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Can you be obese and healthy?

While being overweight is a precursor to obesity and, like obesity, can increase the risk of diabetes, heart attack and stroke, it's also possible to be overweight and still healthy, especially if you're free from chronic diseases like hypertension or diabetes.

wexnermedical.osu.edu - Can you be overweight but healthy? | Ohio State Medical Center

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Author: Sophia Tolliver, MD, MPH

The relationship between health and weight is complex. The concept of weight speaks to how much your whole body weighs—your weight is comprised of not only fat/adipose tissue, but also bone, water weight, organs, skin, muscles and more. What constitutes a healthy weight is dependent on the individual. While being overweight is a precursor to obesity and, like obesity, can increase the risk of diabetes, heart attack and stroke, it’s also possible to be overweight and still healthy, especially if you’re free from chronic diseases like hypertension or diabetes. However, it’s important to keep in mind that many studies have shown an association between excess weight and adverse health outcomes and shorter life spans, especially if your waist circumference is greater than 39 inches for men and 34 inches for women. The way we discuss weight can further be categorized by body mass index, or BMI.

How to think about BMI

Anytime I talk about BMI with my patients, the first thing I say is that I don’t want them to get caught up in the numbers but rather focus on the range and category. Additionally, know that this range is temporary and heavily influenced by what you eat and how often you move. The formula for calculating your BMI is weight x 703 ÷ height. According to BMI standards, underweight is considered under 18.5, normal weight is 18.5 to 25, overweight is 25 to 30 and obese is over 30. However, BMI doesn’t distinguish between muscle and fat and, thus, can be skewed, especially because muscle weighs more than fat. So a very muscular person could be categorized as obese when, in fact, they might be very healthy. BMI can be a good conversation starter, but the real focus should be on barriers to exercise or eating more healthily. You can work with your doctor to formulate a plan of action for success in these areas.

How can you know if your weight is healthy?

Using the BMI range is helpful, however, looking at body fat percentage can be a good tool, as well. It’s not a regularly used method, but measuring body fat percentage can also give us an idea of where your weight status lies, without the possible confusion between muscle and fat weight. Generally, 26-31% body fat is considered to be within a normal range. Above 31% body fat is considered above average, and it’s recommended to try to reduce fat mass at that point.

Maintaining a healthy weight

Maintaining a healthy weight is a long-term construct and the activities necessary to achieve that goal really come down to repetitive, consistent behaviors. I often tell my patients they’ll have the best chance at long-term success if they take things “one decision, one day at a time,” then build upon those successes. Build your successes slowly; slow progress is good. Quick fad diets will likely have you back to the drawing board. Don’t be too hard on yourself—if you mess up, get right back up and don’t dwell on the failure. Tomorrow is another day to get it right. Sophia Tolliver is a family medicine specialist at The Ohio State University Wexner Medical Center.

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What are the three stages of obesity?

Class 1: BMI of 30 to < 35. Class 2: BMI of 35 to < 40. Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “severe” obesity.

cdc.gov - Adult Body Mass Index - Overweight & Obesity - CDC

1Garrow, J.S. & Webster, J., 1985. Quetelet’s index (W/H2) as a measure of fatness. Int. J. Obes., 9(2), pp.147–153. 2Freedman, D.S., Horlick, M. & Berenson, G.S., 2013. A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children. Am. J. Clin. Nutr., 98(6), pp.1417–24. 3Wohlfahrt-Veje, C. et al., 2014. Body fat throughout childhood in 2647 healthy Danish children: agreement of BMI, waist circumference, skinfolds with dual X-ray absorptiometry. Eur. J. Clin. Nutr., 68(6), pp.664–70. 4Steinberger, J. et al., 2005. Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents. Int. J. Obes., 29(11), pp.1346–1352. 5Sun, Q. et al., 2010. Comparison of dual-energy x-ray absorptiometric and anthropometric measures of adiposity in relation to adiposity-related biologic factors. Am. J. Epidemiol., 172(12), pp.1442–1454. 6Lawlor, D.A. et al., 2010. Association between general and central adiposity in childhood, and change in these, with cardiovascular risk factors in adolescence: prospective cohort study. BMJ, 341, p.c6224. 7Flegal, K.M. & Graubard, B.I., 2009. Estimates of excess deaths associated with body mass index and other anthropometric variables. Am. J. Clin. Nutr., 89(4), pp.1213–1219. 8Freedman, D.S. et al., 2009. Relation of body mass index and skinfold thicknesses to cardiovascular disease risk factors in children: the Bogalusa Heart Study. Am. J. Clin. Nutr., 90(1), pp.210–216. 9Willett, K. et al., 2006. Comparison of bioelectrical impedance and BMI in predicting obesity-related medical conditions. Obes. (Silver Spring), 14(3), pp.480–490.

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