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December 3rd, 2013
03:04 PM ET

Study: There's no such thing as healthy obesity

You've probably heard someone say, "I'm fat but fit." Several recent studies have suggested this statement could be true. But a new review of existing studies published this week in the Annals of Internal Medicine may put a stop to the rumor.

"Healthy obesity" is just a myth, the study authors say.

Some background

Scientists know that overweight people can be what they call "metabolically healthy." This means that despite having a high body mass index, or BMI, someone can have a small waistline, normal blood pressure and low cholesterol levels, and show little to no risk for developing diabetes. The opposite is also true; thin people can be metabolically unhealthy, with high blood pressure, high cholesterol and fat that accumulates only around their middle, which is a known risk for heart disease.

This kind of paradox highlights "the complexity of the relationship between weight and mortality," the authors of this new meta-analysis write. A lot of factors impact a person's cardiovascular health, including how much they exercise and when they put on the weight.

The study

The researchers evaluated the eight studies, which included a total of more than 60,000 participants. All of the studies had recorded participants' BMI and their metabolic status, as well as any fatal or nonfatal cardiovascular events, such as a heart attack.

Data analysts split the participants into five groups:

– Metabolically unhealthy and normal weight
– Metabolically unhealthy and overweight
– Metabolically unhealthy and obese
– Overweight but metabolically healthy
– Obese but metabolically healthy

They then compared the number of cardiovascular events that happened in each of these groups with their control group: a sample of normal weight, metabolically healthy people.

The results

As they expected, the researchers found that their control group - the normal weight, metabolically healthy people - had the fewest cardiovascular events of all the groups.

They also found that being metabolically unhealthy puts you at a higher risk for cardiovascular disease, even if you're in the normal BMI range. In fact, the metabolically unhealthy thin people had the same risk as the metabolically unhealthy obese group in the short-term.

Perhaps more surprising was that they found little difference in the risk for heart disease between metabolically healthy overweight individuals and  metabolically healthy normal weight people. The same was true for metabolically healthy obese people.

So why do they say healthy obesity is a myth?

Because when researchers looked specifically at studies that followed participants for at least 10 years, it showed the metabolically healthy obese group had an increased risk of death and cardiovascular events compared to those of normal weight.

And why have some previous studies suggested you can be overweight and healthy?

The study authors say those studies included metabolically unhealthy individuals in the "normal weight" control groups, which influenced their results.

Caveats

Every study has a caveat - something the scientists couldn't control for or didn't analyze that may be affecting the results. The studies analyzed by these scientists did not always have adequate information on the participants' health behaviors, such as what they ate or whether they smoked, and did not collect data about the participants' weight gain over time.  Plus, not every age group was represented equally in these studies.

Takeaway

Excess weight will affect your body, even if the damage isn't apparent now, the study authors say.  And normal weight people shouldn't consider themselves healthy without checking their cholesterol, blood pressure and glucose levels.

"Obesity is taking a toll on the health and well-being of Americans," Drs. James Hill and Holly Wyatt write in an accompanying editorial in the journal. "Accepting that no level of obesity is healthy is an important step toward deciding how best to use our resources and our political will to develop and implement strategies to combat the obesity epidemic."


soundoff (148 Responses)
  1. Elen

    As a former weight management specialist, I can't tell you the number of clients who have told me how frustrating, embarrassing and painful it is to be overweight. They are ashamed of their condition and of the perception others have that they should be able to manage their weight. They hate flying because they cause discomfort for others. They are afraid their spouses find them unattractive. The list goes on. It is a cruelty to them to join in their collective denial that they are trapped and helpless in this situation. There are solutions that have little to do with crash dieting, expensive weight loss programs, and running marathons. We need to treat them with the respect they deserve by not sugar-coating the truth and letting them know the risk they are putting their health in. When we do that we give them the tools they need to be successful.

    December 4, 2013 at 11:09 | Report abuse | Reply
    • w

      sugar-coating is the last thing we should be doing!

      December 4, 2013 at 14:18 | Report abuse |
  2. Mithrael

    Nowhere in the cited study do the authors say "healthy obesity is a myth", but rather in an editorial of the study, written by doctors that run the Anschutz Health and Wellness Center for weight loss. No conflict of interest there. Link: http://annals.org/article.aspx?articleid=1784298.

    December 4, 2013 at 11:58 | Report abuse | Reply
    • Third Eagle of the apocalypse.

      The conclusion is quite clear. As if common sense couldn’t have told you the same thing. You are in denial.

