Research update: No such thing as “healthy obese”

Along with the uptick in the “beauty at any size” mentality has arisen the concept of “healthy obesity.” I’m a huge proponent of self-love and building confidence through health and fitness. But I’m not going to sugar coat a major health epidemic or tell any one that it’s ok to be obese, and now the science supports that.

Healthy obesity is a condition defined as being clinically obese (BMI > 30) but metabolically healthy. In other words, a “healthy obese” person is technically obese based on weight and body fat, but does not have complications such as abnormal triglyceride levels, high cholesterol, insulin resistance or diabetes, and high blood pressure. In past years, the idea that someone could be obese and healthy, fat and fit has shown up in numerous “news” articles and blog posts, and has no doubt influenced a dangerous acceptance of a serious medical condition. Possibly one of the largest health studies ever conducted has now shown this notion to be totally misguided.

The Study

Using 20 years of health records (1995-2015), researchers from The Institute of Applied Health Research at the College of Medical and Dental Sciences, University of Birmingham, UK assembled a cohort of 3.5 million adults who were all initially free of cardiovascular disease (CVD) to determine the effect of various metabolic conditions on health outcomes. These 3.5 million people were divided into groups based on metabolic health as determined by BMI and the presence or absence of three metabolic abnormalities. The groups were then given a metabolic abnormalities score of 0-3. Essentially the comparison groups consisted of normal weight people with no metabolic abnormalities, obese people with no metabolic abnormalities (MHO, or metabolically healthy obese), and obese people with metabolic abnormalities.

The Results

The study confirmed that, when compared to normal weight people with no metabolic abnormalities, metabolically healthy obese people are still at a significantly increased risk for coronary heart disease (CHD), cerebrovascular disease (i.e., stroke), heart failure, and peripheral vascular disease (PVD) despite the absence of metabolic abnormalities.

Specifically, the researchers found that, when compared to normal weight people with no metabolic abnormalities, individuals with MHO had:

  • 50% increased risk of CHD;
  • 7% increased risk of stroke;
  • 96% increased risk of heart failure; and
  • 11% increased risk of PVD.

Demographics and smoking behavior were controlled for when making these comparisons, and all of the above listed results were statistically significant.

The Lesson

As study author Dr. Rishi Caleyachetty contends, “so-called metabolically healthy obesity is not a harmless condition” and we should veer away from using this term to classify people. Health professionals should make it a priority to promote healthy weight loss among all obese individuals, regardless of the absence or presence of metabolic abnormalities.

As part of the health industry, personal trainers, nutritionists, and other health and fitness promoters should also prioritize healthy weight loss for all obese individuals. We all have a responsibility to promote health and help people live healthy lives, and not buying into this idea of healthy obesity is essential to this purpose.

Resources

The study discussed in this article was first presented as this year’s European Congress on Obesity.

Science Daily. “Healthy obese” people still at higher risk of cardiovascular disease events than general population. May 16, 2017.

WebMD. “Healthy obese” may be a myth. May 17, 2017.

Metro, UK. You can’t be both obese and healthy, says study of 3.5 million people. May 17, 2017.

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