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By Dr Dane Vishnubala MBBS PGCME MRCGP FHEA

The last few weeks has seen a flurry of media headlines. You may have seen it. “You can’t be fat and fit” they say.

When I read a headline like that, I never take the top line for granted. First, let us start with where this all came from. The research was carried out at Birmingham University and presented at the European Congress on Obesity in Porto, Portugal. To be clear, there is no published peer reviewed data yet that we have seen. Therefore it is difficult to really take a critical look and decide if we can agree with the media statements or not.

The headlines, however, do raise interesting questions and challenges about what we’ve thought for some time.

How was the research done?

The research was completed by analysing health records of 3.5 million adults from 1995- 2015. These patients were thought to be disease free and measures such as cholesterol, blood pressure and diabetic status were looked at. The patients were then tracked to see if they developed one of the following 4 diseases: Stroke, Coronary Heart Disease, Heart Failure or Peripheral Vascular Disease.

Fitness can be measured in different ways, but fitness in the physical sense was not measured here. My understanding is that the patients’ physical activity levels or results to assess cardio-respiratory fitness were not known. Therefore, the headlines may be misleading and potentially undo some of the hard work of many physical activity groups.

So what do we know?

Most people will hopefully agree with me when I say the consensus at the moment has generally been you can be fat and fit. There are however, many questions now raised. What is more important, being normal weight or being fit? Inactivity is currently a big problem in itself and we know that inactivity is an independent risk factor for the above diseases. Can we really, based on this, tell our patients to lose weight and that activity levels do not matter? Of course not. Let’s be clear though, in a perfect world we would be active and of healthy weight.

What conclusions can we really make?

  1. Being overweight or obese is likely to increase disease risk. (Not new information!)
  2. We need to see the published research to fully understand the study and make further critiques or recommendations.
  3. Perhaps we need to record patient physical activity levels across the board in future and see how that data correlates to disease. We do however know from a number of studies that it does prevent a number of diseases significantly. There are a number of validated tools, I use GPPAQ.

What lessons can we learn?

  1. Never take the headline message as given.
  2. Try and check where the source came from. If it is an actual published paper, read that first and make your own assessment!
  3. Many studies can have glaring flaws or issues that mean they do not really apply to us. We must be critical when reading published papers. Once we have decided it is good, ultimately the key question is: How does this information change our practice? If at all?

Key Points and questions

  1. How should we measure fitness?
  2. Is all obesity the same? Most papers suggest distribution is important as well as certain other genetic factors.
  3. Fat is metabolically active and is thought to contribute to systemic inflammation, which plays a key role in many chronic diseases. Physical activity helps to regulate and suppress this to some extent.

Our next webinar will be on the knee and cover – knee anatomy, examination and common problems and management.

Best wishes,

Dr Dane Vishnubala MBBS PGCME MRCGP FHEA
Active IQ Chief Medical Advisor
@danevishnubala

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