Re: Fitness Over Thinness for Hearts

[Guest guest]

Hi folks:

The view that excess weight doesn't seem to matter for CVD does not

seem to make any sense at all in the context of the WUSTL study.

We know that people established on CRON (those studied in the WUSTL

study) are all quite (very?) slim. (WC/H ~= 0.38 - 0.42; BMI ~= 18 -

20; BF% ~= 6% - 10%). We also know that the WUSTL subjects' heart

disease risk ratings all dropped off the bottom of the charts as they

lost weight in response to their reduced caloric intakes.

So how are these two sets of data to be reconciled?

Rodney.

>

> By Rob Stein

>

> Being fit appears to be far more important than being thin for

decreasing

> the risk of heart disease, while the opposite seems to be the case

for

> diabetes, according to two new studies in women.

>

> One study of more than 900 women with chest pain found that those

who were

> unfit were much more likely to have a heart attack or stroke than

those who

> were overweight. But the other, a study of more than 37,000 healthy

nurses,

> found that being fit did little to reduce the huge risk that

overweight

> women face of developing diabetes.

>

> The new studies, published in today's Journal of the American

Medical

> Association, rekindled an intense debate over the relative risks and

> benefits of being overweight vs. thin, fit vs. unfit.

>

> " The public is going to throw up its hands in exasperation and

say: 'I

> can't get a straight story from you scientists. You're telling me

to lose

> weight. You're telling me to exercise. You're telling me that it

doesn't

> make any difference if I exercise. You're saying it doesn't make any

> difference to lose weight,' " said Arthur , an obesity expert

at

> Washington University. " But no one is really saying that. The real

answer

> is: 'You should do both.' "

>

> The seemingly conflicting findings may be the result of the

different

> diseases and populations of women that were studied, with weight

perhaps

> playing a greater role in diabetes and fitness possibly more

important for

> heart disease, and others said.

>

> " Although closely linked, they are different diseases, and it may

be the

> relative importance of different risk factors will vary between

them, " said

> Lawrence J. Cheskin, director of the s Hopkins Weight

Management Center.

> " The bottom line still is it would be wisest to assume that both

body weight

> and body fat distribution and fitness are risk factors for both

diabetes and

> heart disease. "

>

> With the number of Americans who are overweight and obese

increasing

> rapidly, public health authorities have been warning that the

nation is

> facing a major public health crisis. But some researchers have been

arguing

> that the health risks of being overweight have been exaggerated,

and that a

> growing body of evidence suggests that being sedentary and unfit is

a far

> greater problem.

>

> In the first new study, researchers examined 906 women

participating in the

> Women's Ischemia Syndrome Evaluation (WISE) study.

>

> On average, women who were deemed unfit based on their activity

levels were

> significantly more likely to have blocked arteries at the beginning

of the

> study and to go on to suffer a heart attack, stroke or some other

serious

> cardiovascular problem over the next four years, the researchers

found.

>

> Those who were overweight but relatively fit did not have a

significantly

> elevated risk once researchers accounted for other risk factors,

such as

> diabetes, high cholesterol or high blood pressure.

>

> " For this group of women, their fitness level was much more

important than

> their weight, " said R. Wessel of the University of Florida

College

> of Medicine in Gainesville, who led the research. " We wouldn't say

your

> weight doesn't matter -- obesity has been established as a known

risk factor

> for heart disease. But, at least for this group of women, their

fitness

> level mattered a whole lot more. "

>

> The findings indicate that people who are concerned about their

hearts need

> to make sure they are physically active, Wessel said.

>

> " You need to be out increasing your fitness level and getting back

in

> shape, not just dropping pounds, " Wessel said.

>

> Physical activity and fitness may decrease the risk for heart

disease

> through a variety of mechanisms, including lowering blood pressure

and

> cholesterol and reducing inflammation inside the body, he said.

>

> In the second study, a team led by Amy R. Weinstein of the Beth

Israel

> Deaconess Medical Center in Boston and colleagues studied 37,878

women in

> the Women's Health Study.

