Fatter but fitter

Contrary to conventional wisdom, becoming fit is more important to health than losing fat. A leading US cardiologist and fitness expert who made his first visit to Israel explains why.

Tel Aviv Marathon participants run the race in 2014 (photo credit: MAGEN DAVID ADOM)
Tel Aviv Marathon participants run the race in 2014
(photo credit: MAGEN DAVID ADOM)
Stand an overweight person next to a thin one; which one looks healthier? It’s not what you think.
Cardiologists, sports medicine experts and clinical dietitians have increasingly changed their tune about too many kilos being responsible for disease; instead of worrying just about overweight, be concerned with fitness, says Prof. Carl Lavie, a senior cardiologist and pioneering heart researcher at the John Ochsner Heart and Vascular Institute in New Orleans. The Louisiana physician especially shook things up when, after writing or co-authoring two medical textbooks and hundreds of journal articles, he published last year his first popular volume called The Obesity Paradox: When Thinner Means Sicker and Heavier Means Healthier. He recently made his first visit – three days – to Israel to attend the Fourth Israeli Conference on Exercise is Medicine for the Brain at Tel Aviv University.
“Most of us think that longevity hinges on maintaining a normal Body Mass Index [BMI, an adult’s weight in kilograms divided by the square of their height in meters]. But research conducted over the past decade has found that overweight and even moderately obese people with certain chronic diseases – from heart disease to cancer – often live longer and fare better than individuals with normal weight who have the same ailments,” Lavie wrote.
The book came out in hardcover in April 2014, followed by a Kindle (ebook), audio and soft-cover. It has received good reviews and continues to sell well, presenting the message of fitness to readers. “It shows that this topic is something of interest not only to doctors and scientists but also to the lay public.”
Cancer has been the number-one killer in Israel for several years, but in the largely unfit US, cardiovascular disease remains the leading cause of death. The reasons that heart problems kill a smaller proportion of Israelis than cancer can be attributed to numerous factors, including the healthful Mediterranean diet, genetics, family closeness and a highly accessible medical system.
In the US, an incredible 70 percent of the population are either overweight or obese – but more important is that in today’s digital, lazy age, Americans’ most common “exercise” is moving their fingers over touch screens, remote controls and keyboards.
“Three percent of Americans have a huge BMI of 40 or more. Lack of fitness is the strongest predictor of cardiovascular disease and even cancer and general survival. The fit are less likely to get breast cancer or color cancer.”
American’s health should be much better today than 100 years ago, as there are better medications for blood pressure, cholesterol and diabetes; stents and bypass surgery for diseased hearts and even less smoking. But these disorders still kill more than anything else, said Lavie.
Thin as well as very fit, Lavie runs and exercises regularly. Three of his four children are physicians or studying medicine, and his wife Bonnie is a former sports teacher- turned-housewife. He and his wife eat what is largely a Mediterranean diet.
“As I work on my medical papers and lectures at home, our children realized that nobody was forcing me to do it and that I loved it because it is so much fun. So even though they went to college and didn’t want to study medicine, eventually, most of them did.”
He conducts physiology tests, treats and rehabilitates and recommends preventive measures for patients at his Louisiana medical center and conducts research.
Lavie, whose widely used nickname is “Chip” because he inherited “Carl” from his father, could be mistaken for a Jew because his surname sounds Israeli, but in fact it is French, he told The Jerusalem Post in an interview. After graduating from Louisiana State University Medical School in 1983, he completed his internal medicine residency at Ochsner Medical Institutions. Then he went on to do a fellowship in cardiovascular diseases at the Mayo Graduate School of Medicine, where he joined the faculty in 1989. Today, Lavie holds works at Ochsner – owned by a foundation and including 10 non-profit hospitals – and the Ochsner Clinical School at The University of Queensland School of Medicine.
A professional review of his findings on fitness versus thinness created such a sensation that he was asked to give some 500 interviews, including for The New York Times, ABC News, The Wall Street Journal, WebMD.com and The Telegraph, within a few weeks.
One of the more memorable and emotional pieces he wrote was about his experience surviving and coping with the massive flood in New Orleans almost 10 years ago.
“My 550-bed hospital is above-sea. I was working on a busy inpatient and consultative service.”
He and his wife had been planning a long Labor Day weekend in Florida, where he was scheduled to give professional lectures.
Then came Hurricane Katrina. All electricity went out, the water became undrinkable, toilets didn’t flush and most of the phones went dead. The room he was in shook, and everything was covered with white dust, Lavie recalled.
