- Researchers say people who are overweight or obese can still be metabolically healthy and avoid conditions such as type 2 diabetes and high blood pressure.
- Experts say a person’s overall health can be influenced by their type of diet and the amount of their physical activity.
- Researchers say they hope their study will help dispel some of the myths surrounding obesity.
The way the “obesity crisis” is often framed would make most people think that being overweight or obese makes you automatically unhealthy.
However, new research suggests it’s possible to be overweight or obese and still be metabolically healthy.
The new study, published in the journal JAMA Network Open, reports that the number of metabolically healthy obese (MHO) people is rising.
MHO is defined as having a body mass index score (BMI) over 30 but having no other metabolic disorders such as high blood pressure, elevated blood sugar, or increased triglycerides.
From 1999 to 2018, researchers say, the number of all MHO individuals climbed from 3% to 7%. Among adults, the rate increased from 11% to 15%.
“The study is good in the sense that it supports the fact that we should look beyond BMI to define health,” said Dr. Ana Marie Kausel, an endocrinologist and co-founder of Anzara Health. “Not every obese person is unhealthy.”
“What makes a person MHO is what kind of fat is elevated,” Kausel told Healthline. “We have subcutaneous fat, visceral fat, and liver fat. It takes much more for subcutaneous fat to create disease. It takes only one pound of liver fat to create disease. Visceral fat is somewhere in the middle. If you eat more calories in general, you might gain more subcutaneous fat, but if you drink a lot of sugar and eat a lot of processed foods, it’ll all go to the liver and create liver fat.”
How race, socioeconomic factors play a role
The study authors note that factors such as race and socio-economic status play a part in who is or isn’t metabolically healthy regardless of the number on the scale.
“The overall increase in the proportion of MHO should also be treated in the context of existing disparities in subpopulations,” the researchers wrote. “Among racial and ethnic subgroups, we observed a significant increase in the proportion of MHO only in non-Hispanic White adults, which may be attributed in part to higher income, wider insurance coverage, more accessible health services, sociocultural differences, and other social determinants. Previous studies have suggested that higher-income groups tend to have improved diet quality, increased adherence to physical activity guidelines, and decreased smoking prevalence, which may contribute to favorable trends in the proportion of MHO.”
“I think this study has a lot going for it,” Yelena Wheeler, MPH, RDN, a dietitian based in Los Angeles, told Healthline. “I also see this study impacting physicians and other health practitioners in the way they view their obese patients and constantly pointing to obesity as the root cause of every ailment. I hope it will steer our healthcare into looking at the root cause of medical issues rather than pinning everything on the concept of losing weight and assuming everything will improve.”
“Fit fat” and other factors
This research adds complexity to the discussion around weight issues and obesity, broadening the understanding of the health risks.
For instance, several studies have shown that people with equal levels of physical activity and cardiorespiratory fitness have the same all-cause mortality, regardless of whether they’re normal weight, overweight, or obese.
In addition, staying physically active can decrease your risk of dying from heart disease independent of your BMI score.
There are other factors, too.
For instance, the degree of obesity appears to matter in terms of risks to one’s health. A 2013 JAMA study of nearly 3 million people found that obese people with a BMI of 30 to 35 had no higher all-cause mortality rate. Those with BMI scores higher than 35 had significantly higher all-cause mortality.
Meanwhile, overweight people with a BMI of 25 to 30 had lower all-cause mortality during the study compared to people categorized as normal weight, suggesting some degree of excess weight might be protective.
“Obesity is a multi-layered condition that does not always follow typical stereotypes of an individual being gluttonous or lazy,” Wheeler said. “The focus as a nation striving for better health is to recognize that people can be healthy at every size.”
As for becoming more active, Wheeler said finding what works for you is essential.
“The key factor for activity is listening to one’s body and doing activities that bring you joy. If being in nature and taking a walk outside brings one the most joy, then going to a stuffy gym and having someone scream at you to do countless reps may not be the best exercise for you,” said Wheeler. “Knowing oneself and finding things that spark activity joy is key.”
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