>

> Over an average of seven years, women who were overweight were

dramatically

> more likely to develop diabetes, with their fitness levels

appearing to

> affect that risk only minimally, the researchers found.

>

> " For diabetes, it looks like being fit does not counter the

increased risk

> of being overweight, " Weinstein said.

>

> But proponents of the importance of fitness over fatness said the

heart

> study supports emphasizing exercise because it is a much more

realistic goal

> for many people.

>

> " It is far easier to get a fat person fit then it is to get a fat

person

> thin, " said Glenn A. Gaesser, a professor of exercise physiology at

the

> University of Virginia. " That is really the bottom line. Trying to

lose

> weight and keep it off is, if not darn near impossible, then close

to it. "

[Guest guest]

It seems that much of the current debate on health is couched in terms of

what the " experts " think is possible in terms of behavior alterations.

I doubt anyone questions the obvious benefit of being fit and slender.

However since they don't expect that to be possible for any significant

population they look for easier more possible terminus that might save at

least a few souls.

I find distressing recent reports that more than 30% of children are

overweight. What does that say about their future?

One difficulty in evaluating the effects of being overweight may be due to

static and dynamic effects. Some amount of fat mass is useful in providing

energy during unavoidable fasts. Our fat cells are also involved in hormone

production. At a heavy but stable weight there is probably an imbalance in

these normal fat related hormone levels.

During periods of weight gain (at perhaps at levels of obesity) the fat mass

is unstable. Fat cells routinely burst triggering macrophage (clean-up)

activity. This chronic immune/inflammatory response can't be good for the

rest of our body.

This is a complex issue (doh) and I don't suggest it's as simple as just

these two mechanisms. It's truly a shame that we've been more successful at

meeting our energy needs than at understanding wellness.

JR

-----Original Message-----

From: Rodney [mailto:perspect1111@...]

Sent: Wednesday, September 08, 2004 8:53 AM

Subject: [ ] Re: Fitness Over Thinness for Hearts

Hi folks:

The view that excess weight doesn't seem to matter for CVD does not

seem to make any sense at all in the context of the WUSTL study.

We know that people established on CRON (those studied in the WUSTL

study) are all quite (very?) slim. (WC/H ~= 0.38 - 0.42; BMI ~= 18 -

20; BF% ~= 6% - 10%). We also know that the WUSTL subjects' heart

disease risk ratings all dropped off the bottom of the charts as they

lost weight in response to their reduced caloric intakes.

So how are these two sets of data to be reconciled?

Rodney.

>

> By Rob Stein

[Guest guest]

Hi folks:

Having not yet read the entire study, here are three suggestions as

to where the flaws (from our point of view) may turn out to be in

the 'exercise is more important than weight' discussion.

First, this study is not representative of a sample of the entire

postmenopausal female population. It was a study ONLY of those who

were already exhibiting clinical signs of heart disease, and what

happened to them in the near term thereafter. I can easily imagine

exercise, with its long-documented ability to reduce blood lipids in

the very short term (24 hours), could delay for a time the deposition

of even more plaque, and thereby the onset of CVD 'events' in the

period soon after symptoms first appeared. (Clinton's first heart

disease symptoms did not appear until very recently, and it has been

found, according to the reports I have read, that some of his key

arteries were/are 90% blocked. So it seems likely that many of the

women in this study may have been in a state of health similar to

Clinton's.) If so then the 'exercise benefit' demonstrated in this

study would only apply, in a very special way, to people soon to

experience a heart attack. But not necessarily to the rest of the

world, nor to avoiding hart attacks altogether.

The second issue possibly undermining the study's relevance for us

is: when the headlines say 'fitness' do they really mean fitness as

any of us here would understand it? I think not. Here is an extract

from the CNN.com article about this study:

" In addition to being measured for weight, the women were asked about

their ability to do common physical activities at home, work and at

leisure, such as climbing a flight of stairs, running a short

distance or walking around the block without stopping. "

I suppose I shouldn't laugh. But does not that quote (assuming it

does reflect what was measured in the study) provide a rather

different perspective as to what this study meant when it used the

term 'fitness'?

