Obese and Healthy?
Some Obese People Don't Risk Heart Disease, Diabetes; Some Normal-Weight People Do
Exercise Cuts Risk Even Without Weight Loss continued...
On the other hand, being obese isn't healthy.
"Obesity is not fine," Landsberg warns. "In addition to
cardiovascular risk and diabetes risk there is arthritis risk, cancer risk -- a whole series
of unhealthy outcomes."
But Stefan says some obese people are in particular need of an intensive
lifestyle-change program. His team is now exploring the effects of such a
"At the moment, we see that the lifestyle intervention in general has
effects on reducing liver fat more than total body fat," he says. "Many
people stop the program because they are not happy with a body-weight decrease
of just a few kilograms. But the liver fat goes down very much, and their metabolism increases very much. They must realize this
has benefits. So it is important to tell people to stick with it, even if they
don't lose much weight."
Interestingly, not everyone gets the same benefit from the same amount of
"The most important factor is not how much you exercise, but what the
effect your exercise has in increasing your fitness," Stefan says. "It
looks like at the same level of exercise, some people increase their fitness
and others don't. It looks like there are fitness non-responders. And those
non-responders don't have that good an effect of exercise on liver
These "exercise non-responders" may need more exercise. Or they may
require diabetes drugs to get their risk factors
under control. Stefan and colleagues are testing these interventions in ongoing
"We are seeing fitness as the most important factor, and then on top of
that reduction of intake of carbs has a strong effect," he says. "So
far, our recommendations are increased physical activity, four hours per week
of moderate activity, and reduced carbs. We also recommend a reduced intake of
Reports on the Stefan and Wildman/Wylie-Rosett studies -- as well as an
editorial by Landsberg -- appear in the Aug. 11/25 issue of Archives of