Can You Be Overweight and Healthy?

The answer might surprise you.

We know that carrying some extra weight can increase the risks of conditions like heart disease, high cholesterol, elevated blood pressure, diabetes, stroke and even death. But is being slightly overweight really so unhealthy? The answer might surprise you.

Excess weight and a laundry list of health concerns are not always synonymous. But, don’t be so quick to ward off a healthy diet and exercise—this subgroup of overweight people, dubbed the metabolically healthy obese, fit some very specific criteria.

Defining the risks

Body mass index: An individual’s risks for these conditions don’t depend solely on the numbers that appear on the scale, nor on any other single measure, like body mass index. 

Body mass index (BMI) is a measure used to determine body fat based on a person’s height and weight, and is typically used to assess the risks your weight has on your health, but even that is an imperfect measure.

“I use risk to define everything,” Neil McDevitt, MD, a bariatric surgeon with Summerville Medical Center says. “There's a lot of social issues that go into what people feel comfortable with, so we use a BMI chart to give us an overall gestalt of what your general risk is, based on your weight,” he adds.

By definition, overweight and obese people have a BMI greater than 25 or 30, respectively, but, “there's a weakness inherent in BMI charts,” McDevitt says. “It doesn't take into consideration muscle mass.”

That’s not all. The healthiest BMI for longevity might not fall within the normal range (18.5 to 25), although the jury is still out on the optimal BMI for lowest mortality. In fact, one study suggests the “sweet spot” for longevity is a BMI of 27, which you’ll find right in the middle of the overweight range. Other studies, still, suggest the lowest rates of mortality are among those with a BMI between 20 and 24.    

Waist-to-hip ratio: Concerns over weight may not be directly related to how much fat a person is carrying, but where on the body they’re carrying it. One major risk factor of metabolic syndrome is a large midsection, often described as an “apple-shaped” figure.

In fact, a new study suggests those with a normal BMI who tend to carry weight around their middle have an elevated risk of death from any cause compared to people who are overweight or obese, and carry weight elsewhere.

“We look at something called the waist-to-h ratio,” McDevitt says. “The World Health Organization says that abdominal obesity is significantly more of a risk factor than obesity of the periphery of the body.”

The measure used to determine fat distribution is known as waist-to-hip ratio—a comparison between the smallest part of the waist and largest part of the hip. A ratio of one or greater for men and .8 or greater for women, is considered an apple shape, and thus carries a greater potential for obesity-related health risks and death.   

In combination with BMI, waist circumference gives a good picture a person’s risk of obesity-related mortality—even if you fall within a healthy BMI range.

Other factors: Exercise tolerance and genetics play a role in determining the risks of your weight on your health, as well. “There's a huge difference between somebody who has a higher BMI, who is only able to walk one thousand steps a day, versus somebody who is capable of walking nine or ten thousand steps a day,” McDevitt says.

Good genes can very well bless an overweight individual with normal cholesterol and blood pressure levels, thereby relieving some pressure to shed the pounds.

Extra pounds may be OK

“What I look at is sustainability—if somebody has a BMI of 27 or 28, but they’re healthy, making good food choices, exercising and they’re able to maintain that BMI, then I don’t really foresee an issue,” McDevitt says. “Why should we push them any harder, unless they want to be a lighter weight?”

The bottom line? A BMI that is indicative of being overweight or obese doesn’t innately make in individual unhealthy. “So, it is very possible, and very acceptable, to be overweight and still be healthy,” McDevitt says.

Before you run to the pantry, keep in mind, metabolically healthy obesity isn’t common—about one in every seven people—and it might not last forever. Age, lack of exercise and other factors can turn that excess weight into a dangerous health concern.

One study with a 10-year follow up period found that men who started out metabolically healthy and obese were three times more likely to develop heart disease than metabolically healthy men of a normal weight. The risk doubled for metabolically healthy obese women when compared to healthy, normal-weight women.

Results from another study of more than 3.5 million men and women suggest a similar outcome. Obese individuals who began the study free of obesity-related conditions like diabetes, high blood pressure and high cholesterol were at a higher risk of developing heart disease, stroke and heart failure than normal weight people without these initial complications.

When compared with healthy normal weight people, obese, but otherwise healthy individuals, were 49 percent more likely to develop heart disease, at a 7 percent higher risk of stroke and at a 96 percent increased risk of heart failure, after an average of 5 years and 4 months.

Although extra baggage is OK for some, excess weight is a problem for many—two out of three Americans are considered overweight or obese, and many of them are unhealthy.

What if your weight is an issue?

There are certainly some people whose bodies aren’t built to handle excess weight. In these cases, they may develop metabolic syndrome—a group of risk factors that up your chance of developing issues like heart disease and diabetes.

Excess weight can also take a toll on your knee and hip joints, your ability to sleep and has been linked to respiratory issues and even some cancers. Don’t sweat (or do)—many of these conditions can be managed with weight loss. In the simplest terms, losing weight is a matter of burning more calories than you consume.    

The only sure fire way to assess these risks is to visit your doctor. Work with your healthcare provider to create a diet and exercise regimen that works with your lifestyle. “Adjust your lifestyle, so that you don't have to work harder,” McDevitt says. “If you make better food choices consistently, you don't necessarily have to make up for it at the gym.”

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