Does ‘Healthy Obesity’ Actually Exist?

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Society’s conversation about weight is complicated. On the one hand, Americans — and a lot of others — really do eat way too much, really are overweight, and really do incur all sorts of devastating health difficulties as a result. On the other hand, everyone is constantly being peppered with unrealistic, damaging conceptions of what constitutes a “healthy” body (thigh gaps, anyone?), causing a lot of perfectly healthy people to feel insecure over the fact that they have a few more curves than the average model.

There’s a fair amount of evidence that one’s height and weight don’t tell the whole story. For one thing, the so-called body mass index measure that determines who is and isn’t overweight or obese is widely recognized as seriously flawed. And, perhaps more interesting, some people exhibit signs of “healthy obesity” as the Times’ Anahad O’Connor put it in 2013, despite being very overweight, they “have normal cholesterol levels, healthy blood pressure levels and no apparent signs of impending diabetes.”

Researchers are naturally interested in these folks, who serve as living counterpoints to the otherwise well-buttressed notion that obesity is really bad for you. But some research, cited by O’Connor, suggests that for many people, healthy obesity is really just a stopover on the way to unhealthy obesity — stay obese long enough, in other words, and those once-healthy metabolic indicators will begin to falter.

A letter just published in the Journal of the American College of Cardiology bolsters this idea. The authors, led by Joshua A. Bell of University College of London, analyzed data from the Whitehall II cohort, a big group of British government workers whose health was tracked over the course of decades, and asked a simple question: What was the health trajectory of people who qualified as healthy obese early on in the Whitehall study?

The key paragraph:

After 20 years, approximately one-half of healthy obese adults were unhealthy obese, and only 10% were healthy nonobese. Healthy obese adults were nearly 8 times more likely to progress to an unhealthy obese state after 20 years than healthy nonobese adults, and these subjects were consistently more likely to make this adverse transition than unhealthy nonobese adults.

In other words, assuming that what goes for British government workers goes for everyone else, if you’re healthy obese today, there’s a very heightened risk you’ll be unhealthy obese tomorrow — or in a decade or two — as compared to your slimmer neighbors.

This does, of course, leave half of the healthy obese adults in the study who were able to remain in that state for two decades. Figuring out how some people can pull this off is going to remain a very intense area of study for obesity researchers. In the meantime, the same old boring advice as always still applies: One of the more beneficial things you can do for your body is to control your weight.