Over the past decade, a controversial new topic in healthcare has emerged. The idea that it may be possible to be overweight and healthy at the same time has rapidly gained many supporters as well as detractors.
At the source of the debate are recent studies and observations that showed people traditionally labeled “overweight” can have no signs or symptoms of being metabolically unhealthy.
In one study, individuals that were considered overweight, had normal lab tests (blood lipids, insulin, glucose, blood pressure) and were no more likely to die early than their leaner, normal weight counterparts.
This, of course, has generated much controversy since it flies in the face of research going back to the 1950’s that traditionally linked weight gain to heart disease, diabetes, Alzheimer’s, dementia and certain cancers.
Recently, a couple of Canadian studies have once again ignited the debate and challenged the notion of “healthy obesity.”
Citing flaws in previous studies, they found that so-called “metabolically healthy” obese people were still at greater risk of developing heart disease and diabetes later on in life.
So who is right? Can you be healthy and overweight? Or should simply being overweight be considered a health condition, even in the absence of current signs or symptoms of disease?
The answer is not a simple one.
First, it is important to define your terms. Being overweight and/or obese has typically been measured using Body Mass Index (BMI, average weight over average height). Often criticized for being overly simplistic, it is the standard measurement on which most studies are based.
When measuring BMI, there are many people on the margins of “overweight” category, who could be considered healthy. However, all studies show that being in the worse “obese” category always had a negative health outcome.
Second, if you measure metabolic health only by lipids, BP, glucose and insulin, then the answer is yes. Other tests such as body fat percentage, heart rate variability, MRI to determine fat around the organs, blood markers of inflammation such as A1C, CRP, homocystein and LDL particle size are newer tests that are not commonly measured, but will likely help answer this question in the future.
Finally, the major criticism of the “healthy overweight” movement has been that these studies only looked at mortality (early death) and failed to properly study quality of life and morbidity (rate of disease) in those later years.
Asking if an overweight person can be healthy, is missing the point. Body composition, weight loss and physical appearance should not necessarily be the goal of any diet or fitness program. They should be considered favorable side effects, of a healthy lifestyle.
The quality of life should be the real goal and could very well be independent of weight in some people.
The WHO defines health as: “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In other words, Health isn’t just about being “not-sick,” it is about maximizing your physical potential, mental state and healthy relationships.
In my opinion, this is a better definition of health, regardless of weight or BMI. If a person is living a healthy lifestyle, then it is unlikely they remain obese or even overweight for long.