Fat and Fit? Lean and Fit? Which Works?

"There is a general consensus out there that a fat person is basically a premature death waiting to happen."
"The only conclusion is that [the focus on weight] has not worked -- it literally, on a population level, has not worked. And it's insane to think it's going to work in the future if we just tried a little bit harder."
"It's far easier to get a fat person fit than it is to get a fat person slim."
"The lowest mortality rates of anyone in America are those considered overweight. So, people with a BMI of 25 to 30 have better prospective for longevity than people in the so-called normal weight or healthy weight range."
Dr.Glenn Gaesser, professor, exercise physiologist, Arizona State University, Phoenix

"At the population level, so-called metabolically healthy obesity is not a harmless condition and perhaps it is best not to use this term to describe an obese person, regardless of how many metabolic complications they have."
Dr.Rishi Caleyachetty, University of Birmingham, England

"I don't believe in the concept of the metabolically healthy obese."
"I think the fit, fat guy is not as healthy as the fit, lean guy."
Dr.Eric Ravussin, director, Nutritional Obesity Research Center, Pennington Biomedical Research Center, Baton Rouge, La.

Penn State

Dr. Gaesser of Arizona State University remains convinced that morbidly overweight people exposed to exercise regimens can reverse their future health prospects without dieting; focusing instead on becoming fit. It has been his experience, just as it has been every other scientist in the field of health science that simply put, diets don't work. They may have an initial pleasing effect in shedding some weight, but dieters tend to bound back to their original weight, proving that dieting in general is an exercise in futility.

On the other hand, he and Steven Blair, professor emeritus at University of South Carolina, pointed out in a paper published in Medicine & Science in Sports & Exercise that the cardiovascular system, lungs and muscle fitness can be viewed as a more instructive predictor of disease and death, than can obesity, and with exercise an improvement of significant proportions in those indexes can be achieved. Not that he suggests that the state of obesity is benign, simply that it can be substantially mitigated. "Nor do we contend that we should be complacent about obesity or ignore it"; rather, working toward fitness is a superior goal than struggling with weight loss, they aver. 

Apart from radical surgery, they point out with confidence, scant few other solutions serve to lose weight and to keep it that way, The annual probability of an obese individual managing to attain a "normal" body weight was about one in 210 for men and one in 124 for women over a follow-up of nine years' duration, according to a 2015 study published in the American Journal of Public Health. And for men with "morbid" obesity (a BMI of 40 or higher), those odds soared to one in 1,290, and one in 677 for women.

Weight cycling -- where huge amounts of of weight are lost and then regained can be dangerous. As weight is regained, fluctuations in blood pressure, heart rate and circulating levels of blood fats and insulin result, increasing the risk of a heart attack or stroke, according to studies. The risk of dying was lower for overweight than for normal weight adults according to one study in 2016 which made use of U.S. national health data, even though the data were adjusted for smoking and pre-existing conditions such as diabetes, cancer, cardiovascular disease, asthma and kidney disease.

Rohitshyokan.com

On the other hand, bypassing the dieting option and focusing instead on exercise with a goal to improving fitness -- blood pressure, blood fats and blood sugars improve and people realize a lesser risk of depression and anxiety. "They feel better and move around more", added Dr. Gaesser. "Their quality of life improves." He points to the inescapable reality of the great numbers of Americans who rely on diets to lose weight, despite which the obesity issue has continued to rise notably over that same period of decades where 25 to 50 percent of the population dieted.

Cardiorespiratory, or aerobic fitness, he insists, is the more successful route to take to achieve overall health fitness. Backing up their fit-fat hypothesis was a 2014 meta-analysis of close to 93,000 people, where it was found that those who are fit, whether of normal weight, overweight or obese status, ended up with similar survival rates whereas the unfit experienced twice the risk of dying from any cause during follow-up. "Fit individuals who are overweight or obese are not automatically at a higher risk for all-cause mortality", the study authors had written. Everyone, "including those unable to lose weight or maintain weight loss" might see comfort in that conclusion.

Generalhealthmagazine.com

The exercise regimen recommended was by no means unduly onerous, rather the recommendation was for regular, moderate physical activity, about 150 minutes of brisk walking or cycling weekly, whose effect seemed to diminish some of the negative consequences of obesity. On the other hand, a 2017 study viewing 3.5 million obese men and women discovered an increased risk of coronary artery disease and a doubled risk of heart failure in comparison to normal-weight men and women in follow-up checks five years later, including those who were initially "metabolically healthy".