Fat But Fit: Metabolically Healthy Obesity


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Suzanne Tucker/Shutterstock

Can you be fat and healthy at the same time? Apparently so, according to a new study by University of Pennsylvania physicians and obesity researchers who say that there are people with “metabolically healthy obesity.”

Many obese people are classified as such when their body mass index or BMI reaches a certain value. BMI, a formula based on a person’s weight and height, was invented by Belgian mathematician Adolphe Quetelet in the early 19 century and has garnered wide acceptance as a simple way to measure “fatness.” It’s quick and easy to administer – requiring only a scale and a ruler – and allows for comparison for broad populations, taking in age and country-by-country variations. Indeed, BMI is a good statistical measure of the obesity of a whole population of people.

Doctors have noted, however, that some people with BMI in the obese range are actually quite healthy and that in many cases, fat people fare better than thin ones with the same ailments. In the “obesity paradox,” researchers noted that diabetic patient of normal weight are twice as likely to die than those who are obese. Others have pointed out that thin dialysis patients are more likely to die than heavier ones.

In recent years, the medical field has began to accept that BMI is not a reliable measure of health in individuals, and that some people who are obese do not have nor are they in any danger of developing obesity-related diseases.

But how many people are actually “fat but fit” and “not fat but not fit”? The answer may surprise you. For 1 in 5 Americans, BMI may actually tell the wrong story:

– 8% of normal-weight adults in the United States are actually metabolically unhealthy
This translates to 19.2 million people whom doctors may not currently worry about but should.

– 10% of obese adults
are actually metabolically healthy
This means that 24 million chubby Americans are not in any danger of dying because of obesity-related illnesses, but are probably badgered by their family, friends and employers to lose weight.