Can you be overweight or obese and healthy?

It’s widely accepted that being overweight or obese can increase the risk of conditions like heart disease, diabetes, stroke, and some cancers. But is carrying extra pounds really so unhealthy?

It’s a complicated question. It’s true that excess weight doesn’t always translate to health issues. Metabolic health is your body’s ability to use food for energy. It’s measured largely via blood sugar, blood pressure, and cholesterol levels. Some people who are overweight or obese are also metabolically healthy.

But don’t dismiss the importance of eating a well-balanced diet, exercising, and maintaining a healthy weight for your body. Over time, excess weight can take a toll.

Defining the risks

A person’s risk for weight-related health issues doesn’t depend solely on the numbers that appear on the scale. Nor does it depend on any other single measure of weight. There are many different measurements and factors to take into account. Healthcare providers (HCPs) often consider the following.

Body mass index

Body mass index (BMI) is a measure used to determine body fat based on a person’s height and weight. It’s typically used to assess the risks weight has on health. By definition, overweight people have a BMI of 25 to 29.9. Obese people have a BMI of 30 or higher.

“I use risk to define everything,” Neil McDevitt, MD, a bariatric surgeon in Mount Pleasant, South Carolina. “There's a lot of social issues that go into what people feel comfortable with, so we use a BMI chart to give us an overall gestalt of what your general risk is, based on your weight,” he adds.

But BMI is a flawed measure. “There's a weakness inherent in BMI charts,” Dr. McDevitt says. “It doesn't take into consideration muscle mass.” Because muscle weighs more than fat, a muscular person—such as an athlete—may have a high BMI.

Since BMI doesn’t account for body composition or fitness, it shouldn’t be used by itself to determine a person’s disease risk. Combining it with other measurements can create a more detailed picture of health.

Waist-to-hip ratio

The amount of fat a person carries is a factor for disease risk. So is that fat’s location on the body. Metabolic syndrome is a group of conditions that increase the risk of heart disease, stroke, and diabetes. One major risk factor of metabolic syndrome is a large midsection, often described as an “apple-shaped” figure.

Research suggests that people who tend to carry weight around their middle have a higher risk of death from any cause compared to people who are overweight or obese and carry weight elsewhere.

“We look at something called the waist-to-hip ratio,” McDevitt says. “The World Health Organization (WHO) says that abdominal obesity is significantly more of a risk factor than obesity of the periphery of the body.”

Waist-to-hip ratio is a comparison between the smallest part of the waist and largest part of the hip. For men, a ratio of 0.9 or greater is considered to be an apple shape, according to the WHO. For women, the ratio is 0.85 or more. A higher ratio carries a greater potential for health risks.

Other factors

Exercise ability also helps determine the impact of extra weight on health. “There's a huge difference between somebody who has a higher BMI, who is only able to walk 1,000 steps a day, versus somebody who is capable of walking 9,000 or 10,000 steps a day,” McDevitt says.

Genetics play a major role in weight and health, as well. Depending on genes, for example, some people may naturally have higher or lower cholesterol or blood pressure levels. This can greatly affect disease risk.

Age is another significant factor. For people ages 65 and older, the healthiest BMI may be in the overweight range. Body composition changes as time passes, and a few extra pounds could actually be protective.

Extra weight and overall health

A BMI that is indicative of being overweight or obese doesn’t necessarily mean a person is unhealthy. “What I look at is sustainability—if somebody has a BMI of 27 or 28, but they’re healthy, making good food choices, exercising, and they’re able to maintain that BMI, then I don’t really foresee an issue,” McDevitt says. “Why should we push them any harder, unless they want to be a lighter weight?”

It's understood, however, that being overweight is linked to some health risks, which increase for people who are obese. And the higher the amount of body fat, the greater the disease risk.

Being obese and metabolically healthy isn’t common. And even if a person with obesity starts off in good health, the way the body deals with extra weight can change with age, lack of exercise, and damage to joints, muscles, and bones. Research has consistently shown that people who are obese and metabolically healthy are still much more likely to develop heart disease, stroke, and other weight-related conditions over time.

Ultimately, while carrying extra pounds may be workable for some, excess weight is a risk for many. Nearly three in four adults in the United States are considered overweight or obese, and have greater chances of developing related health problems.

What if your weight is an issue?

Many health conditions linked to being overweight or obese can be managed with weight loss. In the simplest terms, losing weight is a matter of burning more calories than you consume. For advice and recommendations, visit an HCP. They can assess your risk and work with you to create a diet and exercise regimen that works best for your personal situation.