The Healthy Overweight

by Miller Chandler | Exercise physiologist, educator, blogger, and Owner of Foundation Wellness, LLC, an onsite wellness-services provider located in Nashville, Tennessee.

According to the World Health Organization (WHO), “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Music to the ears of this wellness professor. It is, indeed, progress that the WHO now defines health in a manner historically reserved for the more comprehensive, umbrella term “wellness.” In my estimation, this elevates areas that have been deemphasized in the past — topics such as mental/emotional health and physical fitness — to a much higher status. So, following the definition of “complete physical, mental and social well-being,” is it possible for one to be obese based on body mass index (BMI) and still be overall healthy? With this more comprehensive view of health taking hold, will “healthy but overweight” eventually be viewed as complete contradiction?

When I teach my wellness classes at Belmont University in Nashville, and we begin discussing BMI, which is based solely on a ratio between one’s weight and height, I always like to point to the example of a certain former running back for the Tennessee Titans to place things in perspective. In his playing years, former Pro Bowler Eddie George stood at 6’3” tall and weighed 240 pounds. If viewed solely through the prism of BMI (weight in kilograms/height in meters squared), he would have been considered very overweight — just shy, in fact, of obese. However, this info, must of course be further qualified. During the lead-up to the Titans’ Super Bowl run in 1999, sources listed George’s body-fat percentage as being an amazingly low 3 percent. In fact, if his percentage had been any lower back then, it would’ve been considered too low. And obviously he was an incredible athlete, running the 40-yard dash in 4.5 seconds and punishing NFL defenses with his take-no-prisoners rushing style. Clearly BMI alone was not the best way to assess his size and whether it was or was not healthy.

But what about the average, pretty athletic guy? The gym rat, who loves to lift, has a similar weight/height ratio as George, but has a, say, 15-percent body fat? For a male, this body-fat percentage is still good, especially if we are talking about a middle-aged man. But does he do cardio? How is his diet? Is his stress level okay? Is he getting enough rest?

We could use similar female examples based on relevant body-fat norms and the same types of questions. The point would remain the same: If a person’s BMI is well above 25 kg/m2, then he/she had better be extremely healthy and fit otherwise and very muscular, or else he/she is at elevated risk for chronic disease.

A few years ago, Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health, and some of his colleagues defined the term “metabolically healthy obesity” as obesity existing alongside:

  • a waist size of no more than 40 inches for a man or 35 inches for a woman
  • normal blood pressure, cholesterol, and blood sugar
  • normal sensitivity to insulin
  • good physical fitness

So, ostensibly these obese individuals are categorized as low risk health wise. However, the same researchers warn that this condition is rare. And in the overwhelming majority of cases, when individuals are obese there are negative metabolic effects and ensuing chronic disease. They also caution that this state of seeming metabolic health can change.

In a 2016 meta-analysis of 22 prospective studies, researchers investigated the link between individuals presenting with the metabolically healthy obese (MHO) phenotype and risk of all-cause mortality (death from all causes) and cardiovascular disease (CVD). These individuals did not show an increased risk in all-cause mortality when compared to “metabolically normal healthy weight” individuals; however, they did present an increased risk for CVD. These studies, which involved over 580,000 participants, support the idea that, although this obesity subgroup might be healthier than their metabolically challenged counterparts, they are still at increased risk for chronic disease.

The bottom line for people to remember is that, as common sense would dictate, more active is better than less active, and (to a point) leaner is better when it comes to health. But one also must know that, although directly related, sedentary lifestyle and obesity are CVD risk factors independent of one another.

Therefore, one should always try to strike the right balance. If you are being physically active, but your BMI is still well north of 25, then, yes, you are healthier than you would be if you were sedentary. But you would be healthier (assuming you aren’t Eddie George) if you would do more exercise or tweak your diet or both, so that you can remove this CVD risk factor as well.

And if you keep a balanced approach, taking frequent “stand-up breaks” at the office in order not to be sedentary; taking the stairs rather than the elevator and walking whenever possible in order to increase physical activity; following the type of dietary advice you will find on choosemyplate.gov; and getting in regular exercise five days a week — then the weight (and body-fat percentage) will more than likely take care of itself. And your physical, mental, and social well being will be one step closer to being complete.