Is it possible to be fat but healthy?

Is it possible to be fat but healthy?

New York Times Article

Can you be fit and healthy, even if you’re overweight? And will working out, despite the extra pounds, reduce your risk of a heart attack?

The idea that you can be “fat but fit” has long been controversial. While health experts endorse physical activity as beneficial, many doctors view the concept of being “fat but fit” with suspicion.

Now a massive new study, believed to be the largest of its kind, suggests that even when overweight or obese people are free of health complications, they are still more likely to develop heart disease than their peers who aren’t overweight.

It didn’t matter whether obese people were free from diabetes, high blood pressure or high cholesterol, a condition sometimes referred to as “metabolically healthy obesity.” As long as they were obese, they were at modestly higher risk for having a stroke, at nearly 50 percent greater risk of coronary heart disease and had nearly double the risk of developing heart failure than people who were not overweight and in similar metabolic health.

People who were metabolically healthy but considered merely overweight were at a 30 percent greater risk of coronary heart disease compared to their normal weight and metabolically healthy peers.

“The bottom line is that metabolically healthy obesity doesn’t exist,” said Dr. Rishi Caleyachetty, of the College of Medical and Dental Sciences at the University of Birmingham in England, who was the lead author of the paper, published in the Journal of the American College of Cardiology. “Obesity is not a benign condition.”

But critics say the analysis, based on the electronic health records of 3.5 million British patients who were followed from 1995 to 2015, leaves a lot out. Doctors’ records don’t typically capture lifestyle habits, so the study fails to account for the wide-ranging effects of diet. They classify weight status by using body mass index, a formula based on height and weight that doesn’t distinguish muscle from fat. Most important, critics say, such analyses don’t take fitness level or physical activity into account.

Other studies have found a higher rate of heart failure among obese individuals, said Dr. Carl Lavie, the medical director of cardiac rehabilitation and preventive cardiology at the John Ochsner Heart and Vascular Institute in New Orleans. But when it comes to coronary heart disease outcomes, studies that take both weight and physical fitness into account have concluded that “fitness is more important than fatness,” at least for the moderately obese, he said.

“For the very large number of people who are overweight or mildly obese, I don’t think it’s doomsday if they can keep themselves out of the low fitness level,” Dr. Lavie said.

Dr. Caleyachetty, the author of the new paper, agreed that the lack of information about fitness and exercise was “an important caveat.”

“Those people who are metabolically healthy, obese and vigorously active may have a decreased risk of developing cardiovascular disease,” he conceded.

Critics say that’s an important message to convey, because many people will find it easier to embark on an exercise regimen and stick with it than to lose weight and maintain the weight loss.

“I do think that’s a better message than telling people, ‘You better not gain weight,’” Dr. Lavie said. “People aren’t trying to gain weight. They’re not trying to get to be obese. A better message would be to tell people that if they get themselves to be more physically active, they can improve their prognosis, despite carrying a few extra pounds. That’s a better message, and a more obtainable message.”

But Jennifer W. Bea, an assistant professor of medicine at the University of Arizona Cancer Center who was a co-author of an editorial accompanying the new study, said, “we haven’t heard the whole story yet” and questioned whether someone can be obese but “metabolically healthy.”

“Obesity itself is a metabolic disorder,” Dr. Bea said, noting that being overweight and obese is often associated with low-grade inflammation that may contribute to cardiovascular disease, regardless of metabolic measures.

That doesn’t mean that weight trumps all. Indeed, the study found that individuals who were considered to be of normal weight but who had a single risk factor such as diabetes, high blood pressure or high cholesterol were actually at greater risk for coronary heart disease than the healthy obese people.

“The messaging is always, ‘lose weight no matter what,’” said Patrick Bradshaw, an epidemiologist at the School of Public Health at the University of California, Berkeley. “But when you’re at normal weight, you’re not given a lot of lifestyle guidance. Your doctor may say ‘exercise and eat right,’ but if you have these metabolic abnormalities you’re at higher risk of disease, and you may need more intensive lifestyle modifications — not to lose weight, but to improve health.”

One of the messages of this new paper “is that metabolic health is important regardless of your weight,” Dr. Bradshaw said.

That goes for people who are considered underweight as well. The new study found, for example, that underweight individuals with no metabolic problems were at higher risk for stroke than normal weight, overweight or obese people with no metabolic problems, and if underweight people had metabolic issues, their risk increased even further.

