Is There Such Thing as Healthy Obesity?

by Jennifer Purdie
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Is There Such Thing as Healthy Obesity?

If you’re overweight but keep yourself in shape by running half marathons or doing hill drills on your bike each day, you might think such a high level of physical activity counterbalances the extra pounds — but recent research suggests otherwise.

A new study challenges the concept of “healthy obesity.” Published in the August 2017 issue of the European Heart Journal, researchers tested the hypothesis that individuals without any metabolism dysfunctions, who still carry excess weight, have no greater cardiovascular risk than their leaner counterparts. The researchers defined “obesity” and “overweight” using body mass index (BMI), and “unhealthy” using indicators like elevated blood pressure, hyperglycemia, high waist circumference, hypertriglyceridemia (a condition of high blood levels of fatty molecules) and low HDL-cholesterol.

Using an analysis of 520,000 people from the European Prospective Investigation into Cancer and Nutrition study, researchers compared the following two measurements between overweight/obese people and metabolically healthy normal weight people:

  • Hazard ratios: How often an event happens in one group versus how often it happens in another group over a period of time. In this case, the study looked at incidents of coronary heart disease over 12.2 years.
  • Confidence intervals: The probability a population parameter falling between two particular values. In this case, researchers accounted for gender, age, education, smoking, diet and exercise at 95% confidence intervals, meaning, they expect 95% of the intervals will include the parameter.

CAN WEIGHT BE SECONDARY TO FITNESS?

Results showed that regardless of metabolic health, overweight and obese people had higher cardiovascular health risk than lean people. The study also found that weight increases your risk of heart disease by 25%, even when everything else falls in the normal range. In short, any amount of extra weight can be bad for your health. These findings are contrary to the belief that as long as you’re fit, weight is secondary.

LaFarra Young, MD, general adult and pediatric pathologist in Brookhaven, Mississippi, affirms the study’s results, “Overweight and obese individuals with healthy metabolic function continue to have a slightly higher risk of coronary heart disease than lean individuals.” She recommends these individuals pay close attention to metabolic health factors when determining risk factors for various diseases and complete mandatory follow-up with a health care provider when determining the status of their metabolic health through the parameters discussed in the study. In addition, “Individuals with a high BMI, but not quite overweight, considered normal weight, should definitely get regular checkups to ensure their metabolic health is intact.”

A CAVEAT ON BMI

“The BMI is used to help determine an individual’s level of fitness and, by extension, their risk of chronic diseases. Healthy [BMIs] fall between the 18.5–24.9 range, with any score over 30 considered obese,” says Faisal Tawwab, MD, of Multicare Physicians DPC in Lake Mary, Florida. However, Tawwab notes, “measuring BMI is not a perfect science, especially when taking different body types into consideration. However, it does serve as a good indicator of whether or not lifestyle changes need to occur.”


READ MORE > EVEN ENDURANCE ATHLETES ARE AT RISK FOR THIS


BMI should not be a sole determinant of an individual’s risk of specific health outcomes. “An individual’s genetic makeup and metabolic health determines the effect of a larger BMI on their risk for coronary heart disease,” says Young. Often athletes with high muscle mass may have a high BMI (up to 25), even though they’re actually not considered overweight. “Various factors determine the cause of this scenario, such as high muscle content. In cases where people are concerned about future health complications, a determination of body fat as well as lifestyle may be very informative,” she says.

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  • Chris Gross

    Way to deflate anybody trying to improve themselves? I still find it VWRY hard to believe it is better to be lean without any cardiovascular capacity than to be over the BMI generic ideal weight and capable as an athlete.

    This is ONE study. I will wait for more peer review or meta-analysis. This article basically condones starvation as a healthier lifestyle than being active with any extra weight “even in the normal range”. Really?

    This former college athlete isn’t buying it. I will NEVER fit in the BMI standard…. ever. Even as a collegiate athlete on the track team I was “overweight” with an 18% body fat ratio as a female. Some people will never fit in that small little window and I wish we weren’t punished for it: health insurance, life insurance, judgement from the people who can do nothing and fall in the normal range.

    If you are out there and active: Keep Going! Don’t let one study make you think “why bother?” Is this really the message MyFitnessPal wants to promote????

    • awfulbliss

      My thoughts exactly!

      I love using MFP, but every single article is geared towards being thin, celebrating one kind of body type, etc. They seldom post articles that feel relatable.

      • Tony Fernandez

        Nobody likes a cliché stereotype either.

    • Tony Fernandez

      Awe, I’m sorry you’re way too fat to lose weight. I hope you feel better soon.

