Can you be overweight and healthy

Can you be overweight but healthy?

The relationship between health and weight is complex. The concept of weight speaks to how much your whole body weighsyour weight is comprised of not only fat/adipose tissue, but also bone, water weight, organs, skin, muscles and more.

What constitutes a healthy weight is dependent on the individual. While being overweight is a precursor to obesity and, like obesity, can increase the risk of diabetes, heart attack and stroke, its also possible to be overweight and still healthy, especially if youre free from chronic diseases like hypertension or diabetes. However, its important to keep in mind that many studies have shown an association between excess weight and adverse health outcomes and shorter life spans, especially if your waist circumference is greater than 39 inches for men and 34 inches for women.

The way we discuss weight can further be categorized by body mass index, or BMI.

How to think about BMI

Anytime I talk about BMI with my patients, the first thing I say is that I dont want them to get caught up in the numbers but rather focus on the range and category. Additionally, know that this range is temporary and heavily influenced by what you eat and how often you move.

The formula for calculating your BMI is weight x 703 height. According to BMI standards, underweight is considered under 18.5, normal weight is 18.5 to 25, overweight is 25 to 30 and obese is over 30. However, BMI doesnt distinguish between muscle and fat and, thus, can be skewed, especially because muscle weighs more than fat. So a very muscular person could be categorized as obese when, in fact, they might be very healthy.

BMI can be a good conversation starter, but the real focus should be on barriers to exercise or eating more healthily. You can work with your doctor to formulate a plan of action for success in these areas.

How can you know if your weight is healthy?

Using the BMI range is helpful, however, looking at body fat percentage can be a good tool, as well. Its not a regularly used method, but measuring body fat percentage can also give us an idea of where your weight status lies, without the possible confusion between muscle and fat weight. Generally, 26-31% body fat is considered to be within a normal range. Above 31% body fat is considered above average, and its recommended to try to reduce fat mass at that point.

Maintaining a healthy weight

Maintaining a healthy weight is a long-term construct and the activities necessary to achieve that goal really come down to repetitive, consistent behaviors. I often tell my patients theyll have the best chance at long-term success if they take things one decision, one day at a time, then build upon those successes. Build your successes slowly; slow progress is good. Quick fad diets will likely have you back to the drawing board. Dont be too hard on yourselfif you mess up, get right back up and dont dwell on the failure. Tomorrow is another day to get it right.

Sophia Tolliver is a family medicine specialist at The Ohio State University Wexner Medical Center.

Overweight and healthy: the concept of metabolically healthy obesity

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Carrying too many pounds is a solid signal of current or future health problems. But not for everyone. Some people who are overweight or obese mange to escape the usual hazards, at least temporarily. This weight subgroup has even earned its own monikermetabolically healthy obesity.

Health professionals define overweight as a body-mass index (BMI) between 25.0 and 29.9, and obesity as a BMI of 30 or higher. (BMI is a measure of weight that takes height into consideration. You can calculate your BMI here.)

Most people who are overweight or obese show potentially unhealthy changes in metabolism. These include high blood pressure or high cholesterol, which damage arteries in the heart and elsewhere. Another harmful metabolic change is resistance to the hormone insulin, which leads to high blood sugar. As a result, people who are overweight or obese are usually at high risk for having a heart attack or stroke, developing type 2 diabetes, or suffering from a host of other life-changing conditions.

But some people who are overweight or obese manage to avoid these changes and, at least metabolically, look like individuals with healthy weights. Obesity isnt a homogeneous condition, says Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health. It appears that it doesnt affect everyone in the same ways.

Dr. Hu and three colleagues wrote a Personal View article in Lancet Diabetes and Endocrinology reviewing what is known about metabolically healthy obesity. They identified several characteristics of metabolically healthy obesity. These include a high BMI with

• a waist size of no more than 40 inches for a man or 35 inches for a woman
• normal blood pressure, cholesterol, and blood sugar
• normal sensitivity to insulin
• good physical fitness

BMI isnt perfect

BMI is not a perfect measure of weight or obesity. It often identifies fit, muscular people as being overweight or obese. Thats because muscle is more dense than fat, and so weighs more. But muscle tissue burns blood sugar, a good thing, while fat tissue converts blood sugar into fat and stores it, a not-so-good thing.