Interestingly, while the risks of being overweight and obese draw scrutiny, doctors are often at a loss to explain the risks of being too thin.

(Ref: Front Endocrinol (Lausanne). 2014; 5: 121. Published online 2014 Jul 30. Prepublished online 2014 Jun 3. doi:  10.3389/fendo.2014.00121 How Much Should We Weigh for a Long and Healthy Life Span? The Need to Reconcile Caloric Restriction versus Longevity with Body Mass Index versus Mortality Data Antonello Lorenzini1,)

Being overweight costs more

People who are obese have higher demands for medical care than those of the normal weight people. However, in view of their shorter life expectancy, it is unclear whether obese people have higher lifetime medical expenditure. Researchers examined the association between body mass index, life expectancy and lifetime medical expenditure. The 41 965 participants aged 40–79 years.

In spite of their shorter life expectancy, obese participants might require higher medical expenditure than normal weight participants. In men aged 40 years, multiadjusted life expectancy for those who were obese participants was 41.4 years (95% CI 38.28 to 44.70), which was 1.7 years non-significantly shorter than that for normal weight participants (p=0.3184). Multi-adjusted lifetime medical expenditure for obese participants was £112 858.9 (94 954.1–131 840.9), being 14.7% non-significantly higher than that for normal weight participants (p=0.1141). In women aged 40 years, multiadjusted life expectancy for those who were obese participants was 49.2 years (46.14–52.59), which was 3.1 years non-significantly shorter than for normal weight participants (p=0.0724), and multiadjusted lifetime medical expenditure was £137 765.9 (123 672.9–152 970.2), being 21.6% significantly higher (p=0.0005).

According to the research, lifetime medical expenditure might appear to be higher for obese participants, despite their short life expectancy. With weight control, more people would enjoy their longevity with lower demands for medical care.

Excessive Running – Is it bad?

There is a growing pile of studies claiming that excessive running is bad for health. The latest one, published in this month's Journal of the American College of Cardiology, should be taken with just as big a grain of salt as the others. Researchers in Denmark set out to discover what too much running might do to the heart.

"Long-term excessive exercise may be associated with coronary artery calcification, diastolic dysfunction and large artery wall stiffening," lead author Dr. Peter Schnohr of Copenhagen's Frederiksberg Hospital wrote in the study.

Based on data from the Copenhagen Heart Study, the researchers concluded that people who ran faster than 11 kilometres per hour (what they termed "strenuous jogging") for more than four hours a week had no difference in their mortality rates than sedentary people. In other words, running harder and more frequently won't make you live any longer than a couch potato, the study concludes. However, jogging at a slower pace for less time each week, researchers found, vastly decreased a person's mortality risk.

"The dose of running that was most favourable for reducing mortality was jogging 1 to 1.4 hours per week, with no more than three running days per week, at a slow or average pace ," the authors write. Such runners were found to be 78 per cent less likely to die than sedentary people.

"If your goal is to decrease risk of death and improve life expectancy, jogging a few times a week at a moderate pace is a good strategy," Dr. Schnohr writes. "Anything more is not just unnecessary, it may be harmful."

As with all such previous studies, it's worth delving in to the data before we decide there's no point going for a run today. Danish researchers followed 1,098 healthy joggers and 3,950 people who do not jog for nearly a decade. At the end of that period, 28 of the runners had died while 128 of the people who did not run passed away.

A number of problems in the design of the study and its conclusion were raised in an accompanying editorial written by Duck-chul Lee, a kinesiologist at Iowa State University, who did not participate in the study. These problems are as follows: The study only looked at white people between the ages of 20 and 93; it did not take into account other forms of exercise, which seems like a pretty huge oversight; it also relied on participants to self-report, which could lead to bias or error; and, finally, having only 127 strenuous joggers in the study may not have provided a large enough sample size to accurately determine mortality risk.

"Further studies are needed to better evaluate this controversial issue," the editorial says. "Ideally these studies will be well-controlled interventions, because we certainly agree that the goal is not to unnecessarily frighten people who wish to participate in more strenuous exercise."

There's surely a point at which too much running becomes bad for your health by damaging the heart, but no study has yet to find it conclusively.

