from 30.5% to 42.4%, and severe obesity increased from 4.7% to 9.2%. That means that obesity-related conditions like heart disease, stroke, type 2 diabetes, and certain types of cancer are also on the rise, unfortunately.

And the pandemic certainly hasn’t helped. The newest data from the CDC shows 16 states now have obesity rates of 35% or higher, which is an increase of four states: Delaware, Iowa, Ohio and Texas. To put that into perspective, in 2011, not a single state had reached the threshold of 35% obesity, and now, among the 16 at that level, a handful are close to 40%. obesity rates infographic

And, as with other issues in our country, the obesity epidemic seems to be hitting minority communities particularly hard. There are big racial differences in the impact of obesity: A separate CDC survey from 2017-2018 showed: 

  • Nearly half of all African Americans and 57% of African American women are obese. 
  • In the Latino population, the rate is nearly 45%, while among Caucasian adults the rate is 42%. 
  • Asian adults had the lowest rate at 17%.

Some studies also suggest that poverty and rates of obesity go hand-in-hand, as well. 

Even if you knew we had a bit of a problem in this country, those numbers are pretty shocking. And while there are a lot of factors that go into this obesity epidemic, the portion sizes that we find acceptable and normal seem to be getting bigger at the same rate that our waistlines do. 

Out-of-Proportion Portions 

It’s been made clear that the rising obesity rate is a problem in this country, and that there are probably multiple factors contributing to it. We’ve also been told that eating right – and not overeating – is one of the keys to maintaining a healthy weight. But it’s not always made clear that we’re actually consuming much, much bigger portions of things than we should be – or that we used to be.

So no, it’s not your imagination: the sizes of the packaged and fast foods that are for sale have been getting bigger and bigger, despite the fact that recommended serving sizes for these types of not-so-healthy food is certainly not getting any bigger. In fact, according to a recent report published in the American Journal of Public Health (AJPH), the size of packaged foods and fast food items in America has increased between two and five times the previous normal serving sizes when originally introduced, and those increases run directly parallel to the rise in obesity in this country. Not only that, but many products have not changed their sizes since 2002 recommendations that recommended they do so, with packages still up to five times bigger than they were previously.

cheeseburger and fries


You might be thinking that food companies are simply bowing to consumer pressure to give value for money, but the problem here goes beyond our wallets. In fact, if anything, these supersized portions are costing our country a whole lot of money in healthcare and lost wages for those who become ill because of excess weight. As the AJPH study points out, “To consumers, large portions may appear as a bargain, but they contain more calories and encourage overeating.”


And yes, the food industry is required to tell you on packaging what a “serving size” actually is, but that doesn’t seem to help much when the amount of food being sold is so far beyond that serving size. According to  Lisa Young, PhD, RDN, a lead researcher for the AJPH report, “Larger packaged portions lead to overeating because people pay little attention to the size of their portions, focusing instead on what they are eating. Research also shows that we eat more when presented with more food—even if we are not hungry and don’t like the food.”

Portions Matter

The processed and fast food industries definitely make it easy to overeat the things we really shouldn’t be overeating, but you might also be thinking: isn’t it really about moving our bodies more? And yes, exercise is incredibly important for our overall health and maintaining a healthy weight, but we’d like to add to the study above another, and far more surprising, study. According to Dr. Herman Pontzer, an evolutionary biologist, “Your brain is very, very, very good at matching how many calories you eat and how many calories you burn. The person who has a sedentary lifestyle and the person who has the active lifestyle will burn the same number of calories.”

He thinks that we are looking at our “body’s flexible metabolic engine,” which according to his research, constantly adjusts depending on what we eat and how much we move, in the wrong way, and that we cannot achieve the weight loss we want from exercise alone. According to him, the amount we consume just makes way more of an impact.

His theory comes from studying the Hadza people of Tanzania, hunter-gatherers who walk for miles every day looking for food, meaning they’re constantly in motion, and get more exercise in a day than most Americans do in a week. Pontzer and his colleagues were sure that would also mean that they burn a ton more calories than we do, but surprisingly, when the researchers measured how much energy the Hadza burned, it turned out to be the same amount as most of their more sedentary Western counterparts. 

