Fit and slim - but we got fat diseases

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scale lib sxc.hu 'Though obesity is a serious risk factor for conditions such as heart disease, some slim people can have a genetic susceptibility that makes them vulnerable too.'

London - Being overweight is bad for your health, we all know that. It is a major risk factor for a host of conditions, including snoring, heart disease, arthritis and cancer.

Last week, reports said women with a waist measurement of 88cm or more are three times more likely to develop type 2 diabetes. Men with a waist of 101.5cm or more face a similar risk.

But it’s not just the overweight who are vulnerable to so-called “fat people’s diseases” - skinny people should also be alert to changes in their body.

“Though obesity is a serious risk factor for conditions such as heart disease, some slim people can have a genetic susceptibility that makes them vulnerable too,” says Professor David Kerrigan, a bariatric surgeon and weight loss expert at the Countess of Chester Hospital.

This group of slim and healthy men and women - who all have a body mass index (BMI) in the normal range of 18 to 24.9 - were all diagnosed with obesity-linked illnesses, as they reveal...

 

Kash Khan, 36, a business development consultant, lives in Birmingham. He has type 2 diabetes, despite a normal BMI of 22 and a waist of 30 ins (76,2cm). At 5 ft 11 ins (1,78m), he is 11 st 6 lb (72,7kg).

When I was diagnosed, I couldn’t have been slimmer or fitter. I was 24, going to the gym four or five times a week, and living a healthy lifestyle - I don’t drink or smoke.

At the time, I was studying computer sciences at university and, by 3pm every day, I found myself falling asleep in lectures. I was also going to the loo a lot, perhaps every hour. I thought I was just run-down.

Diabetes was, however, on my mind, as my twin brother had been diagnosed a few months before. I bought a blood glucose home-testing kit, and was horrified when the reading was 28 - it should be 4 to 7. A more sophisticated test by the GP also gave a high reading, and I was diagnosed with type 2 diabetes.

I was put on medication - metaformin - and have cut back on sweet snacks; I used to have chocolate or sweets every day. I still go to the gym at least four times a week and watch my diet but, frustratingly, I still have random high blood sugar readings.

The only possible trigger is that people of south Asian origin are more prone to diabetes.

I’m very conscious of long-term complications, such as circulation and vision problems, so my feet and eyes are checked regularly. I can’t do much more than trying to live the healthiest way I can.

EXPERT COMMENT: “Obesity is a major risk factor for type 2 diabetes - the more weight a person puts on, the less able the body is to produce insulin and process blood sugar,” says Dr Dushyant Sharma, a consultant diabetologist at the Royal Liverpool Hospital. “However, around 20 percent of people with type 2 diabetes are a healthy weight.

“People with an Asian background are up to six times more likely to have it, but slim people of all backgrounds can be at risk if they develop insulin resistance through frequent snacking on foods such as chocolate.

“This causes a peak and crash in blood glucose levels, which may affect the efficiency of the insulin they produce.

“There’s also some evidence that foods with a high glycaemic index - that break down into sugars quickly - such as white bread and sweet snacks, can damage insulin-producing cells.

“To reduce risk, regular exercise and sticking to a diet that includes low GI foods, such as porridge and brown bread, are vital.”

 

Mandy Holdsworth, 51, an oncology and chemotherapy nurse, lives in Tewkesbury with her husband, Simon, 51, who works in computing. She was diagnosed with bowel cancer in March 2011. The couple have three children. At 5 ft (1,5m), she weighs 8 st (51kg)- her BMI is 21. Her waist is 27 ins (68.5).

Since I was slim and didn’t have any of the traditional symptoms, I would never have set myself out as a candidate for bowel cancer.

A few years ago, I joined a running group and ran in the middle of the pack but, after a couple of months, I found myself getting slower. My doctor gave me iron tablets, as a blood test showed I was anaemic. As a cancer nurse, alarm bells began to ring. I knew that unexplained anaemia could be a sign of bowel cancer - caused by bleeding in the bowel. After a colonoscopy, where a camera is used to examine the large bowel, doctors broke the news I had a tumour. I was shocked.