He and his family were stuck in the hospital while he had to cope with primitive and chaotic conditions to treat patients injured in the catastrophe. Almost a million people were left homeless and jobless, but the Lavie home remained standing and suffered only minimal damage.
New Orleans is probably the “Fat Capital of the US” because of the obesity in the Hispanic community, even more than African- Americans.
“It’s probably a combination of poor diet, genetics and lack of physical activity. Many Hispanics are very obese and suffer from metabolic abnormality. The irony, however, is that they are less likely to suffer from cardiovascular disease than African-Americans and Caucasians, probably because some genes protect them,” Lavie said.
A lot of thin people are not healthy, he continued.
“They tend to have too little muscle. In fact, if you’re overweight, you develop some muscle because you have to carry yourself around. Muscle is good. When you lose weight, you lose muscle along with fat,” said Lavie. “I typically examine fat and muscle components in patients.”
Having never been here before, Lavie was “impressed when I went running late at night on the Tel Aviv beach and saw thousands of Israelis running, jogging, walking and playing volleyball. I was impressed by people still moving at that hour.”
Physical inactivity “is the greatest danger in the 21st century. For smokers, tobacco use is worse than physical inactivity, but most people are not smokers,” he noted. “Most people in the US don’t meet the minimum requirements for exercise. I recommend 150 minutes a week of moderate exercise or 75 minutes of vigorous physical activity. If not that, then people need 60 minutes a day of any kind of physical activity such as walking to your car from a few blocks away or going up a flight of stairs. Positive reinforcement and feedback such as that from smartphone apps can be helpful,” he said.
While more Americans are taking out subscriptions to gyms and buying home exercise equipment, only a minority of them actually go for a workout or do more with a treadmill, stationary bike or elliptical machine than hang their clothes on them, bemoaned Lavie.
“People complain they don’t have time, but just 30 minutes a day of fast walking is not a lot of time, and it meets requirements.”
Lavie doesn’t agree that running is potentially dangerous – unless you already have damaged joints.
“If you start running as a kid and keep going, I don’t think it causes problems. I have a paper coming out on this subject in The Mayo Clinic Proceedings; I found that runners get less arthritis and fewer hip replacements than those who haven’t been running. But these are retrospective studies.
It’s quite impossible to do a randomized, prospective study on running and orthopedic health, instructing some runners not run and non-runners to suddenly do it. So we can do only retrospective studies to see influences, so perhaps there is a selection bias.”
But it is clear, he added, that being sedentary and overweight can cause arthritis.
“Today, dogs in America don’t even have to be walked; there are devices that dispose of their excrement in the home. So the owners and the dogs get fat.”
Getting more healthy is not the reason for running a marathon.
“Runners have already gotten healthy with less exercise. If you run, you eat more.
It doesn’t make you healthier; it’s a challenge and enjoyable for those who like it.
The majority of people don’t have to run long distances,” advised Lavie. “About one out of 20 people who exercise is overdoing it.
He explained the science behind the obesity paradox and how to achieve maximum health rather than minimum weight. Lavie not only explained how extra fat provides additional fuel to help fight illness, he also argued that Americans and other Westerners have gotten so used to framing health issues in terms of obesity that they overlook other potential causes of disease.
The New Orleans cardiologist greatly values statins, the highly successful drugs given to lower cholesterol.
“I recommend them to most of my patients. They are wonderful drugs. But not everybody needs to be taking statins; it is for those who are at risk of cardiovascular conditions or who already have them.”
He does not believe that it should be included in a “polypill” that will include three blood pressure-lowering drugs and a statin to lower cholesterol.
“Prescribing one may mean over-treating those not at risk and under-treating those at risk. You have to look at the patient’s personal profile.”
He was pleased when a panel of experts recommended to the US Food and Drug Administration earlier this month approval of two injectable drugs to significantly lower cholesterol levels and help protect against heart attacks. One is generically named alirocumab and made by Sanofi and Regeneron, while the other, called evolocumab, is made by Amgen. They could soon become available to qualified American patients whose high lipid levels have not been lowered by oral drugs. But Lavie added that it has to be injected chronically and thus might not be popular except among those who are desperate for improvement. In any case, fitness contributes much to lowering cholesterol.
This is really the first generation of Americans who, because of the lack of fitness and obesity, will have shorter lives than their parents and grandparents, he said.
“If they are very stationary and overweight as they reach adulthood, they face big potential health problems. They have to learn to get up from their chairs and move,” he concluded.