People tend to assume that obesity is synonymous with ill health. It is a common belief that thin individuals are healthy, while people with obesity are not. It might be valid to some extent. However, someone with obesity needs not necessarily develop atherosclerosis, insulin resistance, or other metabolic complications. Such people have metabolically healthy obesity. However, the term, healthy obesity, can be misleading at times. Because while obese people can be healthy today, they might not be healthy tomorrow. Obesity on its own carries certain risk factors, thereby making “Healthy Obesity” medically an oxymoron.
What is Healthy Obesity?
You’re obese if your body mass index (BMI) is greater than or equal to 30. Obesity is often associated with metabolic abnormalities. Metabolic syndromes include increased inflammation, nonalcoholic fatty liver disease, hypertension, dyslipidemia, and type 2 diabetes. Unfortunately, metabolic syndromes are rising among men, women and children in development, due to changing lifestyles and urbanization.
Metabolically healthy obesity or MHO is a subset of obesity. It is known simply as healthy obesity. There is no universally acknowledged criterion for defining it. However, an obese person who lacks metabolic abnormalities such as metabolic syndrome, impaired glucose tolerance, and dyslipidemia is healthy obese. In contrast, metabolically unhealthy obesity increases the risk of adverse cardiometabolic outcomes.
What is the Possibility of Being Healthy and Obese?
In recent years, healthy obesity has been a critical part of clinical and epidemiological studies. According to a study based on the health records of 3.5 million people, about 14.8% were obese with no metabolic abnormalities. Therefore, these people were obese but healthy. Further, 25.7% of people from the observed pool were overweight with no significant signs of ill health. Interestingly, the prevalence of healthy obesity was more likely among younger individuals who never smoked. Moreover, it has been that around 10% to 25% of obese individuals, irrespective of gender and race, are initially healthy.
Over 5-10 years, individuals in the healthy obese category start showing signs of obesity-related disorders. For example, they become more likely to develop heart disease, have a stroke, high blood pressure, and diabetes. That’s because being healthy is usually brief. Metabolically healthy obesity can turn into metabolically unhealthy obesity gradually. The likelihood of obese people staying healthy is directly related to age, diet, lifestyle choices, and physical activity.
Health professionals conclude that in comparison to unhealthy obese patients, people with healthy obesity show favourable metabolic function and are less likely to acquire adverse outcomes. However, when compared to non-obese individuals, metabolically healthy obese people are at a higher risk of cardiovascular disease.
Why Does Healthy Obesity Happen?
Genetic factors might play a role in determining if you belong to the healthy obese or non-healthy obese category. Relative to unhealthy obese individuals, those with healthy obesity have reduced inflammation, smaller fat cells, and less visceral fat tissues. A study investigated if inflammation influences the division between healthy and unhealthy obese people. And as per the results, those with lower levels of inflammation had a greater likelihood of metabolically healthy obesity.
In addition to inflammation, the following factors can be why some people with obesity stay healthy.
Though there is limited scientific evidence, sleep duration and overall sleep quality may be indicators. It is important for an individual to have at least 7 to 8 hours of deep sleep. Sleep deprivation tends to disrupt metabolic processes in the body. Thus, getting uninterrupted and quality sleep is crucial in maintaining metabolic homeostasis. A good night’s sleep is one factor that keeps obese people metabolically healthy. Furthermore, a cross-sectional study shows that metabolically healthy obese individuals have slightly better overall sleep quality. However, this is in contrast to those with metabolically abnormal obesity.
Not all people with obesity lead a sedentary lifestyle paired with high-calorie intake. Some obese people choose healthy food options and stay physically active, making them healthy obese. Following a consistent exercise schedule and a balanced diet can improve overall health, regardless of whether they are obese or not. Some lifestyle habits that make an obese person healthy are:
- Eating five or more servings of fruits and veggies daily
- Exercising for a minimum of thirty minutes a day
- Avoiding or limiting alcohol intake
- Quit smoking
What Are the Risk Factors of Healthy Obesity?
