Acing this test!
November 17, 2009 5:47 PM   Subscribe

Me = fat guy, annual health checks = "A" grade. What gives? Actual data inside, BP, LDL, HDL, Cholesterol etc, inside...

So, without a doubt I am obese, about 135kg/200lbs. (BMI at 40 this year). I have always struggled with weight, and pretty much spent 23 years fighting it. There is a lot of kanji in here I can't read.

The data is as follows, sorry it is so hard to read, couldn't find how to make tables in meta.

BP: 108/70_____128/86_____118/80
Kanji: 84_____84_____81
HbA1c: 4.7_____4.6_____X

Cholstr: 119_____122_____133
Kanji: 54_____79_____60
HDL-C: 50_____45_____42
LDL-C: 91_____87_____X

UricAcid: 6.9_____6.7_____6.5

Kanji: x_____x_____6.7
GOT(AST): 25_____25_____26
GPT(ALT): 23_____24_____34
y-GTP: 13_____13_____15
AL-P: 209_____195_____213

LDH: X_____X_____204
T-Bil x_____x_____0.6

I'm a bit unsure what I am doing "wrong" I guess. My diet is not fantastic, but sure better then it has been before. (In terms of carbs anyway). I cycle to/from work, but maybe i need more exercise (don't we always).

I recently threw in the towel on trying to get smaller, clearly I am not going to win. I have decided to go the other way, if I am to be big, I want to be big, meaning muscle, so I have started that instead. I feel really good about that though.

The only "*" I got was on Cholesterol, I guess they feel it is getting high. (Although, their guide says 150-219). Perhaps it is 'too low'. How can a fat guy have too low cholesterol?

Although I am aware that these checks are more for the health insurance to know what to charge the company, than they are about my health. But it feel peculiar to get "A" grade, when you get droned about how bad it is to be fat.

Amusingly, I seem to fit the profile for AD-37, but I get the feeling that's more fringe-science..

And yes, you are not my doctor. :)
posted by lundman to Health & Fitness (24 answers total)
BMI isn't a reliable indicator of anything.

As for the data--yeah, pretty much impossible to read, even if I were a doctor.
posted by dfriedman at 5:51 PM on November 17, 2009

You're not doing anything wrong if all of your blood readings are good.

Scale weight alone is not a good measure of health or fitness in an individual. Do what feels good and healthy for you; don't worry about your scale weight.
posted by Sidhedevil at 5:57 PM on November 17, 2009 [1 favorite]

Serum cholesterol is only one part of measuring "health", but it's the one most associated with heart attacks and strokes. Serum Cholesterol (which is what those tests are, other than BP) has little to do with body mass and composition. As you see, one can be obese and have great blood numbers; conversely, one can be skinny and have crap blood numbers. Many obese people do have crap blood numbers, but not all.

There are lots of other problems associated with obesity. Obesity with good blood numbers is more about overworking the heart and lungs from hauling the extra weight around, and joint and bone problems (knees, hips, spine). Also, obesity increases the tendency toward diabetes (blood sugar/glucose), high blood pressure, and gout, none of which is reflected in the cholesterol tests.
posted by jlkr at 6:04 PM on November 17, 2009

I've recently lost a lot of weight, but I'm still around 30-40 pounds above my goal. I was moaning about this to my doctor, and he basically said he doesn't care about my weight at all. He only cares about my test results. Once those are all in the good ranges, as far as he's concerned the weight itself is just an aesthetic project.
posted by BlahLaLa at 6:05 PM on November 17, 2009

I was moaning about this to my doctor, and he basically said he doesn't care about my weight at all. He only cares about my test results.

I wish my doctor felt this way. I have excellent test results, but he keeps telling me I should lose weight because "You're a beautiful woman, but you're even more beautiful without the extra weight."
posted by Evangeline at 6:09 PM on November 17, 2009

There are problems that being overweight or obese can trigger, even if your blood tests are good or have been good for a long time. For example, sleep apnea, type II diabetes, joint problems. But if you're not being affected by those things, I am not sure why you need to worry.

I am sure a doctor will come along and tell us why I am wrong about that.
posted by cabingirl at 6:11 PM on November 17, 2009

Also, obesity increases the tendency toward diabetes (blood sugar/glucose), high blood pressure, and gout, none of which is reflected in the cholesterol tests.

Yes, but all of these can be tested for (blood glucose tests, blood pressure tests, and purine levels), so the OP's doctor can verify that he's not at risk for any of those currently.
posted by Sidhedevil at 6:11 PM on November 17, 2009

I wish the formatting was better, it's hard to read. Also, you don't give ranges - these differ from lab to lab, so you can't just take a number and think it's universal - there is variability in lab results. Further, you don't give your age - and that matters, because for example blood pressure tends to go up with age etc.

That said, a few points. On your blood pressure. Your systolic BP (the higher number) is getting up there, at least intermittently. You really should not go above 120, and 110 would be better, depending on age. However, BP is notoriously hard to measure in a single examination (white frock effect etc.). Ideally, you should be taking your BP several times a day over many days (first thing in the morning, mid day etc.).

