Your Weekly Checkup: Can You Be Fit and Fat?

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 


Like many Americans, I am overweight—not a lot, but I’d love to lose ten pounds from my pot belly. Despite exercising an hour each morning, my weight remains constant because to lose, I must combine diet with exercise, and I don’t do the former. Because I lift weights and work out on the treadmill, bike, and elliptical, I tell myself I am fat but fit.

Is that really true? Can I be overweight and not at increased risk for heart disease? A recently published study based on the electronic health records of 3.5 million British patients followed from 1995 to 2015 says no. Being overweight makes me 30% more likely to develop coronary heart disease (atherosclerosis) compared with normal weight individuals, despite the absence of other health issues. The study outcome challenges the belief that I can be metabolically healthy (no diabetes, elevated cholesterol, or high blood pressure), overweight, and not at increased risk, possibly because obesity is associated with inflammation, and the latter plays a role in the development of coronary heart disease. They conclude that there is no such thing as benign obesity. Importantly, the authors also found that normal weight individuals who had metabolic risk factors such as diabetes were also at increased risk for developing coronary heart disease, despite not being overweight.

Critics argue that the study, despite its size, has flaws and that fitness outweighs fatness, if the latter is not excessive. This is a crucial point because many people, like me, find it easier to exercise daily than to diet. A bad combination is to be sedentary and overweight. Being fit at least counteracts some of the risk of being fat.

The same study found that being too lean also has risks. Underweight individuals with no metabolic abnormalities were at higher risk for stroke than individuals who were at normal weight, overweight, or obese with no metabolic problems. The risk to underweight people with metabolic issues increases even further. Metabolic health is important regardless of weight.

So, what should you do? Lose weight, of course. If you cannot, be sure to treat metabolic abnormalities such as controlling blood pressure, reducing cholesterol, and keeping blood sugar normal. This will counter some of the risk from being overweight. And get off the couch! Run, walk, exercise any way you want. But do something!