The risk factors of healthy obesity are not different from unhealthy obesity. Both are functions of your diet and exercise habits. Still, they can also get influenced by medical conditions, medications, and injuries. For example, some medical conditions lead to unexpected weight gain, which causes obesity. A few of the diseases that can serve as obesity risk factors are:
- Insulin resistance
- Polycystic ovary syndrome (PCOS)
- Prader-Willi syndrome
- Cushing’s syndrome
The following medications lead to weight gain:
- Anticonvulsants or seizure treating medicines such as valproate and carbamazepine
- Prednisone and other corticosteroids
- Sulfonylureas, Insulin and thiazolidinedione are examples of diabetes medications.
- Beta-blockers, for example, are used to treat high blood pressure.
The Transition of Healthy Obesity to Unhealthy Obesity
Compared to metabolically unhealthy obese persons, a person with healthy obesity leads a better lifestyle and is less severely obese. However, when a person with healthy obesity becomes metabolically unhealthy, it simultaneously increases bodily dysfunctions and health issues. Thus, healthy obesity is a temporary phase leading to metabolic syndrome and insulin resistance.
Some of the health risks that accompany the transition are:
- Bone and cartilage damage or degeneration
- Gallbladder disease
- Sleep apnea
- Respiratory Problems
- Coronary artery disease
- High blood pressure
- Type 2 Diabetes
- Colorectal cancer
Should Someone With Healthy Obesity Seek Treatment?
Obesity is a worldwide health concern. It is bound to cause mild, moderate, or severe health complications. For this reason, it is essential to go for professional consultation, irrespective of healthy obesity or unhealthy obesity. An easy way to do it is by downloading the HealthifyMe app.
Obesity Friendly Diets
There are numerous kinds of diet and meal plans available for obesity. The most straightforward and most effective approach is to choose a calorie deficit plan. To lose weight, you need to burn more calories than you eat. Avoid processed foods and sugary snacks while increasing your whole grains, fruits, vegetables, and lean protein intake.
You might not find the ideal diet plan on the first try. It can be a process of trial and error. Find what works best for you and your fitness goals. Any diet or meal plan will only be effective when you do it consistently and strictly adhere to it.
Calorie counting is vital in obesity management. However, do not obsess over it. You can use calorie tracking and fitness apps like HealthifyMe to count calories accurately and simplify the process.
Staying active promotes healthy living. It can help you lose weight and prevent the transition from healthy obesity to unhealthy. In the beginning, aim for thirty minutes of brisk walking or jogging. Then, work your way up, including resistance training and cardiovascular activities to your exercise schedule.
While dieting, obese people lose muscle mass with fat which is absolutely normal since in later stages of weight management it is recommended to gain some muscle mass.. Incorporating bodyweight exercises can help combat muscle loss.
Healthy or not, obesity requires medications to subside the side effects. Sometimes, doctors prescribe medicines for weight loss. Qsymia, liraglutide, and orlistat are some common examples. However, a medication that works for one person might not work for you. Ask your doctor for the medication that suits your lifestyle and diet.
Surgery is the recommended approach for people with a BMI range of 30 to 35. However, before opting for a surgical procedure, the doctors look at several other parameters. BMI is an indicator and not an absolute measure. Some start healthy but are vulnerable to extreme health fluctuations. Weight loss surgery makes your stomach smaller, thereby reducing the food intake. Doctors recommend them for those at risk of developing weight-related severe problems. However, people with healthy obesity must try a non-surgical approach as the first-line treatment. Even small dietary and lifestyle changes offer considerable benefits. These options include liposuction, and bariatric surgery (Roux-en-Y gastric bypass, adjustable gastric banding, and sleeve gastrectomy).
The risk of adverse metabolic complications in healthy obesity is substantially lower than those with metabolically unhealthy obesity. However, the concept of metabolically healthy obesity is debatable. It can be misleading since people assume that obesity can be healthy. Furthermore, the period of healthy obesity is temporary. A person can transition from healthy obesity to metabolically unhealthy obesity. On that account, obese people certainly face health problems down the road. Therefore, every person with obesity must work to achieve an average weight in the long term. If they do not lose weight, they can have metabolic disorders and other health issues.
Managing obesity is a combination of exercise, diet, and lifestyle changes. In extreme cases, medications get added too. However, following a disciplined approach is necessary for weight loss. Obesity management takes commitment, patience, effort, and time. At times it is also recommended to reduce weight surgically but liposuction, bariatric surgery etc. But it is always recommended that one should try to reduce weight naturally first.