FAT AND HAPPY — THE WAY WE WERE; SKINNY AND EMACIATED — THE WAY WE ARE

{“Fat and Skinny had a race…up and down the pillowcase…Fat fell down and broke his face…Skinny won the race.”} GMK, circa 1950s

I often wonder what experts in the field deem a greater health risk, being overweight or underweight.

Weighing too much is body-protective to a degree but can overburden the heart among other vital organs.

Weighing too little can prevent the organs from being overtaxed unless “too little” means emaciated. Then the organs ultimately can not survive.

Six of one and half-a-dozen of the other?

That of course opens several cans of worms.

As it happens, occupying either extreme on the weight spectrum is replete with consequence.

Overweight or obese people tempt fate with high levels of body fat which can act as a catalyst in the development of a host of serious health conditions including coronary heart disease, diabetes, high blood pressure, liver disease, gallbladder disease and even some cancers. Obese women are more prone to fertility problems and abnormal menstruation than women of a normal weight.

But the medical research record also reflects that being overweight does not in and of itself promote or define a health risk if one is metabolically fit meaning that insulin resistance, high cholesterol, high triglycerides and/or high blood pressure somehow fall within what is considered to be the normal range.

In a study published in the European Heart Journal no fewer than one-half of the obese subjects participating were determined to be “metabolically fit” and therefore thought to be at no greater risk than those of a normal weight to die of heart disease or cancer.

Those who were fat but fit had no higher risk of death than their metabolically healthy normal weight participant counterparts.

Because the issue of obesity is such a prominent one it sometimes obscures the very real medical travails of the underweight.

Being thin and unhealthy are not mutually exclusive.

Interestingly, the genetic predisposition to leanness could very well place one at a higher risk for diabetes than discernible, visible fat.

According to John Naish writing for dailymail.co.uk scientists have “discovered a ‘lean gene’ that puts thin men in danger of developing diabetes… [The gene,] IRS1, which keeps some people skinny, is linked to a raised risk of Type 2 diabetes and cardiovascular disease.”

The thinking is that men who have this gene which can ensure a certain slimness could deposit fat internally in dangerous places around the heart and liver.

And so how do we determine where we store fat?

We don’t. Gender and genetics do.

In a genetic study analyzing more than 75,000 people an international group of scientists spearheaded by Ruth Loos at the UK’s Medical Research Council found that the type of fat and where it’s stored is of paramount importance.

Fat deposited just under the skin does not markedly contribute to the development of metabolic disorders such as diabetes or heart problems. But fat build-up in deeper tissues and organs within muscle and embedded in the liver for example absolutely creates increased risk of contracting these diseases.

Women tend to store fat under the skin, while men are more likely to deposit it deeper in tissues.

And as for the genetic component, the researchers were able to identify one variant (out of more than 2.5 million candidate sites on the genome linked to body fat) which appears to predispose people to deposit so-called visceral fat rather than the more benign subcutaneous fat.

Loos explains that the gene found “causes an error such that it’s harder for these people to store fat under the skin. So the fat is stored elsewhere, around the organs and in muscle where it disturbs the normal function of these organs.”

The profound influence of this genetic abnormality on metabolics such as cholesterol and triglyceride levels as well as on insulin resistance startled the scientists.

Specifically even people with low body fat but who possessed this version of the gene consistently registered higher levels of blood cholesterol and were more apt to show some resistance to processing insulin, a red-flag precursor to the onset of diabetes.

The interrelationship between weight, body fat and disease is of critical importance and must be more deeply understood. Things are not always as they appear either on the inside or out.

And physical appearance in general in our society is vastly overrated.

What matters is not how you look, but how you feel and the latter is inextricably linked to good health.

Rather than standing on a soapbox and preaching moderation — noble pursuit that it may be — regularly-scheduled doctor’s appointments could probably do the trick.

For the fat and the skinny.

[Editor’s Note: This piece was written by Mr. Kaplan in November 2016.]