Can You Be Overweight and Healthy?

I'm not sure anyone is reading the article so I'm posting it here. It's long, so still not sure how many will read it. It raises some interesting points, I think.

By Robert H. Shmerling M.D.
Beth Israel Deaconess Medical Center

There's little question that the current epidemic of obesity has come with a staggering cost to public health. Current estimates suggest that obesity-related illness accounts for $150 billion and 300,000 premature deaths each year in the United States.

The number of conditions linked to excess weight is large and growing. They include:

Type 2 diabetes
High blood pressure (hypertension)
Heart disease
Stroke
Certain types of cancer
Impaired sleep
Arthritis
But can people who carry extra weight still be healthy? Are you healthy if you're overweight or obese but physically active, have a normal blood pressure and good "metabolic numbers" (including cholesterol levels and blood sugar)? To some degree, the answers depend on our definitions of "overweight" and "obese." And there is more than just physical health at stake in the answers. Increasingly, employers or insurers provide discounts for "leanness." And, many overweight and obese people face subtle (and not-so-subtle) discrimination.

Confusion Between Terms

When it comes to discussions of health and weight, overweight people and obese people are often lumped together. Consider this quote from a recent news summary (emphasis added) that mixes the concepts of overweight and obese in the same sentence:

NBC Nightly News reported that new research suggests that individuals cannot be simultaneously overweight and physically fit. NBC's Chief Medical Editor Dr. Nancy Snyderman said that the research indicates that "there is no such thing as healthy obesity."

One of the most common (and commonly studied) ways to define healthy weight is the body mass index (BMI), which adjusts weight based on height. While it's not perfect (especially for the very young, the very old, those who are particularly muscular or women who are pregnant), it is a good place to start.

Normal weight is a BMI between 18.5 and 24.9.
Overweight is a BMI between 25 and 29.
Obesity is a BMI of 30 or greater.
In the United States, roughly a third of people are currently overweight. Another third are obese. These proportions are much higher than in prior decades.

Is "Fat But Fit" a Myth?

Two recent studies "weigh in" on this question.

The first one was published in early 2013 in the medical journal, JAMA. It analyzed data from nearly 100 studies and included almost 3 million people. It found that people who were overweight were 6% less likely to die during the average study period than people whose weight was considered normal; the obese (and extremely obese) died earlier.

This study looked only at death rates, not fitness or even how well the overweight people felt. Still, the results were a bit surprising. The study authors suggested several possible explanations, including:

Being overweight may lead to more frequent doctor visits and, perhaps, better medical care.
Having some extra body weight "in reserve" may be beneficial for a person with a serious illness or chronic disease.
The metabolic effects of extra body fat are somehow protective.
It's even possible that some people in the normal weight group had lost weight due to illness (including undiagnosed cancer) that lead to their deaths. So, despite the results of this study, being overweight doesn't necessarily have a "protective" effect. Rather, the findings could be explained by a higher death rate among those of normal weight.

The second study combined data from prior research that included more than 60,000 people. It concluded that "there is no healthy pattern of increased weight." However, this study did not find higher rates of death or heart and blood vessel events among overweight people, as long as their cholesterol, blood pressure and blood sugar levels were in a healthy range. (High cholesterol, blood pressure and blood sugar are some of the conditions that can lead to metabolic syndrome, which increases your risk of heart disease and diabetes.)

The researchers found that:

On average, the higher the BMI, the higher the blood pressure and the greater the tendency toward diabetes (as measured by the body's resistance to insulin, which is considered a key first step toward developing the disease).
The higher the BMI, the lower the HDL (the "good" type of cholesterol that tends to lower heart attack and stroke risk).
The health effects of excess weight vary for different people, perhaps due to genetics.
Obesity was linked with an increased risk of death and cardiovascular events.
People of any weight who have high cholesterol, blood pressure or blood sugar tend to have higher rates of death, as well as heart and blood-vessel disease.
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The Bottom Line

Avoiding obesity is important. But these studies suggest that you can expect to have a normal lifespan even if you're overweight, as long as you are in good metabolic health. But, keep in mind that the health impact of being overweight likely depends on which way your weight is headed. Rising BMI is linked with an increase in heart and blood vessel risk factors (including metabolic syndrome).

What about the idea that you can be obese but fit? Unfortunately, compelling evidence suggests that obesity is linked with an increased risk of death and heart events, even if one's metabolic and heart health numbers are good.

The challenge for people who are overweight is to avoid gaining even more weight and becoming metabolically unhealthy, obese or both.

amusedmonkey wrote: »

Can you smoke and not develop lung cancer? Definately! But the risk is much higher, so why risk it? Being overweight increases the risk of heart disease and diabetes, so why risk it?

Does it really? The article seems to suggest that it's not always so.

amusedmonkey wrote: »

Need2Exerc1se wrote: »

amusedmonkey wrote: »

Can you smoke and not develop lung cancer? Definately! But the risk is much higher, so why risk it? Being overweight increases the risk of heart disease and diabetes, so why risk it?

Does it really? The article seems to suggest that it's not always so.

What the article is stating is that as long as you are in good metabolic health you should be fine, and yes you could be overweight with a great metabolic health. But it also does state that the higher you slide on the BMI scale the higher your risk is of developing metabolic issues.

You could be overweight but active enough to counteract it, you could be overweight but lucky enough to have good genetics, you could be overweight by BMI but with a good fat distribution or a larger build, you could be overweight ever so slightly that you are actually at a good weight for you despite of what BMI says. Yes, all of these are possible. But if all things were equal (genetic predisposition, activity level, fat distribution.. etc) I believe a person who is within the normal range (not necessarily according to BMI) would be healthier than someone who has more extra weight.

Interesting. Why do you believe the part I bolded?