I had 8 ins of my bowel removed, followed by six months of chemotherapy. Being in good shape helped with my recovery and, a month after finishing chemotherapy, I was back at work.

I feel great now, am in remission and the prognosis is good. I want people to know bowel cancer is not a “fat person’s disease”.

EXPERT COMMENT: “Many large studies have found that bowel cancer is more common in overweight or obese people,” says William Steward, professor of oncology at Leicester University.

“One study revealed that obese men have about 50 percent higher risk than those with a healthy weight. One theory is that the cells that cause rapid turnover that triggers cancer are damaged by obesity.

“However, sometimes, people can be unlucky and develop spontaneous genetic abnormalities, which is what may have happened to Mandy. If you’re slim, there are other risk factors to consider: avoid burnt, over-barbecued meat - which may be carcinogenic. And cut down on red and processed meat.”

 

Cem Hilmi, 39, a company director, lives in London with his wife, Rosa, 37, who works in recruitment, and their daughter, Layla, nine. Cem suffered a heart attack in March 2011. His BMI is 23 (he is 5 ft 7 ins (1,67m) and weighs 10.5 st (65.7kg); his waist is 30 ins (76.2cm).

There are still times I can’t believe that I had a heart attack. Not only because I was young, slim and healthy, but because, at the time, I was the fittest I’ve ever been.

I was preparing for the London Triathlon and training six days a week, doing a 15-mile cycle one day, then a 1km swim or six-mile run the next.

I’d started doing serious exercise about six years before, as I felt lethargic because of my desk job.

On the day of the heart attack, I felt a bit off-colour, then began to get a dull ache down my left arm. I rang NHS Direct, and was told to go to hospital. The doctors suggested I’d pulled a muscle and sent me home with painkillers.

But on the way home, I began to feel a tightness in my chest. By the time I got back, it was like an elephant was pressing on my chest. Suddenly, I collapsed.

Rosa rang for an ambulance and I was taken to A&E - while I was waiting in the reception, I collapsed again. I was given an ECG (electrocardiogram) - this measures the electrical activity of the heart - and was taken by ambulance to The Heart Hospital in London.

It was only as we raced through the streets that I heard the words “heart attack”. Tests revealed blockages in two of my arteries and I had surgery to have a stent, a small tube, fitted to open up the blockages. I was discharged after five days, but came home feeling like an old man.

I could only get up the stairs on all-fours because I was so out of breath, and I couldn’t walk more than a few steps. I was on aspirin, statins, beta blockers and anti-coagulants, most of which I’ll have to take for the rest of my life.

In the following weeks, I fell into a terrible depression, crying all the time. How could a slim, healthy man be reduced to this? My only vice was being an occasional smoker - no more than five a day.

Slowly, I started using a treadmill and began to regain my strength. Within three months, I was back at work, albeit part-time.

I’ve been told my heart attack was “one of those things”. But it’s taught me never to take life for granted - even if you’re fit and healthy.

EXPERT COMMENT: Dr Glyn Thomas, a consultant cardiologist at the Bristol Heart Centre, says although Cem was young and fit, “it’s possible his excessive exercise regimen may have played a part in his heart attack. Over-exercising in people without any known heart disease issue can rupture fatty deposits in the coronary artery, leading to a blockage that can cause a heart attack.

“It’s important to exercise moderately, building your fitness level slowly, perhaps walking 20 to 40 minutes, three times a week. Whatever you choose to do, do so with enough exertion to become mildly breathless, though you should still be able to talk in sentences.

“Cem thought social smoking wasn’t an issue, but even five cigarettes a day raises risk of a heart attack. Also, some people can be thin on the outside, but have fat accumulating around vital organs such as the heart.

“The best advice is to get blood pressure and cholesterol checked regularly, at least once a year, follow a balanced diet, low in saturated fat, and exercise regularly.”

 

Jamie Gordon, 44, a marketing and communications manager, lives in Twickenham, West London, with partner, Katherine, 44, a fundraiser, and their baby daughter, Eliza. He was diagnosed with sleep apnoea - a disorder that affects breathing, causing snoring - in June 2011. His BMI is 24 (he’s 6 ft (1,8m) and weighs 13 st - or 82.5kg) and his waist is 34 ins (86.3cm).