      • A

        Wow. How can you respond to a thoughtful comment with that insulting nonsense and pretend your prejudice has anything to do with health? Wanna hear the truth? I was just as healthy at 330 two years ago as I am now at 160. My blood pressure was fine. My cholesterol was fine. I was never diabetic or prediabetic. BMI is arbitrary bull. I get that making fat people feel like second class citizens makes you feel better about your own shortcomings for a minute, but your ignorance and lack of empathy are pretty clear to see.

        • Tony Fernandez

          Oh wow that’s awesome! I’m glad to hear you’re back to normal! Losing weight is pretty hard to do and no one would blame a person who is really fat to get up and do something about it.

        • Jay Bruno

          I’m happy to hear you’re at the correct weight again. it’s a good thing you lost all of that fat before your body’s inflammatory responses overwhelmed the blood vessels and created an irreversible plaque buildup.

          • Angiers

            You sound like you don’t know how inflammation works. Inflammation isn’t caused BY fat, fat is one symptom of many as an inflammatory response to something in your environment. Symptom NOT a cause. correlation does not equal causation. Classic scientific misunderstanding. School yourself before you wreck yourself.

          • Tony Fernandez

            No but it sure as hell makes it worse. The only thing that’s going to wrecked here is your fat body.

        • Not a Troll

          “I was just as healthy at 330 as I am now at 160”
          Yeah lol keep telling yourself that buddy
          Remember this comment when you balloon back up over the years

        • Mel

          I’m glad you made the decision to lose the weight before it adversely effected your health. As a nurse who has worked for many years in various settings I will say one thing, age has a lot to do with how much of an impact your weight will have on your health (over or underweight). While I see many very underweight frail elderly oatients with fractured bones from osteoporosis, I see many young 40, 50, 60 year old patients where complications of their obesity has eventually caught up with them. Diabetes, hypertension, sleep apnea, supplemental oxygen dependence, heart attack/stroke. All things that yes, they may have had at a normal weight but not with all the complications that come with them and not as early in life as they ended up developing these processes. If their weight was in check, they may not have happened too.

          One thing I can say in almost two decades of practice, I have NEVER had a morbidly obese very old (80+ years) patient. I have had numerous 90-100+ year old normal weight patients. This should tell you that eventually that 330 pounds would effect your health, and not just be a cosmetic or social inconvenience.

          I will say that I am totally disgusted with anyone who treats someone differently because if their size. There are many things that cause someone to be overweight and addressing the root cause is the only way to get the weight off and keep it off. People aren’t obese because they just like to eat. It goes so much deeper than that and anyone who thinks they are better than someone because of their size is extremely shallow and has no right to judge. I’m saying this as a relatively thin individual who is sick of hearing people take cheap shots at someone else just because of their size.

  • Tony Fernandez

    It’s really awesome to hear news like this. I really put effort into being slim and in shape. Fitness is a lifelong journey and I love to see what I do to keep myself in shape is also keeping me as healthy and as energetic and vigorous as I feel every day.

    • Mike Shephard

      That’s awesome man! I’m happy to hear there’s people out there who make the effort to stay in shape and eat right. And I’m with you, fitness is a life long journey 100%.

  • Mike Shephard

    Man I agree with this. I used to feel bad all of the time when I was overweight. One day I said get it together and just started dieting. And MyfitnesPal is something I use every meal, I’ve been really strict about my habits. And before I knew it I was in the healthy BMI again. And I could feel it in my bones how much better I am. My blood work is back to normal and because of that I was able to workout again.
    Now between eating better and working out I feel like a new man. And it’s all because of studies like this that motivated me to improve myself, because I knew nobody was going to do it for me.

  • DC

    I wish more studies like this were available to the public. I am weary of seeing clearly obese women who claim they are healthy and do not express a desire to lose weight. My fear is they become role models to young overweight girls who see no reason to curb their eating or try to lose weight because they see no downside to obesity.

    • Tony Fernandez

      Oh don’t be afraid. I’m sure one day there will be a mass double blind study showing at least one upside to being super sized.

      • No Days Off

        Yeah, harder to kidnap!

    • John H

      So what? Your idea of optimal heath is not actually a moral imperative. Even if being overweight is relatively unhealthy, it doesn’t mean we have any good reason to try to make people lose weight if they do not wish to do so.

      • Tony Fernandez

        Like Willam said, a jar of mayonnaise is 330 grams of fat. How many jars are you?

    • kkjjxl

      Everyone in our culture is aware that it is preferable to be thin. If people learn to accept themselves as they currently are, and enjoy how they look and feel, you really see that as a bad thing?

      In my own experience, accepting myself the way I am (overweight) was, actually, a huge step in getting past my yo-yo dieting ways and toward meaningful, long-term weight loss. Because any diet born out of self-hatred is not really sustainable.