The takeaway? While there’s some disagreement about how little exercise matters to weight loss, most research does point to the fact that what you eat and how much of it is really, really important. 

Portion Control

The authors of the AJPH study want to see things like price incentives for selling smaller portion sizes of ultra-processed foods, larger sizes discontinued, and even restrictions on marketing of large portions. But there are also ways that you can help yourself keep your portions sensible. Try:bag of chips open and some on a table

  • Buying single-serve items – You’re not too likely to reach for multiple, single-serve bags of chips!
  • Make your own snack packs – If buying bigger packages is better for your budget, try making your own single-serve packs.
  • Use smaller plates and bowls – It sounds silly, but the size of your plates and bowls really does make a difference! The bigger they are, the smaller your portion looks to you, and vice versa.
  • Do some measuring – You don’t have to go crazy weighing all of your food, but it is useful to know how much a cup serving size actually is.
  • Add more fruits and veggies into your diet – You don’t need to worry too much about how many fruits and veggies you’re eating, and the fiber in them will fill you up. Having trouble finding or affording the fresh stuff? Frozen or even canned is just as good. 
  • Take a beat – Before you snack, think. Studies show that thinking about your last meal and reviewing what you ate during the day (even keeping a food journal) helps you to consume fewer calories.
  • Drink more water – Studies have found that people who drink at least 2 glasses of water before meals can lose 30% more weight than those who don’t, so stay hydrated and keep yourself fuller!
  • Eat more protein – Getting enough protein in your diet can help to curb overeating. In fact, in one study, people who ate a low-protein diet reported feeling hungrier and ate 12% more calories throughout the day than those who consumed more of the muscle-building nutrient. This 12% could add up to an extra 2.2 pounds of weight gain per month, or more than 26 pounds a year.
  • Give yourself a hand – You can use a literal rule of thumb to remind yourself of portion sizes. A serving of fat should be about the size of your thumb, a true serving of rice or pasta is about the size of your fist, and lean meats should be about the size of your palm.

We’re living in a supersized world, and that can wreak havoc on our health and waistlines. But with a little bit of knowledge about portion sizes, eating the right foods in the right amounts, and getting the exercise we need, we can navigate it, and keep ourselves fit, healthy, and happy!

High Cholesterol Is More Common Than It Should Be

More likely than not, you know someone with high cholesterol, or maybe you have been diagnosed with it yourself: roughly 38% of American adults have been diagnosed with this condition – and even more might have it and not know, because there are no symptoms. It is important to get checked and to know your numbers, though, because high cholesterol puts you at risk for heart disease and stroke, two of the leading causes of death in America. In honor of September being National Cholesterol Education Month, we will discuss what different cholesterol levels mean, what is considered high, and how to help manage and lower your high cholesterol. 

What Is Cholesterol? molecular makeup of cholesterol

Cholesterol is a waxy, fatty substance that is produced naturally by your liver and found in your blood; it is also found in certain foods and animal products, and eating foods high in saturated fat and trans fat will raise the levels of cholesterol in your blood. While we might automatically think of all cholesterol as “bad,” it’s actually necessary for good health, because your body uses it for making hormones and digesting fatty foods; in addition, there are two types of cholesterol, one that is considered “good” and one that is considered “bad.” Having a higher “good” number is helpful, but having too much “bad” cholesterol in your blood is a problem, and puts you at risk for heart disease and stroke. There are no signs or symptoms of high cholesterol, so the only way to know if you have it is to get blood work done. 

Understanding Cholesterol Numbers

Cholesterol travels through the blood on proteins called lipoproteins. There are two types of lipoproteins:

  • LDL (low density lipoprotein), also known as “bad” cholesterol, because it builds up on the walls of your blood vessels in the form of plaque; this plaque makes your blood vessels narrower, meaning blood will have a harder time flowing to and from your heart, which is what causes heart attacks. So, if your LDL number is high, you are at greater risk for heart disease and stroke.
  • HDL (High-density lipoprotein), also known as “ good” cholesterol. Your body will absorb this type of cholesterol, carry it back to the liver, and flush it from the body. Having a higher HDL will help lower your risk for heart disease and stroke.

