Regular physical activity improves metabolic health, even in the face of excess fat. Fit but fat people are metabolically healthier than thinner people who don’t exercise. Measures of poor metabolic health include high blood pressure, elevated levels of triglycerides, blood sugar, and C-reactive protein; insulin resistance, and low levels of HDL (the good cholesterol). A study presented at the European Congress on Obesity found that obese but metabolically healthy people showed a higher risk of heart disease, stroke, and heart failure than leaner people. The study, however, did not consider levels of physical activity. People who exercise vigorously have a lower risk of cardiovascular incidents than non-exercisers— regardless of weight or body mass index. The three most important risk factors for poor metabolic health are age, physical inactivity, and waist circumference. Physically active people have smaller waists circumferences, regardless of overall body fat. Conversely, many physically active overweight and obese people are metabolically healthy. Regular exercise trims belly fat and improves metabolic health— even in people who are overweight or obese.

 (BBC News, May 17, 2018; Archives Internal Medicine 168: 1617- 1624, 2008)