Can You Really Be Healthy At Every Size?

ome people believe you can be healthy at any size. While it is simply not true, what many people don’t know is that it is possible to have a high BMI, and still be healthy. A BMI between 25-29.5 means you are overweight. A BMI of 30+ and you’re generally considered obese. What does that mean about how healthy you are?

The health risks associated with a BMI this high: hypertension, high LDL (“bad”) cholesterol, high triglycerides, high blood sugar, premature death and disability[1]. There are also two types of healthy obesity: Type I and II. If you’re obese, you may also have one of these types of healthy obesity.

Healthy Obesity Type I

Healthy obesity Type I was recognized as a subtype of obesity in 2009. It is found in 10% to 30% of the 27% of adults identified as obese[2]. What differentiates healthy obesity Type I from unhealthy obesity is its healthy metabolic profile and low risk of cardiovascular disease. Even more interesting is that adults with metabolically healthy obesity Type I appear to be harmed if they lose weight[3].

While adults with unhealthy obesity are at risk for disorders like insulin resistance, type 2 diabetes, dyslipidemia, gout, hypertension and cardiovascular disease[4], adults with metabolically healthy obesity Type I are not. One difference between adults with unhealthy obesity and metabolically healthy obesity is that the latter have higher levels of physical activity[5].

Several follow-up studies confirmed the more beneficial health profile associated with metabolically healthy obesity Type I compared to unhealthy obesity[6,7]. However, the prognosis for metabolically healthy obesity Type I still has a down side. Recent studies have found that both unhealthy and metabolically healthy obesity Type I share the same risk of early mortality[8,9]. More research needs to be done.

If you’re obese, but engage regularly in some form of physical activity, there is a good chance that you have the metabolically healthy obesity Type I. If you do, then you don’t have to worry much about it progressing to diabetes, but dying prematurely is still an important consideration.

Healthy Obesity Type II

The definition of healthy obesity Type II is simple and can be illustrated in a personal story.

About a year and half ago, at the age of 59, I weighed about 267 lbs. and my body fat percentage was approximately 34%. At that point, my wife started going to the gym. I went along with her and started to weight train – it was time for some advice.

Body IO® coach Alex Navarro is a fitness genius. She recommended upping my protein intake to over 200g per day to get the maximum benefit in muscle growth from the weight training. She also introduced both my wife and me to Kiefer’s Carb Nite® and Carb Backloading™. We both began to lose weight rapidly. Alex also told us something very important that went unappreciated at the time: Don’t focus on the weight scale; focus on inches lost.

To track my fat loss and BMI, I downloaded the Navy Body Fat Calculator on my smart phone. Based on inputs of height, weight, neck circumference, and waist circumference, it calculated an estimate of body fat percentage. I reduced my carbs and calories for eight months. The lowest weight I reached was 242 lbs. At that point, my body fat percentage was down to about 28% and my BMI was down to 31. In other words, I was still obese. Frustrating! Alex told me that it was probably because of my gain in lean muscle.

Suffice to say, I didn’t believe her.

As I played with the Navy Body Fat Calculator to figure out how much I had to lose to reach a body fat percentage of 15%, it dawned on me. The biggest impact on body fat percentage happened when I reduced my waist size. Without changing anything else, if I could get my waist size down to 39 inches, my body fat percentage would go down to around 17%, even at a weight of 250 lbs!

The same thing is true for women. A woman who is 35, 5 ft. 10 in. tall, and weighing 175 lbs. with a waist size of 38 in. and a hip size of 35 in. has a poor body fat percentage of 30%. She is also technically overweight, with a BMI of 25.1. However, if the woman can reduce her waist size to 29 in. and change nothing else, her body fat percentage decreases to an excellent 18.5%, despite still being overweight with the same BMI.

Back to what Alex said: focus on the inches!

After more research, there it was: study after study showing that waist circumference as opposed to BMI was the biggest predictor of obesity-related health risks[10-13].

It felt very liberating to discover healthy obesity Type II!