When you have a blood test to check your cholesterol levels, you will be presented with 4 numbers:

  1. Your bad cholesterol, or LDL, which should be less than 100 mg/dL
  2. Your good cholesterol, or HDL, which should be at least 50 mg/dL in women and 40 mg/dL in men. 
  3. Your total cholesterol number, which should be between 125 mg/dL and 200 mg/dL.
  4. Your triglycerides, which is a type of fat in the blood. Normal levels should be below 150 mg/dL.

According to the CDC, roughly 1 in 5 adolescents, and nearly 93 million U.S. adults aged 20 or older have total cholesterol levels higher than 200 mg/dL. Nearly 29 million adult Americans have total cholesterol levels higher than 240 mg/dL.

deep fried chicken wings
Eating deep fried foods can increase your cholesterol level.

What Causes High Cholesterol?

Everyone is at risk for developing high cholesterol, although your risk does go up with age; it can be caused by multiple factors, including your lifestyle and a genetic predisposition to high cholesterol, known as familial hypercholesterolemia. In many cases, though, your diet is the culprit: your body naturally produces all the bad cholesterol it needs, so eating foods high in certain fats  will cause your body to produce too much LDL cholesterol. The main dietary causes of high bad cholesterol include:

  • Not eating enough foods containing healthy fats– Healthy fats will help increase your good HDL cholesterol levels.
  • Eating foods containing unhealthy fats– Full-fat dairy products, butter, deep-fried foods, and baked goods such as biscuits and pastries are high in trans fats, which raise LDL levels.
  • Not eating enough foods containing fiber– Eating foods high in dietary fiber, like veggies, fruits, whole grains, nuts, and seeds can reduce the amount of bad cholesterol in your blood. 
  • Older age– The older you get, the harder it is for your body to clear cholesterol from your blood. 

Conditions That Increase Your Risk

Certain health conditions can increase your risk of high cholesterol, such as:

  • Type 2 diabetes– lowers your good cholesterol levels and raises bad cholesterol levels
  • Obesity– linked to higher LDL cholesterol levels, and lower HDL cholesterol levels

Prevention & Treatment of High Cholesterol

Getting your cholesterol levels checked is extremely important for catching and managing high bad cholesterol, since there are no symptoms of this condition. Everyone aged 20 or older should get tested every 5 years; if you have cardiovascular disease risk factors, you should get tested more often. 

If you do find out that your numbers are high, you can take steps to help lower your cholesterol levels, including:

  • Losing weight- Being overweight or obese raises bad cholesterol levels and lowers good cholesterol levels. Losing weight can help improve those numbers.
  • Eating a healthy diet– Limit foods high in saturated fat, such as full-fat dairy products, fatty meats like red meat, fried foods, butter, and coconut oil. Instead focus on eating plenty of vegetables, fruits, healthy protein sources such as fish, lentils, and nuts, avocados, low-fat milk, low-fat or fat-free dairy products, and foods high in fiber.legs of a woman in red workout pants tying her shoe lace of her sneaker
  • Exercising- A sedentary lifestyle will lower your good cholesterol levels. You should aim to do about 2 ½ hours a week of some type of aerobic exercise, such as walking, swimming, or biking.
  • Quitting smoking– Using tobacco products, including vaping, lowers your HDL cholesterol. By quitting, you can lower your LDL cholesterol and increase your HDL cholesterol levels. 

If you are unable to get your cholesterol numbers down through diet and exercise alone, you might need to take medications like statins to help manage your cholesterol, and lower your risk of heart disease. You will likely be prescribed medicine if:

  • You have already had a heart attack
  • Your LDL cholesterol level is 190 mg/dL or higher
  • You’re 40-75 years old and have diabetes

Be Prepared

Having the right health insurance plan means being able to get tested and treated for conditions like high cholesterol, without having to worry about  forking out a lot of money for medical bills. If you do not have health insurance, or your current plan is not sufficient for your needs or is too expensive, EZ can help. One of our highly trained agents will work with you to compare available plans in your area and will find the right one for your medical and financial needs. All of our services are free, so your focus can be on finding a great plan, not worrying about spending extra money. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890. No obligation and no hassle.