So you lead a pretty active lifestyle and maintain a nutritious, healthy diet. You don’t smoke, you drink alcohol on occasion, but not in excess, and according to your most recent check-up, you’re perfectly healthy. But are you really healthy if you’re also classified as obese?
The term ‘healthy obesity’ implies that people who are excessively overweight can be ‘fat and fit’. Coined in the 1980s, it describes people who are obese or morbidly obese but don’t have diabetes, high cholesterol, hypertension or any of the other illnesses commonly associated with obesity.
“All obesity is not created equally,” is the encapsulating phrase borrowed from a 2017 study investigating the concept of metabolically healthy obesity.
“But the more we look at it, we see that people who are obese run into health problems later in life.”
President of the World Obesity Federation and director of Boden Institute at University of Sydney, Ian Caterson, says he doesn’t believe in the term ‘healthy obesity’. Even though you might be free of disease and feeling good now, the chances are that over the long-term poor health will catch up with you.
“It is becoming more obvious that when you become obese or have obesity, in the first few years, you may not have any health problems,” says Caterson. “But the more we look at it, we see that people who are obese run into health problems later in life.”
There are two groups of health problems faced by people with obesity. The first is metabolic diseases, like diabetes, high blood pressure and heart disease. “It appears that if you are obese and wait long enough, you will get there,” adds Caterson, who is also the director of Charles Perkins Centre Royal Prince Alfred Clinic.
The second set of problems is mechanical. The heavier you are, the more pressure you put on your joints and the more risk you face of related illnesses.
“If you’re a 40 year old who’s gaining a kilo or two a year, then that’s okay at this stage. But it won’t be okay at age 50. Or I might measure you at age 39. You are overweight or have obesity. Your other [health] signs are good now but in 10 years time, they might not be.”
How do I know if I am actually 'obese' if BMI is a flawed measure?
Body Mass Index (BMI) is what most of us will use to work out if we are a healthy weight, overweight, obese or morbidly obese. It’s a measurement that takes both your height and weight into account and charts your resulting index according to a sliding scale of health.
Caterson believes it’s a pretty accurate measurement that’s also simple and free to calculate, unlike other costly tests that need to be conducted to determine obesity. “All you need is a tape measure and a set of scales.”
However, he says, it’s not perfect. There are some instances where BMI will mistakenly classify someone as obese when they are healthy. It doesn’t work for people who are very young, those who are very old and have lost a lot of muscle mass, or individuals with a very muscular physique like athletes and body builders. There are cultural exceptions too, like various Asian races and Pacific Islanders who have different fat-muscle proportions.
“These two measurements combined – BMI and waist circumference – are a really useful indication of your health."
Caterson also explains that BMI might not generate an accurate measure of health if you have very long legs. “Because in general, you might not have much fat on your legs. So you might want to measure your waist circumference as well.”
Regardless of your build, a waist circumference measurement can indicate whether you are healthy or unhealthy because abdominal fat is the more metabolically active than fat in other areas.
The Heart Foundation says a waist measurement of over 94 cm for men and 80 cm for women is indicative of fat deposits around the body’s vital organs. This can increase the risk of heart disease and stroke.
“These two measurements combined – BMI and waist circumference – are a really useful indication of your health,” he says.
I’m obese but eat really well. Wouldn't I be healthier than other people with a poor diet?
Surely if two people who are the same height and age, eat the same amount and type of foods, and have the same level of activity each day, they will both maintain the same health status regardless of their weight. Right?
Again, Caterson says no. “If you have someone who is leaner and they eat well, they may be a little bit better off metabolically than someone who is obese or overweight who also eats healthily.”
A paper, published in 2017, shows that obese people have a higher risk of coronary heart disease than metabolically healthy normal weight.
Another study, also conducted in the UK in the same year, looked at the data of 3.5 million metabolically healthy obese adults who had no metabolic abnormalities at the time of the study. The researchers found that the obese adults had a 50 per cent increased risk of coronary heart disease, a seven per cent increased risk of stroke and a double risk of heart failure.
“If you have someone who is leaner and they eat well, they may be a little bit better off metabolically than someone who is obese or overweight who also eats healthily.”
Of course someone who is lean and in the healthy weight range may still be at risk of other conditions like diabetes, breast cancer or heart disease because of their family history. But their risk may be mitigated to some extent with a good diet and lifestyle.
“If you are obese but are eating healthily, that’s okay,” he says. “You are better off than someone who is obese and eating unhealthily but maybe what you are eating is too much for you with your current genetic pre-disposition.”
To demonstrate this point, Caterson compares siblings. “If someone is compared to their brother or sister who doesn’t have a problem with obesity, you will notice that the person who is obese will run into health issues later in life while their sibling might not or they might get sick at a much older age.
“The person with obesity may be 70 years old when they get sick but their sister is 80 when they develop the same issue. If you are obese, it’s just a matter of when.”
“You my think ‘I’m feeling pretty good now’. But you’ve got to think about the future and how you want to live in those later years of life: free of disease.”