Can you be 'fat but fit'

It’s currently a trending hashtag but can you still be healthy even if you’re overweight so long as you’re fit?  

What you weigh might not be the only thing that plays a role in how healthy you are, but does carrying too much weight pack the biggest punch to your health status, or is it possible to ignore what you see on the scale and be #fatbutfit?

Scientists have swung both ways about whether you can be overweight but still fundamentally healthy, particularly if you exercise regularly. The most recent research points clearly in one direction but there are still a few things to consider. 

Worth the weight?

According to the latest science, the answer is no – you can’t bank on the fat-but-fit-is-okay theory. When Swedish researchers tracked more than 1.3 million 18 year old men for 29 years, they found that young men who were unfit but whose weight was in the ‘normal’ range were almost three times less likely to die early compared with obese but aerobically fit young men. 

These findings suggest that you are more likely to die early if you are obese than if you are unfit, but also that the positive effects of fitness don’t necessarily protect you when you’re carrying too much weight. 

It contradicts an earlier review, published in 2014, which not only found that unfit people had twice the risk of dying than fit people regardless of their BMI, but that overweight and obese people who were physically fit were no more likely to die early than normal-weight fit people. In other words, in this study, fitness played a bigger role in determining someone’s risk of dying than their BMI.  

Confused? Here’s what you need to know

First up, it’s worth noting that the studies mentioned above relied on body mass index (BMI) to decide normal weight, overweight and obesity – and more and more experts acknowledge that it’s a probably a flawed measure. So use it to decide the ‘fat but fit’ argument, and the answer could go either way. 

Calculated using a weight-to-height comparison, not only does BMI fail to take body composition into account, but a 2016 study found that up to 50 per cent of people who were considered overweight according to their BMIs were actually ‘metabolically’ healthy and 30 per cent of people with normal-range BMIs were metabolically unhealthy, once other metabolism and health markers such as blood pressure and cholesterol were measured.  
person about to measure waist
That supports the idea that you can’t always use weight alone to pinpoint how healthy you are as other factors are likely to play a role in your overall health too. In fact, Canadian scientists found that being metabolically unhealthy, for example having high cholesterol and blood pressure, leads to an increased risk of dying or having a heart attack, regardless of your BMI. However, the review also found that obese, metabolically healthy people are at a greater risk of dying earlier, compared to normal-weight metabolically healthy people, backing up the idea that weight may matter most.  

So, what to do? 

One idea is to keep a close eye on your waist-to-height ratio, regardless of how much you weigh or how fit you are – or aren’t. It may be a better predictor of heart disease, diabetes risk and life expectancy in some people than BMI, because it’s a measure of internal abdominal fat, the kind that affects organs like the heart, liver and kidneys more than the fat found elsewhere on the body.  

So, while the jury might remain divided about whether you can be fat but fit, having a high waist-to-height ratio, regardless of fitness, seems to be a sign you need to take action. 

To find your waist-height ratio, use our tool here or go old school and divide your waist measurement (in centimetres) by your height (in centimetres). Aim for a ratio that’s less than 0.5, which means your waist circumference is less than half your height. 
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