I’ve always been keen on staying in shape - I love long walks and have done 5km charity runs. Yet, from a young age, my father used to tell me I snored loudly.

Two years ago, Katherine started to say how much my snoring was disturbing her - what’s more, she told me I’d stop breathing for a second and then start again.

I’d sometimes wake with a dry mouth and headache. But far worse was that I felt incredibly sleepy after lunch - it was a real struggle to stay awake and I’d avoid arranging meetings for early afternoons. If I had a long drive, I had to stop every hour as I felt so shattered.

My GP referred me to a sleep clinic where I spent three nights being monitored. I was astonished when doctors told me I was waking up about 40 times an hour - and the problem was sleep apnoea.

Basically, the tissue in my throat was collapsing, narrowing the airway; if the airway closes completely, you stop breathing for a couple of seconds, and the brain forces you to wake up. This was why I was feeling so exhausted, though my doctors were baffled, as usually sleep apnoea affects people who are overweight. The only explanation was that perhaps I had some muscle weakness around my gullet.

I now use a continuous positive airway pressure machine every night. This involves wearing a mask over my nose to deliver a continuous supply of compressed air to stop the airway closing.

The difference has been enormous - it’s not the most romantic thing to wear in the bedroom, but I’m getting a really good night’s rest and I feel great.

EXPERT COMMENT: “Weight gain is the main cause of sleep apnoea, as fat deposits around your upper airway may obstruct your breathing,” explains Professor Russell Foster, director of the Sleep and Circadian Neuroscience Institute at Oxford University. “However, some people have a naturally narrow throat or enlarged tonsils, which can block the airway.

“Avoid drinking alcohol in the evening as this causes the muscles of the throat to relax. Sleeping on your side rather than your back can help; otherwise, your tongue is more likely to fall back into your throat and block your airway.”

 

DEYA Chauhan, 30, a dispensing optician, lives in Leicester with her husband Sumit, 31, a dentist. She suffered a stroke in June 2012. At 5 ft (1,5m), she weighs 7 st (44.4kg), giving her a BMI of 19; she has a 24 in waist (61cm).

The morning I had my stroke, I was at work when I began to suffer a crashing headache, like my head had been caught in a vice. I had a terrible thudding on either side of my eyes.

I couldn’t grip a patient’s glasses in my left hand - that side of my body from the top of my arm right down my leg had gone numb.

Being slim and not yet 30, having a stroke didn’t cross my mind; I thought it was pins and needles. I went to the bathroom to splash my face. It was then I could see the left side of my lip had started to droop. Alarm bells started to ring. A colleague called an ambulance and I was raced to Leicester Royal Infirmary. Doctors confirmed I’d had a stroke, caused by a bleed on the brain. I couldn’t believe what was happening - it was like my life had been hijacked.

I was transferred to a disability unit for young people and ended up staying for three months, having physiotherapy and occupational therapy. When I left, I had to walk leaning on a three-wheeler buggy before graduating to a stick.

After three months, I could finally walk independently, albeit with a limp. I have some movement in my shoulder and wrist, but none in my fingers, so I have had to learn new ways to cope with simple things such as eating.

This was a random, unfortunate thing; I had a normal blood pressure, I didn’t have high cholesterol, I was slim and I exercised.

At the moment, there’s no prospect of going back to work and I yearn for my independence. In the meantime, I volunteer with the Stroke Association. I intend to fight this. I always used to love dancing. One day, I’ll dance again.

EXPERT COMMENT: Pippa Tyrrell, professor of stroke medicine at the University of Manchester, says while obesity “is a significant risk factor for stroke, about 15 percent of cases are linked to a bleed in the brain”.

“This can have nothing to do with being overweight. However, brain bleeds are linked to high blood pressure, which can affect slim as well as overweight people. So it’s important to have blood pressure checked at least once a year.

“Slim people can also be at risk of stroke due to abnormal heart rhythm, particularly atrial fibrillation. Knowing your pulse rate is one of the easiest ways to detect a potential problem.

“Your pulse, which indicates your resting heart rate, should be between 60 and 100 beats per minute. If it’s above 120 or irregular, see your GP.”

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