      December 10, 2013 at 12:00 | Report abuse |
  3. scourge99

    The actual results of the study show that being metabolically healthy is FAR better than being metabolically unhealthy. Regardless of whether you are overweight or not.

    Being obese and metabolically healthy is insignificantly worse than being normal weight and metabolically healthy.

    As usual, a reporter has to dramatize and play word-games with the ACTUAL results. What comes out is a story that's inaccurate and a misrepresentation of the actual facts.

    December 4, 2013 at 12:18 | Report abuse | Reply
    • sqeptiq

      I guess in your world, cardiac events are "insignificant."

      December 4, 2013 at 22:18 | Report abuse |
    • kdw31

      It is how much does the risk increase. According to the study being metabolically unhealthy increased the risk of cardiac events significantly more than being metabolically healthy and obese.

      Eight studies (n = 61 386; 3988 events) evaluated participants for all-cause mortality and/or cardiovascular events. Metabolically healthy obese individuals (relative risk [RR], 1.24; 95% CI, 1.02 to 1.55) had increased risk for events compared with metabolically healthy normal-weight individuals when only studies with 10 or more years of follow-up were considered. All metabolically unhealthy groups had a similarly elevated risk: normal weight (RR, 3.14; CI, 2.36 to 3.93), overweight (RR, 2.70; CI, 2.08 to 3.30), and obese (RR, 2.65; CI, 2.18 to 3.12).

      December 4, 2013 at 22:51 | Report abuse |
    • jennyct

      And being metabolically healthy and overweight vs obese? I am going to assume that it remains the same as previously... it's healthier than being metabolically unhealthy and normal weight.

      December 6, 2013 at 12:57 | Report abuse |
    • Third Eagle of the apocalypse.

      You are the one trying to misrepresent the facts. The reporter dumb-ed it down for you and you’re still not getting it.

      December 10, 2013 at 12:02 | Report abuse |
  4. Patricia

    Considering that wasted hormones and environmental toxins make their way to fat cells and are stored there indefinitely then carrying around excess fat is toxic to the body. It is no coincidence that health epidemics such as colon cancer are killing too many people in our population. Storing extra fat in one's body is very damaging and no study needs to confirm this. Understanding what is contained in that fat cell is all you need to know. Fat = toxic.

    December 4, 2013 at 12:58 | Report abuse | Reply
  5. myrtlemaylee

    Apparently the only constant in medical studies is: results = who funds the study. The results consistently went one way until researchers were informed of patients BEHAVIORS that allowed labels to be applied. Then, all of a sudden, the same results had to be viewed in a different light.

    The best gig in the world is doing taxpayer funded health studies. Personally, I'm sick of the daily or weekly contradictions. How about if western medicine promotes health & healthy behaviors without resorting to fear, blame & confusion?

    December 4, 2013 at 13:42 | Report abuse | Reply
    • Pete

      This study didn't necessarily contradict the other studies, it just accounted for metabolically health people vs non metabolically healthy people. The previous studies just divided people into obese/fat vs thin. There are plenty of people who were thin but unhealthy that were throwing off numbers in the previous studies.

      December 4, 2013 at 23:22 | Report abuse |
    • Third Eagle of the apocalypse.

      Your lack of understanding the scientific method is your failure not other.

      December 10, 2013 at 12:04 | Report abuse |
  6. Jakerman

    My older sister who has gained weigt as many do when they get older checks out very healthy with colesterol, blood pressure and no health woes at this point. My brother and i who have been fit all our lives have had high blood pressure among a few other serious things. Go figure.

    December 4, 2013 at 13:49 | Report abuse | Reply
    • Helena

      High blood pressure and high cholesterol shows up after many years of bad nutrition. This means that you can look thin, but you started to eating unhealthy food from childhood, the side effects will show later in life.

      December 4, 2013 at 19:43 | Report abuse |
    • Third Eagle of the apocalypse.

      Jake .. you are allowing yourself to come to a conclusion based on assumptions and an obvious lack of medical knowledge. I’m sure you are a very intelligent person and would benefit greatly from discussing this with your doctor. He/she will explain it to you in a much more reliable way that comments on the CNN bored from people trying to justify their obesity.

      December 10, 2013 at 12:07 | Report abuse |
  7. Piña

    Personally, I believe that overwieght people are LAZY in terms of loosing weight. It is simple, if you want to loose weight, exercise and get on a diet. Genes can play a role, but it depends on the will the person has to loose those extra pounds.