The contra-argument

The study simply had no statistical power to detect differences between the jogging groups. Although there were 128 deaths among the 413 non-joggers there were only 17 deaths in all the 1,098 joggers, including only 2 deaths among the 36 strenuous joggers. The authors calculated that those 2 deaths represented a two-fold increase in risk for the strenuous joggers compared to the non-joggers, but the enormous confidence interval, ranging from less than half the risk to an 8-fold increase, illustrates the futility of obtaining any sort of reasonable estimate of risk based on so few data points. Quite simply, there's just no way to estimate the comparative effect of strenuous jogging with no jogging based on the data in this study.

Running protects the brain

Neurogenesis might influence oligodendrogenesis and selectively instruct myelination in the mammalian brain. Running exercise could induce neurogenesis and protect the myelin sheaths in the dentate gyrus of AD mice. It is unclear whether running exercise could protect the myelin sheaths in the absence of neurogenesis in the hippocampus of AD mice.

Six-month-old male APP/PS1 transgenic mice were randomly assigned to a control group (Tg control) or a running group (Tg runner), and age-matched non-transgenic littermates were used as a wild-type group (WT control). The Tg runner mice were subjected to a running protocol for four months. The behaviors of the mice in the three groups were then assessed using the Morris water maze, and related quantitative parameters of the myelin sheaths within the CA1 field were investigated using unbiased stereological and electron microscopy techniques.

Learning and spatial memory performance, CA1 volume, the volumes of the myelinated fibers, and myelin sheaths in the CA1 field were all significantly worse in the Tg control mice than in the WT control mice. Learning and spatial memory performance, CA1 volume and the volume of the myelin sheaths in the CA1 field were all significantly greater in the Tg runner mice than in the Tg control mice.

These results indicated that there were demyelinating lesions in the CA1 field of Alzheimer's disease (AD) mice and that running exercise could protect against myelin sheath degeneration in the absence of neurogenesis, thereby reducing CA1 atrophy and delaying the onset and progression of AD.

Bodybuilding and Longevity – An Opinion by Austin Gill

Bodybuilding has changed a lot during its short life, but the motivation behind it hasn’t. Bodybuilding is all about the gain train. We lift to look good, to be strong, and because we like it - health is an afterthought. But society has become increasingly health conscious. Within the past decade human lifespan and longevity have come to the forefront of health interest. We’re even seeing this interest work its way out of research environments and into specific activities, sports, and realms of fitness. Even bodybuilding.

This integration of fitness and longevity has presented an interesting complication, the two pursuits seem to contradict each other.

It’s as if there’s a fork in the road with one way leading to optimal performance and the other to optimal longevity. Does it have to be this way? Must we prioritize one over the other? Regardless, you chose bodybuilding - meathead. I’m totally with you. Muscles are legit, which is why I’m writing this article. So, let’s look at how bodybuilding, or muscle, affects your body, and attempt to answer whether or not the pursuit of gains can live in harmony with longevity.

The Physiology: What Happens to Your Body When You Lift, Bro?

First, what is Muscle? Muscle is bands of fibrous tissues in the body that control movement, and for a long time this is all we understood it to do. But within the last 20 years research has shown that muscle also functions as an endocrine system - it regulates the function of other cells and tissues by releasing hormones and myokines. Myokines are cytokines produced by the muscle. Cytokines are tiny proteins that send signals or commands to other cells around your body. When you bodybuild / resistance train / weight lift you are telling your muscles to release even more of these signals. What then is muscle signalling your body to do? And do we want more or less of it? Answering these questions will reveal the health benefits or consequences of lifting.

Boost Fat Oxidation

Muscle is the primary regulator of leanness.

Resistance training releases the myokine Interleukin (IL)-6, which increases fat oxidation within skeletal muscle via AMPK phosphorylation - it forces your body to burn fat for energy. Lifting also depletes your muscle glycogen stores and increases glucose uptake and glucose transporters so sugars are better utilized and less likely to be converted into fat.

This restores insulin sensitivity and glucose metabolism function leading to further reduction in fat mass over time. All of which lowers your chances of becoming obese and developing fat related diseases such as type 2 diabetes. Reduced fat mass also improves leptin (satiety hormone) and ghrelin (hunger hormone) regulation. This helps your body determine how much food it needs and protect you against over eating. You’re now better able to burn fat less likely to store it, can efficiently utilize energy because your metabolism has improved, and consequently have less inflammation, which brings me to my next point.

