Can I Be Overweight and Still Healthy?

Dear Lifehacker,
I’m an overweight man who has struggled to lose weight my entire life. My doctor tells me that my BMI is in the “overweight category.” To be honest, I’m happy with my body. I don’t have any medical issues and I try to live healthily as much as possible. Is it possible to be overweight and still healthy?

Sincerely,
Happily Overweight Harold

Dear Harold,
Thanks for the note. The first thing we need to ask is what does it mean to be “overweight?”

You might have heard of the Body Mass Index (or BMI), the metric that is frequently used to measure “body fatness.” It’s important to note that this isn’t always the best metric, but it’s an easy one to determine, which is why many doctors default to it. However, as obesity physician Dr. Spencer Nadolsky explains, it does have some limitations:

A lean young male with a BMI of 27 is very different from an abdominally obese post-menopausal female with the same BMI. BMI doesn’t take many things into account, such as muscle mass. If everyone could get their body fat measurements taken via DEXA, doctors would just use that, but that isn’t always feasible.

As Dr. Nadolsky mentioned, body fat percentage is a much better metric to use. For example, my BMI is 28, which is only two away from obesity, but I’m not overweight, because I have a relatively low body fat percentage. This number is difficult to obtain, however, and often requires expensive equipment for high accuracy.

In lieu of body fat percentage, Dr. Nadolsky says that you can use your BMI in conjunction with waist measurements. This method is cheap, effective, and allows you to understand some of the limitations of BMI. You can find out how to use these measurements, along with their limitations here.

When Being Overweight Leads to Health Issues

We’ve learned about some weight-related metrics, but this tells us nothing about what it means to be “overweight.” That term, by definition, implies that one needs to lose weight, so let’s look at the specific cases when this needs to happen.

The risk of weight-related illness rises when your weight goes up. For example, if you already have insulin resistance, type II diabetes, or heart disease, then you need to lose weight. If you don’t have these illnesses, you can be overweight and healthy, depending on certain health markers. According to Dr. Nadolsky:

You can still be healthy and overweight. While the BMI cutoff of overweight is 25 to 30, there are plenty of individuals who are healthy in this range. We generally look closer at metabolic markers of health when in that range and also distribution of weight and body composition. Blood pressure, glucose, and lipid markers must be examined as well in order to determine risk profile.

Obviously, only your doctor can tell you if you are at risk for these diseases. It’s possible, however, that you’re not at risk and don’t need to lose weight for health reasons. Dr. Yoni Freedhoff, author and owner of Weighty Matters who also runs one of the largest obesity clinics in Canada, explains:

I’m about two pounds away from being “overweight” and I’m pretty healthy. Health isn’t measured in pounds. No doubt, the risk of weight related illnesses rise with weight, but being skinny doesn’t prevent a person from ill health, nor does having obesity guarantee problems.

Weight does increase the risk of medical problems, and so prevention might be a fair argument in favor of loss. But it’s also worth noting is that healthful lifestyles mitigate the risk of most chronic diseases, regardless of weight.

But according to Dr. Nadolsky, there is one exception: exceptionally high BMI. He states that even if your current health markers are fine, as BMI increases beyond 30, recent research suggests that weight-related illnesses (heart disease, diabetes, metabolic syndrome, and arthritis to name a few) can occur down the road:

There are three classes of obesity, each with escalating risks.

• 30-34: Class 1 Obesity. This is a bit of a grey zone in terms of risks. It’s important to look at waist measurements as well as labs from your doctor.

• 35-39: Class 2 Obesity. Risks increase further.40+:
• 40+: Class 3 Obesity. This is the highest class with the highest risks.

If your BMI is in one of the categories above, then you probably need to lose weight. Just because you don’t have any health issues today, it doesn’t mean that you won’t have any tomorrow.

Making the Decision to Lose Weight

A word of caution here. There’s a tendency to use articles like this to justify complacency with weight and health, even if you really should lose weight. If this applies to you, don’t gleam the parts of this article that allow you to rationalize reasons not to.

If you are completely healthy, then the only other reason to think you’re overweight is if you want to be leaner for personal reasons. In this case, you can lose weight by changing your diet and starting an exercise regimen. If you don’t have any health-related risks or illnesses, whether or not you’re medically overweight is your choice, and no one can tell you that you are—they don’t know what your lipid profile or relationship to your body is like.

Other than that, there is no reason for a healthy person without a high-risk BMI to lose weight. According to Dr. Freedhoff, living a healthful life is much more important:

If the life being lived is healthful, and that person’s weight isn’t affecting their quality of life, there’s certainly no urgency to lose weight. If a person exercises regularly, eats healthfully, gets good nights of sleep, doesn’t smoke, doesn’t drink to excess, and cultivates friendships, they’re probably going to do pretty darn well in life in general.

So, Happily Overweight Harold, I’ll leave you with this: your initial question is flawed. If you are truly healthy and happy with your body, then you are not overweight at all.

Sincerely,
Lifehacker

Images by Tania Anisimova (Shutterstock), Michael B, and Alan Cleaver.

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