Your cholesterol is pretty OK, though not exactly ideal. It looks like for example, your HDL can get a touch lowish (42), though as long as it doesn't dip below 40, no alarms. Your LDL is fine, but again, even people with TC below 150 can get heart attacks, and it is the HDL that's important here and the ratio of HDL to TC. You also don't have any number for your TG - if your trigs are high, then it's possible that your VLDL is high and we have no way of knowing, since you provide no number for the TC either (total cholesterol). Missing data here, pardner.

Anyhow, fit & fat is better than slim & deconditioned. So, if you can lose weight, great (and yes, you can - through calorie cut back more than exercise), but exercise is good too, so at least you'll be fit. Excess weight has other issues that may not show up in blood tests - for example stress on your skeletal system, especially knees etc. Clean up your diet and cut back on calories (not necessarily food bulk though), but if you can't, then keep exercising.
posted by VikingSword at 6:32 PM on November 17, 2009 [2 favorites]

I'm a bit unsure what I am doing "wrong" I guess. My diet is not fantastic, but sure better then it has been before. (In terms of carbs anyway). I cycle to/from work, but maybe i need more exercise (don't we always).

Your diet is what's stopping you from losing weight. You need to reduce your calorie intake if you're going to see any results. You need to burn off more calories than you take in to start losing weight and since there's no such thing as an afterburn effect, merely exercising won't drop the inches along your waist (though regular exercise will make you feel great). You need to eat better and eat less. Your doctor and a nutritionist should be able to help you formulate a plan to help you lose weight.

It's great that your bloodwork and tests look good. You're one of the lucky few who is able to be obese and still be relatively healthy. However, if you're not happy with how you look, you're at a privileged position where you can change how you look in a relatively healthy fashion since you won't be carrying around any excess health baggage that others would have if they were in your shoes.
posted by Stynxno at 6:34 PM on November 17, 2009

IANAD or a nutritionist and someone else will probably come on and be able to give you better advice and a better analysis of your data, but the thing that stood out to me was your cholesterol. It is certainly well within the healthy range, as you noted even below the range suggested. However your LDL is higher than your HDL. HDL is actually your "good" cholesterol (H for healthy vs. L for lousy is an easy way to remember it). It is my understanding that ideally your HDL should be higher than your LDL. However It could be a non issue when your overall cholesterol number is so low.

Another data point, my ex has gained quite a bit of weight in the last few years. He's about 6' and used to weigh about 185, now he's pushing 220 (he used to run, but hasn't for 3-4 years and still eats like he's 17 and on the cross-country team). He's also about your age. At his last checkup his doctor said that he really should try to start losing weight, but added she really couldn't give him a lot of shit about it because his test results were so good. What does your doctor say? If possible could you consult a nutritionist? Maybe your food choices are worse than you think or maybe your portion sizes are out of whack.
posted by kaybdc at 6:34 PM on November 17, 2009

on review, sorry, I thought the OP listed his age as 40, but later realized it was his BMI.
posted by kaybdc at 6:40 PM on November 17, 2009

If you are a man, weigh 200 lbs and your BMI is 40, you must be 5 feet tall? BMI is sort of a useless number, and this goes double for anyone outside the average, in either height or body fat percentage. The majority of obese people don't really have any health problems - I know my husband and I both get good grades.
posted by muddgirl at 6:56 PM on November 17, 2009

You need to eat better and eat less

Or not. The poster would do well to talk with a nutritionist, as would we all, but the poster may be eating a well-balanced, nutrient-packed diet with no extra calories and just be a fat person with a high set-point weight.
posted by Sidhedevil at 7:20 PM on November 17, 2009

Sorry, yes, I am 38, so practically 40 I guess :) I am 178cm tall according to the test (5'11" or so?) The data I put in is what is on the page. There is a bunch from the ECG as well, as well as usual sight, hearing, and something listed as MCV/MCH/WCHC.

I don't eat a lot, Japanese portions are generally good/medium, and "small" according to my American coworker (if you don't count the rice, which I don't eat much of). Breakfast is a pot of yoghurt, lunch is restaurant with coworkers (which is Japanese, so *much better* than pub lunches in London back in the day! Pasta, turkish, korean, indian) and dinner is at home with wife (who can eat about twice as much as me).

I do have snacks after dinner, which would be my greatest weakness. ice-cream, maybe some chocolate. Not chips, as starchy/potatos don't like my old ulcer.

Not that my weight has changed much in the last 3 years. 2-3L water/day, and coke-zero. Alcohol-wise, I only drink rum and coke-zero. I don't like beer.

But the feedback has been interesting, general health I'm doing great, certainly compared to 1999 when my gallbladder just about exploded and gave me an ulcer, so I'm not stressed, it just seemed so strange that I get a better rating than my coworker, who is a thin-stick, runs 5 miles/day, and has a cholesterol rating of 160, gets 'B'.
posted by lundman at 7:22 PM on November 17, 2009

Uh, your BMI is 27.9, not 40.
posted by elsietheeel at 7:28 PM on November 17, 2009

I just typed in what the report said, which is most likely what the scales read-out. Maybe Japanese BMI is different :)
posted by lundman at 7:32 PM on November 17, 2009

The BMI used for Asians is, but I was under the impression they used the same calculations, but a different cut-off for what is considered obese (anything over 27.6, rather than over 30).

