You Asked: Can you be overweight and healthy?

The overarching message of public health professionals is united: Eat healthy foods and exercise at least 30 minutes per day. There is also an emphasis on maintaining a healthy body weight as typically measured by the body mass index (BMI). But, with 70 percent of adults age 20 and older considered to be overweight or obese by this measure, one might begin to wonder: ‘Is it possible to be bigger (than normal) and still be healthy?’

According to the Centers for Disease Control and Prevention (CDC), BMI is calculated by taking a person’s weight divided by his/her height in meters squared. The result is the approximate amount of body fat a person carries, which varies based on body type. However, BMI may not always the best indicator of fitness because it does not take into account a person’s lean body mass (amount of muscle versus external fat).

For example: An athlete who strength trains regularly may be lumped into the ‘overweight’ category since BMI doesn’t recognize lean body mass. Muscle mass actually weighs more than fat which increases a person’s body weight measurement. So, it’s entirely possible to be be extremely fit in reality, but look unfit on paper according to a BMI assessment of only height and weight.

“We must separate out the overweight category (as measured by BMI) and obesity,” said Marcia Ory, Ph.D., MPH, regents and distinguished professor with the Texas A&M Health Science Center School of Public Health, who studies factors affecting healthy aging. “We know obesity is related to many negative health outcomes like diabetes, cardiovascular disease and some cancers. But, the risks of being overweight are more debatable—especially since BMI is not a one-size-fits-all; it’s more nuanced.”

Overweight, as determined by body mass index, means you fall into the 25.0-29.9 category, or, you are carrying approximately 25 percent total body fat based on your height and weight—although, it should be noted that BMI is an indirect measure of total body fat.

Ory said there are many elements other than BMI that factor into overall health and wellness. “We need to be looking at measurements like waist size and the amount of abdominal fat present,” she said. “Women should not have a waist size more than 35 inches, and men should not have a waist larger than 40 inches. Excess abdominal fat has been linked to a host of problems, including heart failure.”

It’s entirely possible for someone who is considered overweight to have normal blood pressure, cholesterol levels and a regular blood sugar range—which decreases the chance of insulin sensitivity and metabolic risk factors. However, even if this is true, it’s still unwise to encourage the mindset that the number on the scale and body fat percentage isn’t a concern.

“It does matter. You might be overweight this year; however, if weight gain persists every single year, you can quickly reach the obesity mark,” Ory said. “As public health professionals, we understand that health isn’t purely black and white, but it’s important for people to continue to make healthy lifestyle choices.”

A new study published in The Lancet by the NCD Risk Factor Collaboration estimates there are now roughly 640 million obese individuals around the world—a troubling reality. “It’s the movement from the overweight category, (25 to 29) to the obese category (30 or greater), that sneaks up on you over time. It’s very much a concern,” Ory said.

A new weight subgroup has even emerged: “metabolically healthy obesity” (a medical condition characterized by obesity that does not produce metabolic complications) that is dividing the medical and public health communities on just how dangerous extra weight is. On one side, as long as waist size, blood glucose levels and blood pressure remain normal—combined with good physical fitness—it may not feel like you’re at risk for larger health concerns. This doesn’t mean they won’t occur in the future, though.

“The message we should focus on is ‘Live healthier lives,’” Ory continued. “Instead of looking at target weight, look at target lifestyle changes that are healthy for you. No single number can tell you if you’re healthy or unhealthy. Be more physically active, eat a balanced diet, don’t smoke and maintain regular contact with health care professionals for screening and preventive care. This is what’s important.”