Healthy obesity Type II is the kind of obesity that Arnold Schwarzenegger had back in 1967, when at 6 ft. 2 in. and 246 lbs., boasting a BMI of 31.6 (Class I), he competed and won as an amateur bodybuilder with a waist size of 32 inches. The fact is, BMI as a predictor of health risks breaks down for bodybuilders and fit women with decent muscles because it overestimates body fat for people who are very muscular and physically fit[14].

While the muscle mass-BMI relationship is not new, knowing about it may be encouraging to many of you who have a higher BMI,but are still healthy.

I have a confession to make: I am still “obese.” My BMI is 31, putting me at the Class I level of obesity. Yes, my BMI classifies me as obese, but I really don’t worry about it, because it’s a healthy type of obesity. Realizing that there is a healthy type of obesity is a real relief. That scale weight matters less than what you’re made of and how you exercise.

The last time Alex visited, she measured my body fat percentage in three different ways and arrived at an average body fat percentage of 20%. Not great, but much better than before. My goal is to get down to 15%. My waist size is down to 40.5 in., so I only have 1.5 in. to reach 39 in. and a body fat percentage of 17%. Then, it will only take one more inch to get to 15%! This morning, I weighed in at 248 lbs. Based on my height, my BMI of 31.7 hasn’t changed much, but I really don’t care.

I’m in active pursuit of healthy obesity Type II.

[expand title=”References (click to expand)”]

1. US Department of Health and Human Services, National Heart, Lung, and Blood Institute.Assessing Your Weight and Health Risk. https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm
2. Levy, J. U.S. Obesity Rate Inches Up to 27.7% in 2014.(2015, January 26) https://www.gallup.com/poll/181271/obesity-rate-inches-2014.aspx
3. Wildman, R. P. Healthy obesity. Current Opinion in Clinical Nutrition & Metabolic Care. 2009; 12(4), 438-443.
4. Blüher, M. The distinction of metabolically ‘healthy’ from ‘unhealthy’obese individuals.Current Opinion in Lipidology. 2010; 21(1), 38-43.
5. Velho, S., Paccaud, F., Waeber, G., Vollenweider, P., & Marques-Vidal, P. Metabolically healthy obesity: different prevalences using different criteria. European Journal of Clinical Nutrition. 2010; 64(10), 1043-1051.
6. Pajunen, P., Kotronen, A., Korpi-Hyövälti, E., Keinänen-Kiukaanniemi, S., Oksa, H., Niskanen, L., … & Peltonen, M. Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey. BMC Public Health. 2011; 11(1), 754.
7. Hamer, M., & Stamatakis, E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality.The Journal of Clinical Endocrinology & Metabolism. 2012; 97(7), 2482-2488.
8. Hinnouho, G. M., Czernichow, S., Dugravot, A., Batty, G. D., Kivimaki, M., & Singh-Manoux, A. Metabolically Healthy Obesity and Risk of Mortality Does the definition of metabolic health matter?.Diabetes Care. 2013; 36(8), 2294-2300.
9. Kramer, C. K., Zinman, B., & Retnakaran, R. Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Annals of Internal Medicine. 2013; 159(11), 758-769.
10. Smith Jr, S. C., & Haslam, D. Abdominal obesity, waist circumference and cardiometabolic risk: awareness among primary care physicians, the general population and patients at risk–the Shape of the Nations survey*. Current Medical Research and Opinion®. 2006; 23(1), 29-47.
11. Janssen, I., Katzmarzyk, P. T., & Ross, R. Waist circumference and not body mass index explains obesity-related health risk. The American Journal of Clinical Nutrition. 2004; 79(3), 379-384.
12. Klein, S., Allison, D. B., Heymsfield, S. B., Kelley, D. E., Leibel, R. L., Nonas, C., & Kahn, R. Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Obesity. 2007; 15(5), 1061-1067.
13. Seidell, J. C. Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea.European Journal of Clinical Nutrition. 2010; 64(1), 35-41.
14. Mayo Clinic, BMI Calculator. https://www.mayoclinic.org/diseases-conditions/obesity/in-depth/bmi-calculator/itt-20084938

[/expand]