The message that obesity is unhealthy is drilled into our heads. We see reports on the news and watch shows like NBC’s The Biggest Loser (and the commercials that air during it, which are often filled with diet pills and exercise programs), and the resounding message is this: “Drop the weight;" “Get healthy;" “Being fat is no good."
But what if it’s not that simple? What if “obese” isn’t a catch-all term equal to “unhealthy?"
'Obese' isn’t a catch-all term equal to 'unhealthy.'
In fact, new studies shed light on a subgroup of obesity, called metabolically healthy obesity (MHO), in which obese individuals do not demonstrate an increased risk for developing negative health issues often associated with obesity, such as metabolic syndrome or cardiovascular disease Metabolically healthy obesity: definitions, determinants and clinical implications. Phillips C.M., Reviews in Endocrine & Metabolic Disorders. 2013 Sep;14(3):219-27. While researchers work to better understand this type of obesity, recognizing that obesity is a nuanced condition with a diverse set of possible outcomes may lead to new ways in which we treat obesity and even think about what it means to be obese.
What’s the Deal?
The concept of MHO is fairly new so a solid definition is still in the works, but it's generally described as an obesity phenotype, or a group of characteristics in a person that result from the interaction between his or her environment and genetics Metabolically healthy obesity: definitions, determinants and clinical implications. Phillips C.M., Reviews in Endocrine & Metabolic Disorders. 2013 Sep;14(3):219-27. Put another way, it’s a type of obesity that develops from a combination of a person’s own unique genes, his or her lifestyle, and the environment they inhabit. One study using the body mass index (BMI) measurement found the prevalence of MHO in obese individuals ranged from six to 36 percent (This wide range accounts for the lack of a clear definition of MHO) Defining Metabolically Healthy Obesity: Role of Dietary and Lifestyle Factors. Phillips, C., Dillon C., Harrington, J., et. al. Health Research Board Centre for Diet and Health Research, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland,Department of Statistics, University College Cork, Cork, Ireland, PLoS One. 2013; 8(10): e76188..
It seems that age and body-fat distribution might play a role in determining who is more likely to be metabolically healthy: One study found that sustained metabolic health in obese individuals was more likely to happen to those under 40 and those whose fat distribution was centered less on the waist Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: a cohort study. Appleton S.L., Seaborn C.J., Visvanathan R., et. al., Diabetes Care. 2013 Aug;36(8):2388-94. doi: 10.2337/dc12-1971. Epub 2013 Mar 14. In contrast, excess fat around the stomach can contribute to metabolic syndrome, a collection of factors that increases the risk for health problems like diabetes, stroke, and heart disease.
It may be that the amount of fat on an individual’s body matters less than the type of fat and how it’s distributed.
Greatist Expert Dr. Aaron Mauck, a health services researcher specializing in diabetes and cardiovascular disease, affirms that body shape and fat distribution can play a role in determining the health consequences of obesity.
“Apple-shaped figures, characteristically a male phenomenon, are associated with metabolic syndrome,” Dr. Mauck says. He points out that obese women are still at risk of health complications from obesity but are less prone to metabolic syndrome, even at a higher level of obesity. “If you carry [excess weight] in your hips, legs, or breast tissue, that does seem to be a healthier, or safer, obesity.”
In other words, when it comes to determining long-term health outcomes, it may be that the amount of fat on an individual’s body matters less than the type of fat and how it’s distributed on the body.
Still, some studies suggest that individuals with MHO, regardless of a lack of current metabolic issues, are still more at risk for long-term negative health outcomes (including type 2 diabetes and metabolic syndrome) compared to
“normal-weight,” metabolically healthy individuals Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Kramer CK, Zinman B, Retnakaran R., Annals of Internal Medicine. 2013 Dec 3;159(11):758-69. doi: 10.7326/0003-4819-159-11-201312030-00008. Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan. Hwang L.C., Bai C.H., Sun C.A., Asia Pacific Journal of Clinical Nutrition. 2012;21(2):227-33..
Why It Matters
Metabolically healthy obesity may exist, but that doesn’t mean the lack of immediate risk for cardiovascular disease or type 2 diabetes equates to a clean bill of health—in much the same way that being “skinny” doesn’t guarantee that a person has no risk of developing more serious health issues. The important thing to remember is that all of us—regardless of our weight—should take efforts to protect our health now and down the line.
Eating well and maintaining an active lifestyle are important for everyone looking to promote long-term health.
“Some aspects of health we have no control over, related to genetics and luck. But the important thing is that there is so much that we can control,” says Greatist Expert Dr. James Hardeman, a practicing physician for 30 years. “Everyone, including those who are overweight, should be vigilant in detecting the “Big 3”—hypertension, hypercholesterolemia [high cholesterol], and diabetes—and do something about them if present,” such as consulting a doctor and making lifestyle changes.
Obesity is an ever-evolving and complex topic, and lumping people into one category does nothing to help laypeople and medical professionals understand the experiences, needs, and health factors involved. Even if the concept of “healthy obesity” is still being explored, taking steps to eat well and maintain an active lifestyle is important for everyone looking to promote long-term health.