Lower Chronic Inflammation (The Bad Kid)

Chronic inflammation is systemic (all throughout your body) and raises your metabolic disease risk. Muscle plays a vital role in the fight against chronic inflammation by releasing IL-6, which is accelerated when you lift. IL-6 is especially unique because in addition to regulating cells and tissues, it appears to also regulate other cytokines. In the presence of IL-6 inflammatory cytokines such as IL-1b and TNF-alpha decrease, and anti-inflammatory cytokines IL-10 and IL-1ra increase. A deadly combo for chronic inflammation.

Resistance training also causes acute inflammation via release of IL-8 and other cytokines that attract cells called neutrophils to the area for repair. This type of inflammation is isolated to specific areas and is good for your body.

Lastly, resistance training also lowers plasma levels of C-reactive protein (CRP), an inflammatory substance released by the liver that’s considered a reliable marker of disease risk. Low inflammation makes you feel and perform better, and also protects your body against against oxidative stress, ultimately slowing the process of aging.

Improve Brain Function

Lifting raises Brain Derived Neurotrophic Factor (BDNF), which is crucial for neurogenesis (the creation of new brain cells) and improves learning, memory, and higher thinking. The dumb jock really is a myth. Furthermore, exercise of all kinds has been proven to prevent cognitive decline and neurodegenerative disease, slow brain aging, and increases brain size & memory.

Improve Bone Density

Resistance training improves bone density, protecting against osteoporosis. Denser bones means less injury, which leads to healthier aging. While this is important for both sexes, women suffer higher rates of osteoporosis and thus lifting should never be restricted to men.

Lengthen Telomeres

Telomeres are protective caps at the end of DNA strands that facilitate cell division, which is how your body replaces and repairs old or worn out cells. This is a basic function of life. Each time a cell divides, telomeres become shorter. When they get too short cells can no longer divide, this is called senescence, or cell death. This process of telomere shortening is associated with aging, disease, cancer, and higher risk of death, so much so that telomeres have been likened to a bomb fuse. The good news is that there are ways to reverse the process and lengthen telomeres, resistance training is one of them.

Grow & Preserve Muscle

Muscle naturally deteriorates as we age, a condition known as sarcopenia. Weight lifting fights this by releasing growth hormone and testosterone. Resistance training also releases other growth factors such as IL-15 that decreases protein degradation and mTOR - this is where the gains come from.

The cytokine interleukin-15 (IL-15) has been demonstrated to have anabolic effects in cell culture systems. Researchers tested the hypothesis that IL-15 is predominantly expressed by type 2 skeletal muscle fibres, and that resistance exercise regulates IL-15 expression in muscle. Triceps brachii, vastus lateralis quadriceps and soleus muscle biopsies were obtained from normally physically active, healthy, young male volunteers (n= 14), because these muscles are characterized by having different fibre-type compositions.

In addition, healthy, normally physically active male subjects (n= 8) not involved in any kind of resistance exercise underwent a heavy resistance exercise protocol that stimulated the vastus lateralis muscle and biopsies were obtained from this muscle pre-exercise as well as 6, 24 and 48 h post-exercise. IL-15 mRNA levels were twofold higher in the triceps (type 2 fibre dominance) compared with the soleus muscle (type 1 fibre dominance), but Western blotting and immunohistochemistry revealed that muscle IL-15 protein content did not differ between triceps brachii, quadriceps and soleus muscles.

Following resistance exercise, IL-15 mRNA levels were up-regulated twofold at 24 h of recovery without any changes in muscle IL-15 protein content or plasma IL-15 at any of the investigated time points. In conclusion, IL-15 mRNA level is enhanced in skeletal muscles dominated by type 2 fibres and resistance exercise induces increased muscular IL-15 mRNA levels. 

The Paradox: Growth Simultaneously Slows and Accelerates Aging

We’ve learned that muscle, specifically strength, is good for maintaining mobility and avoiding injury as you age; that muscle mass keeps you lean; exercise lowers chronic inflammation; lifting improves brain function and bone density; and resistance training lengthens telomeres - all incredible benefits that are essential for healthy aging.

On the other hand, the very same pathways required for growth and these results also accelerate aging and increase your susceptibility to age related diseases. The answer lies in alternating periods of growth with periods of rest and repair; anabolism with catabolism; creation with destruction. Healthy aging demands both.

How to Bodybuild for Longevity, a Dual Sided Approach.

Step 1: Properly Manage Growth

Growth is great - as long as you do it right.


Stay Natural

Performance enhancing drugs (PEDs), anabolic steroids, and exogenous hormones can down regulate your body’s natural hormone production over time. Inhibiting your body’s ability to naturally perform necessary functions will damage your health and shorten your lifespan.

