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December 5, 2013

Healthy Obesity?

Overweight people with good blood profiles are still at far greater risk of heart attack and death than their normal weight peers.

Not everyone who is overweight is unhealthy, right? Think of that chubby actor who is so quick and light on his feet. And isn't it better to be a little overweight than painfully thin?

Myths about obesity abound, including the misconception that you can be overweight or obese and still be healthy. At least that's what a new Canadian study says.

When the investigators reviewed data from studies done over the past 60 years, they found that there is no such thing as being healthy and overweight or obese. Even those people whose cholesterol and triglycerides are well within the normal range are still at far greater risk for heart attacks, diabetes and death.

There is no such thing as being healthy and overweight or obese.

People who are metabolically healthy, with normal lipid levels, glucose tolerance, and blood pressure, but who are still obese are more at risk for death and cardiovascular events over the long term, compared to metabolically healthy, normal-weight individuals, according to Ravi Retnakaran, an author of the study.

The findings are not entirely surprising, but they make an important clinical point. “These data suggest that increased body weight is not a benign condition even in the absence of metabolic abnormalities, and argue against the concept of ‘healthy obesity’ or ‘benign obesity.’ ” Retnakaran is a clinician-scientist at the Leadership Sinai Centre for Diabetes at Mount Sinai Hospital in Toronto.

Using data from more than 61,000 people, the researchers found that people who were metabolically healthy but obese had a greater risk of cardiovascular events death, but this increased risk only begins to show up when studies with 10 or more years of follow-up were considered. All metabolically unhealthy groups, whether obese or not, had a similarly elevated risk of death and/or cardiovascular events. People who were normal weight and had metabolically healthy lipid profiles were at lowest risk.

Patients should discuss healthy weight ranges with their doctor, as well as the implications of weight on their health, including the metabolic effects of excess weight, says Retnakaran.

Both body mass index (BMI) and metabolic status should be considered when evaluating a person’s health risks, the authors write. And an editorial accompanying the study insists that both physicians and patients need to acknowledge that healthy obesity does not exist. They should focus on managing and treating obesity as they would any other chronic condition.

The study and the related editorial were published online recently in the Annals of Internal Medicine.
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