Can you really be obese yet healthy?

April 11, 2018

A new paper has called for an end to the term 'healthy obesity', due to it being misleading and flawed. The focus should instead be on conducting more in-depth research to understand causes and consequences of varying health among people with the same BMI.

The term 'healthy obesity' was first used in the 1980's to describe obese individuals who were apparently healthy -- for example they didn't suffer with hypertension or diabetes.

Dr William Johnson, from the School of Sport, Exercise and Health Sciences at Loughborough University, emphasizes in the journal Annals of Human Biology that the construct of 'healthy obesity' is limited. This is because categorizing a population using cut-offs (e.g., BMI > 30 kg/m2 and blood pressure < 140/90 mmHg) results in some normal weight and obese individuals being labelled 'healthy', when there are obviously health differences between the two groups.

However, Dr Johnson does acknowledge that there are health differences between obese individuals with the same BMI and explains that there should be further investigation into contributing factors such as being obese for longer, adverse early life events, and smoking during adolescence. Such research would explain why one person has a disease or dies, while another with the same BMI (or waist circumference) is fine. Dr Johnson explains, "It is undeniable that obesity is bad for health, but there are clearly differences between individuals in the extent to which it is bad."

"While the concept of healthy obesity is crude and problematic and may best be laid to rest, there is great opportunity for human biological investigation of the levels, causes, and consequences of heterogeneity in health among people with the same BMI."

"While epidemiology has revealed many of the life course processes and exposures that lead to a given disease, we know relatively little about the things that occur across someone's life that lead to them having a heart attack, for example, while their friend with the same BMI is fine. Existing birth cohort studies have the data necessary to improve knowledge on this topic." Johnson suggests.

With obesity at epidemic levels worldwide, such research could inform the development of more stratified disease prevention and intervention efforts targeted at individuals who have the highest risk.
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