Further exploration of metabolically healthy obesity could help us fine-tune the implications of obesity, says Dr. Hu. It supports the idea that we shouldnt use BMI as the sole yardstick for health, and must consider other factors.

Genes certainly play a role in how a persons body and metabolism respond to weight. Some people may be genetically protected from developing insulin resistance. Others are genetically programmed to store fat in the hips or thighs, which is less metabolically hazardous than storing fat around the abdomen.

The concept of metabolically healthy obesity could be used to help guide treatment. Currently, exercise and a healthy diet are the foundation for treating obesity. When those efforts arent enough, weight-loss surgery (bariatric surgery) is sometimes an option. Such surgery is appropriate for people with metabolically unhealthy obesity, the authors suggest, but for people with metabolically healthy obesity it might make more sense to intensify the lifestyle approach rather than have surgery. This idea, however, needs to be tested in clinical studies, says Dr Hu.

Dont rest easy

Metabolically healthy obesity isnt common. And it may not be permanent, warns Dr. Hu. Just because a person has metabolically healthy obesity at one point doesnt it will stay that way. With aging, a slowdown in exercise, or other changes, metabolically healthy obesity can morph into its harmful counterpart.

Its also important to keep in mind that obesity can harm more than just metabolism. Excess weight can damage knee and hip joints, lead to sleep apnea and respiratory problems, and contributes to the development of several cancers.

Bottom line? Obesity isnt good, even if its the metabolically healthy kind.

Fat but Fit: Is Being Overweight a Problem if You Have Other Good Measures of Health?

During the early 2000s, researchers at the Centers for Disease Control and Prevention (CDC) looked into the association between body size and early death. They wanted to determine how much being underweight or overweight increased a persons risk for mortality.

Their findings, which appeared in JAMA, revealed some surprises.

Being overweight was associated with lower mortality than being underweight, which we didnt expect to find, says Katherine Flegal, PhD, one of the authors of the CDC study and a consulting professor at Stanford University.

In fact, her study found that people who were overweight according to their body mass index (meaning a BMI between 25 and 30) had no increased risk of death compared with people whose BMIs fell in the normal range (18.5 to 25).

The fixation on BMI and weight loss is overemphasized, Dr. Flegal says. I think it contributes to fat shaming and stigma and misperceptions.

Her work helped usher in new thinking within the medical community and the wider public about body weight and its relationship to health. It has also contributed to the recognition that some people with obesity may be metabolically healthy a concept that more widely became referred to as fat but fit and that considering BMI alone can be misleading.

That said, there is nonetheless a lot of evidence linking obesity and particularly severe obesity with poor metabolic health. Beyond metabolism, research has associated obesity with increased rates of cancer (in EBioMedicine), osteoarthiritis (inMaturitas),and other health issues.

Experts say all these factors and many more need to be taken into account when assessing the health effects of body size and the benefits of weight loss.

What Does the Current Evidence Say About Metabolically Healthy Obesity?

The word metabolism refers to all the processes that occur inside the body to sustain its health and functioning, perStatPearls. Metabolic disease or dysfunction is associated with an increased risk for type 2 diabetes, heart disease, stroke, liver disease, and some cancers, much research shows.

When assessing a persons metabolic health, medical experts usually take into account the following five things, which are components of whats known as the metabolic syndrome, according to Johns Hopkins Medicine:

1. Blood pressure
2. Triglycerides (blood fats)
3. Blood HDL cholesterol (aka good cholesterol)
4. Blood glucose
5. Waist circumference

Experts who have studied the relationship between body weight and metabolic health say there are some consistent patterns, but also lots of person-to-person variation.

Many people who are obese have most or even all of these metabolic abnormalities, but some have few or none of them, says Samuel Klein, MD, a professor and director of the Nutrition Obesity Research Center at Washington University in St. Louis.

