The 'Fat But Powerful' Paradox

The importance of maintaining muscle power as we age, even if we carry extra weight.

Whose grandfather is this? Image created using Midjourney.

This study, published in the British Journal of Sports Medicine in 2021, investigates the 'fat but powerful' paradox in older adults and its association with all-cause mortality.

Key Points

Aim

The study aimed to assess the influence of muscle power and adiposity on all-cause mortality risk in older adults and evaluate the 'fat but powerful' (F+P) paradox.

Methods

• Participants: 2,563 older adults (aged 65-91) from the EXERNET multicentre study in Spain

• Measurements:

  • Adiposity: BMI, waist circumference, body fat percentage, and fat index

  • Muscle power: Sit-to-stand (STS) muscle power test

  • Covariates: Age, sex, hypertension, smoking status, walking and sitting times

• Follow-up: Median of 8.9 years for all-cause mortality

• Analysis: Cox proportional hazard regression models

Participants were classified into four groups:

1. Lean and powerful (L+P)

2. Fat and powerful (F+P)

3. Lean but weak (L+W)

4. Fat and weak (F+W)

Results

1. BMI and waist circumference:

   • F+P group: 45% reduced mortality risk

   • L+P group: 42-43% reduced mortality risk

2. Body fat percentage:

   • L+P group: 47% reduced mortality risk

   • F+P group: Trend for 43% reduction (not statistically significant)

3. Fat index:

   • L+P group: 50% reduced mortality risk

   • No significant benefit for F+P group

4. Relative power:

   • Higher levels reduced mortality risk by 37-47%

Practical Applications

1. Muscle power is a crucial factor in reducing mortality risk for older adults, regardless of BMI, waist circumference, or body fat percentage.

2. Maintaining muscle power can provide survival benefits even for older adults with obesity, except when obesity is defined by fat index.

3. The sit-to-stand muscle power test is a simple and effective way to assess muscle power in older adults, requiring only a chair and a stopwatch.

4. Improving muscle power through exercise may benefit older adults, regardless of their body composition.

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Key Takeaway

The study supports the 'fat but powerful' paradox, suggesting that being powerful (having good muscle power) can offset some negative effects of obesity on mortality risk in older adults. However, this benefit may be limited when obesity is severe (as indicated by fat index).

This research highlights the importance of maintaining muscle power as we age, even if we carry extra weight. Engaging in exercises that build muscle power, such as quick, loaded movements or other resistance exercises performed as fast as possible, could be beneficial for overall health and longevity. It's important to note that while being powerful can help mitigate some risks associated with obesity, maintaining a healthy weight is still crucial for overall health.

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Reference

Alcazar J, Navarrete-Villanueva D, Mañas A, et al ‘Fat but powerful’ paradox: association of muscle power and adiposity markers with all-cause mortality in older adults from the EXERNET multicentre study. British Journal of Sports Medicine 2021;55:1204-1211.