Speaking of supplements, don’t overdo it. Taking 10 times the prescribed amount can lead to liver toxicity and over stimulation. It’s also best to get advice from a naturopath before taking supplements.

Avoid Injuries

You want to be the strongest dude around, and definitely can’t be outdone by your workout buddy. So, you go too heavy too soon and perform reps with improper form putting excessive strain on your skeletal structure and tendons because your muscles aren’t yet developed enough to handle the load, and you get injured.

Injuries shorten life.

Check your ego. If you can’t lift it with perfect form, it’s too heavy.

Learn Proper Nutrition

Body builders and weight lifters tend to be more nutritionally aware than “cardio-ers”, but there are still a lot of misconceptions floating around.

For starters, if you’re fat you aren’t doing it right. Leanness matters.

Protein Requirement When You Lift

The consumption of a high protein diet (>4 g/kg/d) in trained men and women who did not alter their exercise program has been previously shown to have no significant effect on body composition. Thus, the purpose of a recent study was to determine if a high protein diet in conjunction with a periodized heavy resistance training program would affect indices of body composition, performance and health.

Forty-eight healthy resistance-trained men and women completed this study (mean ± SD; Normal Protein group : 24.8 ± 6.9 yr; 174.0 ± 9.5 cm height; 74.7 ± 9.6 kg body weight; 2.4 ± 1.7 yr of training; High Protein group : 22.9 ± 3.1 yr; 172.3 ± 7.7 cm; 74.3 ± 12.4 kg; 4.9 ± 4.1 yr of training). Moreover, all subjects participated in a split-routine, periodized heavy resistance-training program. Training and daily diet logs were kept by each subject. Subjects in the NP and HP groups were instructed to consume their baseline (~2 g/kg/d) and >3 g/kg/d of dietary protein, respectively.

Subjects in the NP and HP groups consumed 2.3 and 3.4 g/kg/day of dietary protein during the treatment period. The NP group consumed significantly (p < 0.05) more protein during the treatment period compared to their baseline intake. The HP group consumed more (p < 0.05) total energy and protein during the treatment period compared to their baseline intake. Furthermore, the HP group consumed significantly more (p < 0.05) total calories and protein compared to the NP group. There were significant time by group (p ≤ 0.05) changes in body weight (change: +1.3 ± 1.3 kg NP, −0.1 ± 2.5 HP), fat mass (change: −0.3 ± 2.2 kg NP, −1.7 ± 2.3 HP), and % body fat (change: −0.7 ± 2.8 NP, −2.4 ± 2.9 HP). The NP group gained significantly more body weight than the HP group; however, the HP group experienced a greater decrease in fat mass and % body fat. There was a significant time effect for FFM; however, there was a non-significant time by group effect for FFM (change: +1.5 ± 1.8 NP, +1.5 ± 2.2 HP). Furthermore, a significant time effect (p ≤ 0.05) was seen in both groups vis a vis improvements in maximal strength (i.e., 1-RM squat and bench) vertical jump and pull-ups; however, there were no significant time by group effects (p ≥ 0.05) for all exercise performance measures. Additionally, there were no changes in any of the blood parameters (i.e., basic metabolic panel).

The researchers found that consuming a high protein diet (3.4 g/kg/d) in conjunction with a heavy resistance-training program may confer benefits with regards to body composition. Furthermore, there is no evidence that consuming a high protein diet has any deleterious effects.

Beware of Overtraining

The term ‘rest day’ is often used by gym goers as an essential component to working out. Research seems to support this.

In an interesting earlier study, researchers looked at the psychological and physiological condition of athletes affect both their performance in competitions and their health. Rugby is an intense sport which appears to impose psychological and physiological stress on players. However, there have been few studies of the most appropriate resting techniques to deliver effective recovery from a match.

Scientists compared the difference in recovery after a match using resting techniques with or without exercise.

Fifteen Japanese college rugby football players were studied. Seven performed only normal daily activities and eight performed additional low intensity exercise during the post-match rest period. Players were examined just before and immediately after the match and one and two days after the match. Blood biochemistry and two neutrophil functions, phagocytic activity and oxidative burst, were measured to assess physiological condition, and the profile of mood states (POMS) scores were examined to evaluate psychological condition.

Immediately after the match, muscle damage, decreases in neutrophil functions, and mental fatigue were observed in both groups. Muscle damage and neutrophil functions recovered with time almost equally in the two groups, but the POMS scores were significantly decreased only in subjects in the low intensity exercise group.