In other words, if you could walk around the block without stopping

for oxygen and a transfusion you were judged to be fit? We will have

to wait to see the entire study to know for sure. But I did not

invent that CNN quote above.

I have quoted here before from Dr Henry 's (and with a name

like that perhaps we should pay attention?) book: 'The Exercise

Myth', that " ... fitness has absolutely nothing to do with health. "

[ is/was a cardiologist at Cornell Medical Centre, NYC].

Another useful piece of information I got from that book that has

relevance here, is that people who get absolutely no exercise at all

(bedridden) very quickly succumb to all kinds of problems, including

heart disease. But 's principal claim was that a high

percentage of the benefits that can be obtained from exercise are

derived from simply pursuing a normal daily life, without doing any

of the things most of us here would think of when the word 'exercise'

is mentioned. In other words, above and beyond getting out of bed,

walking to the bathroom, kitchen, garage, etc., additional exercise

above that, he said, provided rapidly diminishing returns. As I have

said before, I am not saying is right. I don't know. I AM

saying that that is what he said. And he has some credentials.

The relevance of 's observations to this study may be that

those in this study with heart disease who couldn't get out of their

chair, let alone walk around the block, likely were classified as

unfit (NEAR-BEDRIDDEN) and fared less well than the group average.

While those who were able to walk around the block, and got 's

minumum amount of exercise, were considered 'fit' and did better. If

this is the case then no one should be surprised at the results. The

result is simply a function of the minimal exercise threshold to

which referred. But does it have any relevance for the

majority of us who neither have clogged arteries (hopefully) nor are

near-bedridden?

Third: Besides, might not the data be confounded by the possibility

that those who could not walk around the block, were unable to do so

simply because their heart disease was more advanced - their arteries

more blocked, cutting off more blood flow. The others, whose heart

disease was less advanced, and whose arteries were cutting off less

blood flow would be more capable of exercise. And obviously those

whose disease was less advanced would be expected to

experience 'events' later than those in whom the disease is more

advanced. So the higher event rate in the unfit group may merely

have reflected the declining ability to exercise with disease

progression, rather than demonstrating any particular merit to

exercise.

Of course we should wait to see the entire study before deciding

whether to consign it to the ash can.

Rodney.

>

> By Rob Stein

>

> Being fit appears to be far more important than being thin for

decreasing

> the risk of heart disease, while the opposite seems to be the case

for

> diabetes, according to two new studies in women.

>

> One study of more than 900 women with chest pain found that those

who were

> unfit were much more likely to have a heart attack or stroke than

those who

> were overweight. But the other, a study of more than 37,000 healthy

nurses,

> found that being fit did little to reduce the huge risk that

overweight

> women face of developing diabetes.

>

> The new studies, published in today's Journal of the American

Medical

> Association, rekindled an intense debate over the relative risks and

> benefits of being overweight vs. thin, fit vs. unfit.

>

> " The public is going to throw up its hands in exasperation and

say: 'I

> can't get a straight story from you scientists. You're telling me

to lose

> weight. You're telling me to exercise. You're telling me that it

doesn't

> make any difference if I exercise. You're saying it doesn't make any

> difference to lose weight,' " said Arthur , an obesity expert

at

> Washington University. " But no one is really saying that. The real

answer

> is: 'You should do both.' "

>

> The seemingly conflicting findings may be the result of the

different

> diseases and populations of women that were studied, with weight

perhaps

> playing a greater role in diabetes and fitness possibly more

important for

> heart disease, and others said.

>

> " Although closely linked, they are different diseases, and it may

be the

> relative importance of different risk factors will vary between

them, " said

> Lawrence J. Cheskin, director of the s Hopkins Weight

Management Center.