Some of Dr. Kleins work, including a study published in 2019 in the Journal of Clinical Investigation, has examined the science of metabolically healthy obesity, which he says is an ill-defined term.

For example, he says some research efforts have defined medically healthy obesity as individuals who have two or fewer of the above five abnormalities that comprise metabolic syndrome. Meanwhile, other researchers have set the bar at one or zero of these abnormalities. In all, he has found more than 30 different definitions in the medical literature.

He says these inconsistencies make some of the work on metabolically healthy obesity difficult to interpret. In some of these papers, people reported as having metabolically healthy obesity were not metabolically healthy, they just had fewer metabolic abnormalities, he says.

An important takeaway, however, remains that a small subset of people with obesity have no metabolic abnormalities at all. These people appear to be resistant to the adverse metabolic effects of excess body fat, and if you follow them over time, they dont develop diabetes or heart disease, he says.

How Common Is Metabolically Healthy Obesity?

But, Klein adds: But this group represents a small percentage of the population who are obese.

Furthermore, a precise number is hard to estimate, and it depends in part on a persons age, sex, and ethnic background, he says. But if youre using the most sensitive and rigorous measurement tools, about 7 percent of all people who are obese may qualify as metabolically healthy obese, his work has found.

Also according to that work, metabolically healthy obesity is more common in women than in men; more common in younger people than in older adults; and more common in people with BMIs less than 35 than in people with BMIs of 35 and higher.

We usually see it in women with lower body fat distribution, meaning they have increased fat in the thighs, legs, and buttocks, but not in the abdominal area, he says.

Increased waist circumference and abdominal fat are almost always indications of metabolic abnormalities, he adds, and very few men are metabolically healthy obese.

Thats because abdominal fat tends to be visceral fat, the more problematic type of fat thats linked to increased risk of several chronic diseases linked to chronic inflammation, as well as high blood pressure, according to Harvard Medical School. And this is why abdominal fat tends to be indicative of more health risks than fat accumulation around the thighs, legs, and butt areas.

If Youre Overweight or Obese, What Determines if Youre Metabolically Healthy?

Genetics certainly play a role when it comes to whether or not someone with a high weight is metabolically healthy or not. We dont understand the relationship fully, but clearly there has to be a genetic cause for why some people are more resistant than others to the adverse effects of obesity, Klein says.

Lifestyle and behavioral factors likely also play a part. Klein says people who eat a healthy diet low in processed foods, who exercise regularly, and who get plenty of sleep may be better protected from the metabolic harms of obesity.

But a lot of this is theoretical and not borne out by epidemiological studies, he adds.

Researchers ability to measure those lifestyle factors is not very good, he explains, and so that makes it difficult to say for certain whether lifestyle factors can promote metabolically healthy obesity. He adds: It makes sense that eating a healthy diet and exercising would improve metabolic health, but whether it leads to metabolically healthy obesity is something we cant say for certain.

What Role Does Fitness Play in Protecting Against the Risks of High Weight?

A research review published in 2014 found that people who were obese but fit as determined by their maximal oxygen uptake, or VO2 max, a common measurement of overall fitness experienced similarly low rates of mortality when compared with people who were normal weight and fit. Both groups had lower mortality than people who were unfit, the study found.

In line with these findings, more research, including areview published in 2021 in the journal iScience, argued that fitness rather than body weight is a more helpful health measurement. The authors of that review made the case that improving fitness among people with obesity would offer more health benefits than weight loss.

There are research data showing that being fat and fit not being an athlete, but having an ability to consume more oxygen during exercise is clearly associated with a lower risk of developing heart disease or diabetes, or dying from heart disease, than if youre lean and unfit, says Klein.

He says that becoming fit will lead to health benefits among many people who are overweight or obese. Regular aerobic and endurance training can improve metabolic health and may also be protective against metabolic diseases, he says.

But whether becoming more fit will make you metabolically healthy obese will vary from person to person, he says. It may make you metabolically healthier, but not necessarily healthy. He also says that, in most cases, someone who is fit and lean is going to be at lower risk for metabolic or cardiovascular diseases than someone who is fit but obese.