Rugby matches impose both physiological and psychological stress on players. The addition of low intensity exercise to the rest period did not adversely affect physiological recovery and had a significantly beneficial effect on psychological recovery by enhancing relaxation.

What this means is you shouldn’t spend ‘rest days’ on the couch. Instead, hit the pool and do some laps, while showing off the hot body you have from hitting the gym.

Balance to Your Routine

Try not to focus on muscle building at the expense of joint and tendon care, and cardio respiratory exercise. I know, cardio. I’m not saying you have to jog every day but try to incorporate at least on day of HIIT (sprints) with jump rope, hill sprints, cycle sprints, sprint swimming - there’s lots of options. Besides HIIT is better for your heart than traditional cardio with the added benefit of accelerating fat oxidation. And add two or three days of mobility training to your weekly routine - maintaining mobility is increasingly important as you age.

None of this stuff works in isolation, and none of the benefits are permanent.

But if you keep lifting you'll keep your muscle. And if you keep fasting you'll slow aging. Consistently alternate periods of growth with periods of rest and repair, and you may just extend your healthy years beyond what you ever thought could be possible.

Testosterone predicts death

Elderly men who initiate hemodialysis in Taoyuan General Hospital from January 2012 to June 2017 were enrolled in a recent study. Researchers reviewed clinical characteristics and biochemical data from start of dialysis and followed over a 5-year period after dialysis. Body composition parameters were assessed 3-6 months after dialysis. Skeletal muscle mass index (SMMI) was defined by skeletal muscle mass divided by squared height. We defined those with lowest tertile of testosterone values as low testosterone group. Adjusted hazard ratios (aHRs) and 95% confidence interval (95% CI) for mortality and cumulative survival curves were evaluated by Cox hazards model and Kaplan-Meier method. The discriminative power of SMMI and testosterone levels was calculated according to the area under the curve and the receiver operating characteristic curve (AUROC).

From a total of 137 elderly hemodialysis patients, the range of lowest, middle, and highest tertile of testosterone values was <6.25 nmol/L, 6.25-10.5 nmol/L, and >10.5 nmol/L. After multivariate adjustment other than SMMI, total testosterone levels at baseline were a significant predictor for mortality aHR(95% CI): 0.79 (0.70-0.91). The unadjusted and adjusted c-statistics of SMMI vs testosterone values to predict overall were 770 (0.688-0.852) vs 0.779 (0.691-0.866) and 855 (0.812-0.886) vs 0.812 (0.744-0.856) (Ps < .05), whereas the capacity of c-statistics was similar (χ2 = 0.143 and 2.709, Ps > .05).

Total testosterone value was a predictor for mortality. It was superior to SMMI in predicting dialysis mortality.

Double Trouble

Testosterone deficiency (TD, total testosterone ≤350 ng/dL ) and obesity epidemic are growing in parallel in the United States. Yet, the sequelae of TD and obesity on the risk of mortality remain unclear.

To investigate whether the co-occurrence of TD and overall obesity (body mass index ≥30 kg/m2 ), and abdominal obesity (waist circumference ≥102 cm), is associated with a risk of all-cause mortality in American men.

The data were obtained from the NHANES 1999-2004 and the Linked Mortality File (December 31, 2011). A total of 948 participants aged ≥20 years old with endogenous sex hormones and adiposity measurements data were included in this study.

Over a median of 9.5 years of follow-up, 142 men died of any cause in this cohort. Multivariable analysis showed a 2.60 fold increased risk of death among men with TD compared with men without TD (Hazard Ratio = 2.60; 95% confidence interval = 1.20-5.80). No evidence for interaction between TD and overall or abdominal obesity with risk of death (Pinteraction ≥ .80). However, only after comparing men with TD and abdominal obesity with men without TD and no abdominal obesity, we found a 3.30 fold increased risk of death (HR = 3.30, 95% CI = 1.21-8.71).

Men with co-occurrence of TD and abdominal obesity have a higher risk of mortality. The effect of co-occurrence of TD and abdominal obesity should be further explored with a larger and longer follow-up time study.

The bottom line

Don’t do things too extreme if you don’t want to live longer. Having said that, it is your choice if you want to be the biggest, muscly guy in town but be aware off the risk. Anything taken to the edge reduces longevity but by far, the worst exercise you can do is none at all.


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