    December 4, 2013 at 14:34 | Report abuse | Reply
    • Nobody you know

      It's LOSE. Not "loose."

      Now watch Cog come along to throw a hissy fit.

      December 4, 2013 at 15:10 | Report abuse |
    • chazz

      You certainly have a right to your opinion Pina, but you cant use your own facts. Obesity is a complicated metabolic issue with complicated causes. Do you have any idea what sleep apnea is, or what it does to metabolism and lots of other body processes. Do you not realize that exercise is a major problem for those with arthritis and many other disabilities. Do you happen to have an effective diet which can be applied/practiced by most everyone in our world? Do you have a way to supply healthy food to all these people who should diet? Go play in the traffic and see how long you last. Go tell anyone with health problems that willpower is the solution to everything wrong with them.

      December 5, 2013 at 07:36 | Report abuse |
    • dave

      No, obesity is simple, eat more than you burn = gain weight. Eat less lose weight. When that does not work, it is because of self-deception and denial. It

      December 6, 2013 at 09:52 | Report abuse |
    • jennyct

      It is not being "lazy." It's being able to find the perfect balance for your own body. You can have two "similar" bodies, with two similar diets and still have one gain weight. And as much as I want to believe it's calories in/calories out, what you eat does "appear" to make a difference. We know that BMI IS genetically influenced, almost as much as environment is. This is not a one size fits all approach because we are told NOT to go below 1200 calories and believe it or not some people will not lose weight at that intake without some manipulation of other factors (increase muscle mass, eat less carbs (quick energy)).

      December 6, 2013 at 13:04 | Report abuse |
    • Third Eagle of the apocalypse.

      You are right Pina. Laziness is a huge part of the problem. A simple observation of those in your workplace of who takes the stairs every time and who will wait for an elevator to go one/two flights can be pretty informative. But that isn’t the only issue. Most obese people are slightly delusional and very uneducated on the subject. They believe that because they ordered a diet soda with their combo meal… they are doing something to lose weight. They believe because they actually took the stairs for once means its okay to eat the triple chocolate muffin WITH their normal lunch. They believe you can eat as much as you want as long as it says “diet, fat free, sugar free” and still lose weight. The “genes’ excuse is just that. There is no gene that makes you fat. Genes CAN effect how easy it is to gain or lose weight but that’s all. Medical conditions that affect your metabolism do exist but the VAST majority of obese people are not affected by this. They have never been diagnosed with any such thing. They simply read articles online and twist the information to justify their poor health habits.

      December 10, 2013 at 12:17 | Report abuse |
  8. Rick

    So...fat-shaming is still a thing. Take that fluffy people!

    December 4, 2013 at 15:17 | Report abuse | Reply
    • Third Eagle of the apocalypse.

      Shame is a great motivator.

      December 10, 2013 at 12:18 | Report abuse |
  9. cali girl

    Now in the days of Gastric Bypass being available to all, what are the ramifications of that drastic weight loss? A friend had the lap band and was so sick she could eat nothing and lost weight drastically. What effects did that have on their organs? Curious to see if studies will come from these procedures to see if they are really life savers or a death sentence.

    December 4, 2013 at 15:25 | Report abuse | Reply
    • dave

      Lap band surgery is like treating liver disease by removing a kidney. Obesity comes from the brain, not the stomach. Quacks performing stomach disfigurement (lap band surgery) should all lose their licenses.

      December 6, 2013 at 09:50 | Report abuse |
    • Third Eagle of the apocalypse.

      @cali
      They’ve already done several studies on the effects. Feel free to google.

      @Dave
      You are spreading misinformation. The surgeries have proven to be very effective. You are half right though. Obesity does come from the brain but some people need a little more help. It’s the equivalent of putting a cone-collar on your dog so that he doesn’t bite himself. Please do some googling of your own. The requirement for an insurance company to allow such a surgery are extensive and include tradition dieting supervised by a physician and theory.

      December 10, 2013 at 12:23 | Report abuse |
    • Third Eagle of the apocalypse.

      Therapy

      December 10, 2013 at 12:24 | Report abuse |
  10. Baal

    Duh, No "S", Sherlock!!!!

    December 4, 2013 at 17:00 | Report abuse | Reply
  11. Bert

    Really? What is Jim Fixx's opinion?

    December 4, 2013 at 18:54 | Report abuse | Reply
  12. EdL

    This study likely has merit. However these studies keep coming at us, suggesting something new has been discovered but more than half of these studies by researchers have small merit, some bordering the ridiculous, e.g., the study by researchers that discovered school girl pregnancies resulted from their addiction to motherhood.