      • Tony Fernandez

        Also being fat is the NORM now. Don’t be a martyr for a won cause.

        And people are perfectly capable of cutting back on calories to lose weight, only mentally unstable people develop self-hatred because they refused a mini cupcake.

  • blackjew

    Calling this “science-backed advice” is a lie. Since most people won’t actually read the study and ignore these comments because of confirmation bias. What you need to know is that if you feel healthier after you lose weight that is because you are healthier, end of story. Being healthy is about being healthy, active, with a quality diet not your size. Now to the writer of this, I am really sad this got posted and think it needs to be taken down. Where to begin, first read the actual study and not copy and paste a press release. To call this a reputable journal is a stretch at best. It’s rankings on associated and ranked studies is nearly non-existent. That means that as a driver of science it basically does not exist. Second a study of other people’s research is ALWAYS suspect. They did not do the studies themselves, they did not do the data analysis. And when you get into how they “isolated for other factors.” you realize how terrible the math and science on this actually is.

    And it is no surprise this flies in the face of a more limited but actually direct study in the American Journal of Medicine that found that skinny people who live inactive lives are in fact less healthy than so called “obese people.”

    Similarly study after study shows that losing weight more than 1 or 2 pounds a week causes higher rates of heart disease.

    This “study” speaking of which did not find no matter what being overweight is always bad, in fact it found that being unhealthy which they define as inactive and poor eating, means you have the SAME rate of cardiac problems.

    I could go on, but next time you copy and paste a press release do some of your own research. I mean just some caveats on BMI is ridiculous it is totally discredited.

    The reason you don’t see more headlines like this is that despite the fat phobia it isn’t backed by science.

  • Jay Bruno

    This is true. It’s why Dr. Yoshinori Ohsumi won the The Nobel Prize in Physiology or Medicine 2016 for his discovery in the mechanism of autophagy. If you consume less calories and fast the body begins clearing out dying and bad cells from the body. It can help against the negative effects of aging. By fasting and eating less, you naturally become less obese anyway so I’m all about spreading this good news.

  • blackjew

    Wow and rather than post my comments with actual data about why this post is wrong and dangerous it just got deleted. Even more proof how confirmation bias and not science this post actually is.

    • Jay Bruno

      Aww

  • All of this may be true, but it’s one study, and it neglects the health benefits (physical, mental, and emotional) of exercise and attempts to live healthy despite obesity. A combination of metabolic disorder, acute depression, undiagnosed sleep apena and celiacs all led me to a downward spiral over 20 years to the point I was 265 lbs (at 5’9”)

    After I got a CPAP and was diagnosed with celiacs and gave up all gluten, my metabolism was so shot it seems it will never recover. I eat between 12-1600 total, not net, calories a day, and run 25-40 miles a week. The meals are all balanced (~30% lean protein, 30% mostly “good fat” and 40% complex carbs). I don’t eat fast food, sugar, or refined and/or simple carbs (except some fruit). I only drink water and green tea. I lose ~5 lbs every 3 months, and at times I will plateau for 4-5 months at a time. It has taken me 5 years to get to my current 203 lbs. My BMI is now exactly 30.0, which is the lowest obese number, so I am still obese, but am I NOT a more healthy obese?

    Because of the exercise I sleep better, ward off depression better, and feel better. I can now complete marathons, though it hakes 6.5 hours. My blood pressure is still borderline, my sugars are good, my LDL and total cholesterol are good, but my HDLs and triglycerides are still slightly too low and high respectively.

    I have found that diet IS the key to weight loss, but a danger of a focus on diet ALONE is that one will miss all the other benefits of exercise and other wellness choices. It can be very discouraging to those of us who genuinely struggle with and persistently fight against slow metabolism to be told we are unhealthy when we often eat better and exercise more than those blessed with good genes.

  • Not a Troll

    “It’s okay to be fat as long as you’re fit”
    I’m sure you get plenty of gains out of Planet Fitness too
    What a load of sh*t MyFitnessPal is becoming

    • Not a Troll

      (Meant to be about other commenters, not the article in question)

  • John H

    This study provides some fascinating results, though, sadly, a lack of one particular data set – family history of cardiac disease – limits how much we can tell. What I find most interesting is that the average daily kcal intake and activity levels of the metabolicly healthy normal weight and metabolicly healthy overweight populations were nearly identical (2201 vs. 2202 kcal per day, 1% difference in very high and very low activity levels), with very similar diets (slightly higher red meat consumption and substantially higher fruit consumption in the MHO cohort, with the rest nearly identical). This raises the question of why two populations with similar diets (effectively identical caloric intake) and activity levels result in significanrly different BMIs; it suggests that there is some underlying metabloic difference that reduces BMR for the MHO population. One wonders if the same (genetic?) factor might elevate heart disease risk independant of actual weight, such that being overweight is an INDICATOR of a specific risk factor for some of the population but not itself a cause of elevated heart disease risk. Sadly, the results are largely meaningless, because genetic factors that might elevate heart disease risk were not captured by either direct measurement nor family history, and thus the authors could not control for them (the 25% higher risk might disappear when controlling for family history, for example).