Obviously more Googling is called for!

(Anyway, you're not obese. You're overweight yeah, but if your numbers are normal I wouldn't sweat it. Non-thin people can be healthy! Really!)
posted by elsietheeel at 7:36 PM on November 17, 2009

BMI is BMI - it's kg/m^2. It's either an error or some weird scale?
posted by muddgirl at 7:40 PM on November 17, 2009

I don't know, maybe I don't have a good sense about these things, but 5'11" and 200 lbs does not sound obese to me. Yes, you might be considered a bit overweight depending upon your frame and in an ideal world it would be nice if you could lose 20lbs or so, but I wouldn't categorize you as clinically obese. And your BMI sounds way off with those numbers. Just out of curiosity I stuck your height/weight in a online BMI calculator and they came up with 27.9, which yes, puts you smack in the middle of the "overweight" category, but not obese. Sorry if I'm getting hung up on the language, but it skewered how I read your question. As you get older the trick will be not to keep on piling the pounds as then you could veer into obese territory.

It does sound like the evening snacking is the main culprit as your overall diet sounds healthy (although you didn't mention what you typically ate for dinner). It may actually be that you are not eating enough during the day and therefore are ravenously hungry by the time you get home for dinner and therefore more susceptible to the siren call of ice cream and chocolate (my own personal go-to vices!). Try to enjoy them as a special treat and not a nightly routine. And perhaps you could eat a heartier breakfast and bring a healthy afternoon snack such as a piece of fruit or a handful of almonds. Good Luck!
posted by kaybdc at 7:42 PM on November 17, 2009

This is where you call up your parents and thank them very much for your genetics. Sounds like your lifestyle is pretty good too.

But, you've converted between Kg and Lb incorrectly. 200lb = 90.0kg, which gives a significantly different BMI, which is why people are confused. I assume the 135kg is the correct number, which is closer to 300lb. I would start looking into a reason, medical or otherwise, for why you can't lose weight. A BMI of 40 is significant, and even if it's just that you are severely underestimating the amount of calories in ice-cream, it'd be worth getting a professional on board.
posted by kjs4 at 7:47 PM on November 17, 2009

Oh, that makes sense too. I suck at metric.
posted by muddgirl at 7:49 PM on November 17, 2009

Yeah, maybe so. I would categorise myself as someone who never gets hungry. For about a decade I ate no breakfast, but trained myself to have something since people say its better. I don't get hunger-pangs, or any noise from it to say I'm hungry. Thought it'd be fun to test that once, so I went 48 hours without food, just water, to see if I would eventually feel hungry.

I eat snacks cos they taste good, not because I am hungry. I also chew gum, which is Airwaves (sugar free).

Anyway, I should watch out, since my metabolism will most likely drop around 40, so it probably would be prudent to do more. It seems if I do more than 90mins of exercise a day I start losing weight, but who has that much free time! I'm about 60 mins/day now.
posted by lundman at 7:54 PM on November 17, 2009

Ahh my apologies, yes, 300 lbs. I am not so going with imperial, and just made it worse by guessing wrong!
posted by lundman at 7:55 PM on November 17, 2009

IANAD... even though your cholesterol numbers are good, you should also get a fasting-glucose test to see if you're at risk of diabetes. Other than sugar intake, I think the presence of lots of visceral fat raises your risk a bit. You might well be fine, but it'd be better to know.

At 135kg, you're at risk of damaging your spine, not to mention other joints if you're doing high-impact exercise. I know a couple of people around your weight who are about 50 and they have terrible back problems that started in the last 5 years. Crushed discs, pinched nerves, that sort of thing. You really don't want that - it's chronic and severe pain and/or very heavy pain medications. I wouldn't give up on it if I were you.

If you're doing 60 minutes of honest exercise (heart rate of 120-160) per day, not eating a lot and not losing weight, you might have some hormonal issues. Hormones are an excuse frequently trotted out by people too lazy/greedy to lose weight but there are people who really do have hormonal issues that cause massive weight gain/retention despite heavy diet and exercise regimes. That might be you, and some more detail in the blood tests can tell your doctor if that is your issue.

I was a fat bastard all my life but doing 8-12 hours of cycling per week means I'm losing nearly 1kg/week and am rapidly approaching vaguely-normal dimensions. Cycling is great because it's low impact (no pain, unlike running) and you can set your exertion level at the point where you can go for 4-6 hours without a break (burns a LOT of calories) yet not run into exhaustion issues. Great for weight-loss. Once your muscles build up a bit, you can start doing sprints & hillclimbs if you want better cardio fitness. And you get to see the countryside! Exercise is a huge time-sink but the endorphins can be addictive and the health benefits are worth the investment of time - just go for an hour or two at night a couple times during the week, then do a longer period on the weekend. If you don't get hunger pangs, well shit, you've got the biggest dieting hurdle taken away for free!
posted by polyglot at 10:12 PM on November 17, 2009

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