> " The bottom line still is it would be wisest to assume that both

body weight

> and body fat distribution and fitness are risk factors for both

diabetes and

> heart disease. "

>

> With the number of Americans who are overweight and obese

increasing

> rapidly, public health authorities have been warning that the

nation is

> facing a major public health crisis. But some researchers have been

arguing

> that the health risks of being overweight have been exaggerated,

and that a

> growing body of evidence suggests that being sedentary and unfit is

a far

> greater problem.

>

> In the first new study, researchers examined 906 women

participating in the

> Women's Ischemia Syndrome Evaluation (WISE) study.

>

> On average, women who were deemed unfit based on their activity

levels were

> significantly more likely to have blocked arteries at the beginning

of the

> study and to go on to suffer a heart attack, stroke or some other

serious

> cardiovascular problem over the next four years, the researchers

found.

>

> Those who were overweight but relatively fit did not have a

significantly

> elevated risk once researchers accounted for other risk factors,

such as

> diabetes, high cholesterol or high blood pressure.

>

> " For this group of women, their fitness level was much more

important than

> their weight, " said R. Wessel of the University of Florida

College

> of Medicine in Gainesville, who led the research. " We wouldn't say

your

> weight doesn't matter -- obesity has been established as a known

risk factor

> for heart disease. But, at least for this group of women, their

fitness

> level mattered a whole lot more. "

>

> The findings indicate that people who are concerned about their

hearts need

> to make sure they are physically active, Wessel said.

>

> " You need to be out increasing your fitness level and getting back

in

> shape, not just dropping pounds, " Wessel said.

>

> Physical activity and fitness may decrease the risk for heart

disease

> through a variety of mechanisms, including lowering blood pressure

and

> cholesterol and reducing inflammation inside the body, he said.

>

> In the second study, a team led by Amy R. Weinstein of the Beth

Israel

> Deaconess Medical Center in Boston and colleagues studied 37,878

women in

> the Women's Health Study.

>

> Over an average of seven years, women who were overweight were

dramatically

> more likely to develop diabetes, with their fitness levels

appearing to

> affect that risk only minimally, the researchers found.

>

> " For diabetes, it looks like being fit does not counter the

increased risk

> of being overweight, " Weinstein said.

>

> But proponents of the importance of fitness over fatness said the

heart

> study supports emphasizing exercise because it is a much more

realistic goal

> for many people.

>

> " It is far easier to get a fat person fit then it is to get a fat

person

> thin, " said Glenn A. Gaesser, a professor of exercise physiology at

the

> University of Virginia. " That is really the bottom line. Trying to

lose

> weight and keep it off is, if not darn near impossible, then close

to it. "

[Guest guest]

--- In , " Rodney " <perspect1111@y...>

wrote:

......

>

> We know that people established on CRON (those studied in the WUSTL

> study) are all quite (very?) slim. (WC/H ~= 0.38 - 0.42; BMI ~=

18 -

> 20; BF% ~= 6% - 10%). We also know that the WUSTL subjects' heart

> disease risk ratings all dropped off the bottom of the charts as

they

> lost weight in response to their reduced caloric intakes.

.....

Hi All,

Nit picker that I am:

No WC/H data were published in PNAS.

For the CRONers, controls, 15 men; three women, BMI was men 19.6,

25.9; 19.8, 26.

Body fat % was 6.7, 22.4; 18.8, 31.9.

Interestingly, for men the total/HDL cholesterol was 2.6, 4.5;

triglycerides/HDL was 0.8, 3.5; and fasting insulin was 1.4, 5.1.

Cheers, Al Pater.

[Guest guest]

--- In , " Rodney " <perspect1111@y...>

wrote:

> So how are these two sets of data to be reconciled?

In the version of this news item in my local paper, there was some

sort of statement that overweightness gained in later life was

unhealthy relative to fit women born in what I assume would be

politely termed a " large-framed " body.

Logan