    • Tony Fernandez

      kk

    • Angiers

      This study also ignores latest research that points to inflammation as the cause behind many degenerative diseases, also ignores the link between inflammation and obesity. Maybe the cause of premature death is the same cause of obesity? Both are symptoms of a greater systemic problem? This study doesn’t reveal any more information than we already know, that there is a correlation between obesity and mortality. Anyone with a middle education in science knows that correlation does not equal causation.

  • Jessica Edgell

    Okay, though I have never been obese I get where the article is coming from. There are people that are heavier but also workout regularly or are training for marathons. I am not gonna judge a person for actually taking the time out of their day to workout for 30 minutes to an hour. I am actually shocked at the arrogance in the comments. Very hurtful to see people judging each other or calling a person “fat”. Very disgusting attitudes to see here. The fact all of you are using this app shows something we all have in common. We LOVE the healthy lifestyle and this app is an easy way to help us keep track of what we are eating. Stop putting each other down and bring each other up. That is all.

    • Britany Lenz

      I 100% agree with you Jessica! We need to build people up. One thing I was wondering when reading this, overweight and people with obesity who are active (without metabolic disorders) would eventually lose weight UNLESS they were eating excess calories or not elevating their heart rate enough to burn more than they consume. With hard work and consistency, these people would in fact lose weight. BMI is a great start point/indicator that is now underused because of the bad rap it gets.

    • Tony Fernandez

      Oh I’m happy to hear you made an account just to post this comment, and with you as a thin woman with child.

      There’s no hate here. Only truth. People like you need to stop thinking that Marathons are the ultimate fitness test. You realize there are much more difficult fitness events right?

      I’d love to see some tubby do an ultra marathon, we’ll see how all that sanctimonious talk will do for them.

      You don’t have to defend fat people. You know ya’ll are the majority right? Not everyone is a martyr for your cause.

      And you’re not fooling anyone with that pic, we all know you are an incredibly fat goddess with a BMI to match your IQ.

      • Jessica Edgell

        Tony, shut your dumb ass up. You do not know a damn thing about fitness or healthy eating. You are a typical lonely troll who has nothing better to do but be a keyboard warrior. You do not know me or my life and definitely not my body. Your words aren’t harmful to me, you are as irrelevant as your posts on this thread. Where is your picture at? You don’t even have the confidence to show yourself, all you share is your uneducated responses to people’s comments. ANYONE can run a marathon, some may not be as fast as others or as experienced but you can do anything you want if you put your mind and body into the efforts. You must be some scrawny marathon runner since you want to put people down. If all you do is run marathons good for you, because most women want men with actual muscles anyway, and you don’t see body builders running marathons too often now do ya? So stick to your cardio and leave the weight lifting to others.

        • Tony Fernandez

          Nah hoe, you sound fat. I lift weights and am in great shape. My bf and I workout so we know the work it takes to not be a fat ass. The only thing you hurt here was my mind because that was some dumb fucking talk out of your pie hole.

          Also shame on you, you have a “daughter”. Maybe watch that filthy mouth around her. And while you’re at it try not to fill her up with garbage either.

          • Jessica Edgell

            LMAO awwww you mad bruh? Real cute, keyboard warrior. Real tough behind the screen aren’t ya?

          • Jessica Edgell

            “My bf and I” damn now you’re making up the fact you have a bf, cute!

          • Jessica Edgell

            Oh and it’s spelled “ho” hoe is a garden cool, you stupid ass tool.

          • kkjjxl

            This kind of comment does not belong on MFP. This is supposed to be a supportive community.

  • Laura Anglin

    Obesity and overweight are completely different, as in 150 lbs overweight versus 15 lbs overweight. No comparison.

    • Tony Fernandez

      Trust me, 15 pounds overweight feels awful

    • Mary Nsunwara

      Maybe you’re thinking of morbid obesity. Plain obesity starts at a BMI of 30. I doubt you’d have to be 150 lbs overweight to hit that

      • Laura Anglin

        The difference between 15 and 50 pounds overweight is still significant. Or 10 pounds vs. 40 pounds. Heart, lungs, muscle and skeletal structure mean a lot as well for health. Someone who can outrun a smaller BMI would be healthier and achieved more fitness (endurance, athleticism, aerobic and muscular fitness).