    December 4, 2013 at 21:28 | Report abuse | Reply
  13. Pete

    Nobody likes to admit that they are headed down a destructive path. Doesn't matter whether it is an obese person, smoker, or alcoholic. The first step is admitting you have a problem. Don't worry about blame, just get help.

    December 4, 2013 at 22:31 | Report abuse | Reply
    • Offthepink

      They won't admit it to themselves, that's why blame is still a thing. Someone has to point it out, and make it negative for them to WANT to do something about it. Otherwise, a 12 will happily continue convincing herself she is still a size 5 instead of facing reality.

      February 14, 2014 at 07:05 | Report abuse |
  14. andrew

    We'll all be dead in a relatively short time anyway, I'll choose to spend my time, although abbreviated, basking in the pleasures of Double Whoppers with cheese.

    December 5, 2013 at 01:37 | Report abuse | Reply
  15. Your Living Body

    Why did they only look at BMI? BMI is useless. You mean to tell me that a 5'10" football player who is 220 pounds (obese by BMI standards) but has a 6% body fat percentage is unhealthy? Shenanigans. I call shenanigans.

    December 5, 2013 at 11:56 | Report abuse | Reply
    • dave

      Only a tiny percentage of people are muscular athletes - BMI works for most people

      December 6, 2013 at 09:46 | Report abuse |
  16. Jen

    So how old does a fat person have to be before he dies of "old age" instead of "obesity"?

    December 6, 2013 at 01:08 | Report abuse | Reply
    • dave

      why would you want fat people to get old, we need the space now

      December 6, 2013 at 09:47 | Report abuse |
  17. dave

    There is no such thing as a Sasquatch, a Loch Ness Monster, or a BBW - but if they did exist, they would all weigh about the same

    December 6, 2013 at 09:45 | Report abuse | Reply
  18. dave

    You do not ask a gambler how he did at the track; he will lie.

    You don't ask a drunk how much she had to drink; she will lie.
    You don't ask the obese if they are healthy; they will lie.

    December 6, 2013 at 09:56 | Report abuse | Reply
  19. James

    What about Offensive and Defensive Lineman those guys may be heavy as hell but they are professional Athletes and can run faster and lift heavier weights than the average joe?

    December 6, 2013 at 10:45 | Report abuse | Reply
  20. poopmeister

    I don't think we are really hearing anything that we didn't already know in our "gut"...excuss the pun. What we should be talking about is the food industry here in the US. Other countries don't have the problems that we do, because they have a better regulated system. There are quite a few countries that have banned GMOs and we have trouble putting regulations to at least label them....come on, that's pathedic. With McDonalds costing less to purchase than a home cooked meal...it's a problem. You can exercise all you want but if you are still ingesting crap, you ain't gonna be healthy.

    December 6, 2013 at 18:20 | Report abuse | Reply
  21. olympia

    narly facts this is great for a report i doing

    December 7, 2013 at 18:26 | Report abuse | Reply
  22. Arlee

    There are so any different variables to this, and different scientists are all getting different results, why can't we just let this be and for the people who want to be skinny or are already skinny stay or become skinny and for the people who want to be fat stay fat and let them be.

    im pretty sure no person that is overweight will read this article and think, "hm, now that scientists think its not possible to be healthy and fat, i should work on losing weight".

    December 8, 2013 at 15:25 | Report abuse | Reply
  23. Maria

    This summary of the study's results almost implies that metabolic health is evenly distributed throughout the populations. I suspect that is not true. So, the real question is, what percent of the normal weight and overweight/obese populations are metabolically healthy? If metabolic health is what reduces risk, but we find few occurrences of metabolic health within a given weight group, whatever weight group that may be–that's something significant.

    December 9, 2013 at 10:56 | Report abuse | Reply
  24. Samantha

    My last pay check was $9500 working 12 hours a week online. My sisters friend has been averaging 15k for months now and she works about 20 hours a week. I can't believe how easy it was once I tried it out. This is what I do,
    w*w^w . Best96 . c^o*m-

    December 9, 2013 at 11:41 | Report abuse | Reply
  25. TransFatShake

    Eat me.........

    December 9, 2013 at 15:13 | Report abuse | Reply
  26. EdL

    Holy Cow! Another 'study' by 'researchers'. How fortunate we are!

    January 1, 2014 at 20:30 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.