The simple question, “Can you be healthy at any size?” has launched a fierce debate over recent years, with doctors taking both sides of the issue. The Center for Disease Control recently reported that almost 40 percent of adults and 19 percent of youth are obese, the highest rate the country has ever seen in all adults. A new study, regarded as the most extensive piece of research that has emerged so far on the subject, defends the view that “obesity is not a benign condition,” and despite the benefits of maintaining “body positivity,” a confident outlook on carrying extra weight will not suffice for the health dangers that it poses.
Much of the controversy surrounding the “fat vs. fit” debate stems from BMI, a method of determining health with a ratio of height and weight, proven to be inaccurate when it comes to differentiating weight from muscle from weight from fat. The study argues that even participants experiencing what is commonly referred to as “metabolically healthy obesity,” or obesity free of complications like high blood pressure, high cholesterol, and diabetes, still had a 50 percent higher chance of coronary heart disease than their healthy-weighted peers. Their metabolic health, still in tact, did not exempt them from cardiovascular complications of obesity. Participants with BMI categorized as “overweight” had a 30 percent higher risk of coronary heart disease. “The bottom line,” said study author Dr. Rishi Caleyachetty, of the College of Medical and Dental Sciences at the University of Birmingham in England, is that metabolically healthy obesity doesn’t exist.”
The researchers studied health records from 1995 to 2015 within the Health Improvement Network, a database from the United Kingdom’s general health practices. They identified records for 3.5 million people free of cardiovascular issues and divided them into groups according to their BMI, based upon whether they had diabetes, hypertension, abnormal blood fats, or any other metabolic abnormalities. The risks of heart disease appeared to be the same across the board, regardless of metabolic health. “The priority of health professionals should be to promote and facilitate weight loss among obese persons, regardless of the presence or absence of metabolic abnormalities,” said Dr. Caleyachetty,
Opposers of the new study are quick to call out its lack of detail where physical exercise is concerned; many “overweight” and “obese” people enjoy the same benefits of physical activity as people of a healthy BMI, and in turn reap the same health benefits of improved mood, energy, sleep, and arguably, lower risk of disease. Dr. Caleyachetty agrees with critics that exercise can play a critical role in helping cardiovascular risk, stating, “Those people who are metabolically healthy, obese and vigorously active may have a decreased risk of developing cardiovascular disease.”
While both sides can agree upon is the importance of exercise in staving off disease, Caleyachetty and his team hope that the study will deter individuals and health professionals from deeming extra weight “healthy” as long as it checks all the metabolic boxes. “Metabolically healthy obese individuals had a higher risk of coronary heart disease, cerebrovascular disease, and heart failure than normal weight metabolically healthy individuals. Even individuals who are normal weight can have metabolic abnormalities and similar risks for cardiovascular disease events,” the study concluded.