Why Healthy Obesity is Both Real and False

There are more overweight Americans today than there ever were. But while obesity is at an all-time high in the US, the situation may not be as bad as we think. Because if we are to believe some studies, obese people can be healthy, too. These radical discoveries have been met with some resistance over the years, and the idea of “obese and healthy” has been controversial in the medical community.

So, to answer the question – is healthy obesity real? – it depends on who you ask, and what you’d consider “healthy”.

metabolic syndrome

By Definition, Obesity is “Bad”

At its most basic and strictest sense, “obesity” means having too much body fat. By its medical definition, a person is obese if they’re more than 20% over their ideal weight. Several factors come into play when computing the ideal weight, such as height, age, sex, and body type or build.

The National Institutes of Health defines obesity as a Body Mass Index (BMI) of 30 and above. The BMI is measured by taking the weight (kg) and dividing it by the height (m)2. It’s a way to measure body fat based on a person’s weight in relation to their height.

For most adults, a healthy BMI is between 18.5 and 24.9. A BMI between 25.0 and 29.9 is considered overweight. A BMI of 30 or higher is obese.

Obesity is a result of genetics and/or lifestyle choices. Some are simply born with the fat gene, making them more predisposed to piling up the pounds. Others gain weight due to a combination of bad diet and a sedentary lifestyle.

Obesity has traditionally been perceived as bad. It’s been linked to various serious conditions, including heart disease, stroke, diabetes, cancer, high blood pressure, osteoarthritis, breathing problems, to name a couple.

To improve their state of health, obese people have been advised to lose the excess weight by adopting a more active lifestyle and healthier dietary choices. Basically – to stop being obese.

However, the idea of weight loss as the only indicator of health has been contested by a number of studies, giving rise to the “fat but fit” movement.

On The “Pro-Fat” Movement: Exercise Counterweights Weight

For those who claim that obesity can be healthy, the issue of health goes beyond someone’s BMI.

Years of scientific investigation has shown that while excess body fat isn’t ideal, it’s nothing working out can’t remedy.

Exercise has positive effects on the body, no matter the weight or amount of body fat present. And sometimes those effects are significant enough to offset the harms of obesity.

The argument is that weight loss is immaterial. With proper diet and regular physical activity, obese people can lower their risk for heart disease and diabetes, regardless of whether they lose weight.

Another study shifted the concern from obesity to low cardiorespiratory fitness and inactivity. According to the findings, a great portion of the overweight and obese population “is not at an increased risk for premature death”. Rather than weight loss, measures to reduce mortality risk should focus on “increasing leisure time physical activity and cardiorespiratory fitness”.

In other news, obese people who exercise regularly are healthier than thin people who do not. Experts point metabolic fitness as the “game-changer”. And to be metabolically fit, one needs to be physically fit, irrespective of weight. Thin people can appear healthy on the inside, but can be unfit metabolically.

Obese people can be metabolically healthy if they a high BMI, with a waist size of no more than 35 inches (for women) and 40 inches (for men). They must be physically fit. They also have to have normal blood pressure, blood sugar, and cholesterol, with normal sensitivity to insulin.

There are qualifications for metabolically healthy obesity: they must have a high BMI, with a waist size of no more than 35 inches (for women) and 40 inches (for men). They must be physically fit. They also have to have normal blood pressure, blood sugar, and cholesterol, with normal sensitivity to insulin.

The takeaway of these studies: people can be fat and fit. Likewise, people can be thin and unhealthy.

Metabolically Healthy Obesity is an Illusion

The idea of “metabolically healthy” for obese people may just be a myth according to some findings. A major study from the University of Birmingham presented a strong counter-argument to the “fat but fit” movement: their results revealed that obese people who appeared healthy had a 50% higher risk of coronary heart disease than individuals with normal weight. Their risk for cerebrovascular disease, which can lead to stroke and heart failure, was 7% higher.

The study included 3.5 million people, about 61,000 of whom developed coronary heart disease.

The researchers relied BMI to qualify obesity among the subjects, while recognizing that BMI had inaccuracies and could be misleading (weightlifters could have a BMI that indicated that they were obese).

The study showed that on a wider scale, the idea that many people can be obese and metabolically fit, and at low risk of heart disease, was untrue. Health professionals should focus on encouraging and helping obese people lose weight, “regardless of the presence or absence of metabolic abnormalities.”

Metabolically Healthy is Real – but Temporary

On the other hand, some findings don’t dismiss the possibility of metabolic fitness for obese people, but de-emphasize its impact on the body.

Even without high blood pressure or other signs of illness, obese individuals are still significantly more predisposed to developing heart disease than people with normal weight, reveals a Denmark study.

Men who were metabolically healthy and obese from the outset were three times more likely to develop heart disease compared to metabolically normal-weight peers. Metabolically healthy obese women had double the risk compared to their normal-weight counterparts.

About 3% of the study population was “metabolically healthy obese” at the start, and 40% of these became metabolically unhealthy over the next five years.

Another expert has something similar to say: metabolically healthy obesity is uncommon, and it may not be permanent. With changes such as decrease in physical activity, what’s considered metabolically healthy may soon become its harmful counterpart.

Also, excess weight affects more than just metabolism. It can lead to respiratory problems, knee and hip joint damage, sleep apnea, and may contribute to the development of several cancers.

So, while “metabolically health” isn’t necessarily a myth for obese people, it’s not the only metric for health.

Bottom line, obesity is unhealthy, even if it’s of the metabolically healthy kind.

What’s Our Takeaway?

To the answer the question “is ‘obese and healthy’ possible” – yes, to some extent and under specific circumstances, at a certain given moment. With religious physical activity and conscious dietary regimen, obese people can achieve a healthy status, regardless of weight loss.

However, the excess weight is too significant a factor to ignore. Experts propose that if obese people really want to be healthy – in its strictest, simplest definition – the only way is to shed the extra pounds through proper diet and exercise, and turn it into a lifestyle.

Simply, only weight loss is the way to beat the harms of obesity. You’d think these significant findings would end the controversy, but the debate has gone on for years. And it’s far from over.

Pamela Sanchez

Pamela Sanchez is a mid-20s student of life and freelance writer with an interest in health, wellness, and anything she can sink her teeth into.

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