There are surely people out there who meet the fat but fit label. But its unclear whether people who are overweight or obese can avoid all weight-related health problems by focusing solely on improving their fitness, Klein says. Weight loss may still provide additional risk reduction benefits, he adds.

So, Should Weight Loss Always Be the Goal if Youre Overweight or Obese?

For those who are obese, the answer to this question is pretty straightforward.

If youre obese, even if youre metabolically healthy, its reasonable to try to lose weight, Klein says.

Looking beyond metabolic health, he says people who are obese are at increased risk for age-related mobility impairments, joint problems such as arthritis, dementia (per astudy in Alzheimer's and Dementia),and some cancers(such as liver and uterine cancers, per The New England Journal of Medicine) compared with people who are not obese. I think its very rare to find a person who is obese who would not benefit from losing weight, he says.

Other experts echo his sentiments.

Eventually, high weight takes its toll, says Steven Heymsfield, MD, a professor of metabolism and body composition at Louisiana State Universitys Pennington Biomedical Research Center. People who are obese their whole lives often need new hips and knees, or develop other functional problems, and healthy weight loss can prevent that to some extent.

Everyone, at every size, benefits from eating a healthy diet with more whole foods and few ultra-processed foods. Likewise, getting regular exercise, a good nights sleep, and generally moving more (and avoiding sedentary behaviors) are healthy behaviors. If adopting these healthy habits leads to weight loss in someone who is obese, thats almost always a good thing, he says.

But when it comes to people who are overweight, as opposed to obese, the benefits of weight loss are less certain. Especially if a person who is overweight is living a generally healthy lifestyle, trying to drop weight may not always lead to health benefits, says Flegal. (And in older age, carrying some excess weight can be beneficial even, research shows.)

Regardless of your body size, if your healthcare provider recommends that you lose weight, Klein says its helpful to ask a few questions.

Ask what is the benefit of me losing weight, or why should I do this, he says. If they say your triglycerides are high, your blood pressure is on the edge of being abnormal, you have a family history of diabetes or you have prediabetes all of those are major indications for weight loss benefits, he says.

On the other hand, if your parents were both obese and lived to 100 without major diseases, and your body resembles their bodies and youre metabolically healthy Klein says losing weight may not improve your metabolic health.

Should People Who Are 'Fat but Fit' Take Weight Loss Medications?

Theres been much attention paid recently to prescription weight-loss drugs thanks to the impressive results people have experienced taking Wegovy and Zepbound (and the related diabetes drugs Ozempic and Mounjaro). Are they appropriate for someone who is obese but metabolically healthy?

Klein notes that these drugs have not been studied specifically among people who are known to be both obese and metabolically healthy. So for now, judging their usefulness is going to require some guesswork.

The current FDA guidelines state that Wegovy is only appropriate for someone whose BMI qualifies them as obese (meaning a BMI of 30 or higher), or for someone with a BMI of 27 or greater who also has weight-related health problems such as high blood pressure or type 2 diabetes.

Klein says these criteria are very reasonable, but there are situations where even someone who meets these criteria may not benefit from a weight loss drug.

First of all, he emphasizes that BMI can be a flawed measurement tool. A person with little body fat but a lot of muscle mass (such as a bodybuilder) could, based solely on BMI, meet the definition of obesity. This sort of person doesnt need weight loss drugs, he says.

He also says that the FDA-approved weight loss drugs can be very expensive around $1,200 or $1,300 per month and insurance doesnt always cover the cost. If a person is obese but doesnt have obesity-related diseases or risk factors, paying that much money may not make sense.

On the other hand, he says these drugs appear to be very safe. Also, if someone is obese, he says that taking a weight-loss drug might improve their ability to walk and to play with their children, and maybe also lower their risks for non-metabolic diseases such as cancer.

The relationship between body weight and health is complicated. The right answers will depend on many individual factors.

The decision to lose weight and the best approach to losing weight is really for the patient and their physician to discuss, Klein says.