The Gravity of Weight

The daunting science of weight control.

Healthy Obesity: An Oxymoron?

Most people with excessive weight are more likely to have metabolic abnormalities, such as hypertension and abnormal glucose levels. But is there such a thing as "healthy" obesity? There is controversy on whether such a condition exists, and a new study casts doubt on whether someone can be obese and yet healthy, especially if followed over time. Read More

I posted this in another blog

I posted this in another blog earlier today. It references a paper published this year in the JAMA that extensively reviewed over 100 published research articles and found that overweight individuals actually had longer lifespans! This did not hold true for those who were measuring obese.

I would imagine that the answer must be yes.

Wouldn't the definition of someone who is healthy and obese just be someone without serious abnormalities who is at the same time obese? The same way that a person can be an active smoker and healthy at the same time. My great great grandmother lived to be 104 and smoked cigars constantly, and was always smoking cigars. I doubt this is very common but you can't deny that at least in this case the cigars had minimal effect on her lifespan. Same thing with obese people, I'm sure if you gave someone enough time you could find obese people who are perfectly healthy. Just saying that you are in increased risk is really just a double standard, no one says that someone with a family history of cancer is not healthy because they are in danger of getting cancer, or that someone in a hazardous job is not healthy because they are in danger of losing a hand or something. I doubt either of things would lead to increases in lifespan either. Obese people could have a 99% chance of contracting metabolic disorders throughout their lives and it would still be healthy if they didn't show these disorders. And really it wouldn't be wise to bet that no one fits this criteria given the enormous amount of people who are obese.

What really interests me is when it became a moral crime to be obese? People can say that it's because these people are being irresponsible and its detrimental to their own health, however, I don't see this sort of attitude to smoking or drinking. Whenever obesity is discussed i get the feeling of hostility towards the obese, as if they were failing to do their duty as citizens of the united states and be slim. I would imagine that's its mostly from doctors having patients repeated ignore their orders to eat less (really the only way to increase weight is calories in > calories out) or whatever and they end up resenting these patients. It could also be a result of the current trend of putting great importance on someones weight (no idea where this has come from).

Also pro-tip for dieting, don't keep too much junk-food in your fridge. If you don't have a fridge full of easily accessible crap then you will be much less likely to eat on impulse. I learned this at college where I would start with a lot of food stocked in the fridge and pantry but it would rapidly deplete making it so i had to go to the on campus cafeteria (a five minute walk), or the local convenience store (even closer). Yet i wouldn't go since I simply didn't find it worth the trouble (maybe this is more indicative that my laziness beats my gluttony). Really you don't act on cravings if they even a little out of the way. I really doubt someone would go through the trouble of cooking a full meal just to satisfy a craving. Then again i have never been obese just overweight so maybe obese people would in fact go through the trouble. just my two cents :)

I only speak for myself

You say that people aren't a judgmental for those who smoke and drink. I can assure that I am just as judgmental on those who smoke and drink, as those that are obese. Smokers, due to a number of recent laws, are decent enough to now go outside and away from me. As far as the drinkers are concerned, they still think they are doing something cool. I am offended that many of my professional associations see fit to meet in a bar where people act foolish and make inappropriate comments.

None of it is okay.

Kramer article

In your post, you mention the Kramer et al. article recently published in Annals in Internal Medicine. It is important to note that this study had some major limitations. Most notably, they did not account for fitness, nutrition, or any of the many factors that typically mediate the relationship between weight and health. So they did not really examine whether it is possible to be "fat and fit." Recent other research has shown that physical fitness is a far better predictor of health outcomes than BMI. I recently tackled this issue in my PT blog post titled "Don't Believe Everything Your Read"

The Kramer study has even

The Kramer study has even more major imitatinos than those noted above. They did not even adjust for age, which is probably the most powerful confounding factor, so their entire study is questionable. Even given their failure to account for age, however, they found a non-significant increased risk of (their combined outcome of mortality or CVD events) among the 'healthy obese' relative to the 'healthy normal weight' with a relative risk of 1.19 (confidence interval of 0.98 to 1.38). When they limited it to the 4 studies with more than 10 years of follow-up, it inched up to a barely significant value of 1.24 with limits of 1.02 to 1.55. Somehow these small flawed unadjusted and not even significant or barely significangt values became a proof that 'healthy obesity' was a 'myth.' By this logic, you could equally well argue that 'healthy aging' must also be a 'myth' because older people are more likely to die than younger people no matter what health risk factors you control for.

Is "healthy obesity" an oxymoron

Thank you to Dr. Conasson and to the "anonymous" critic (why not include your name?) who clarified some of the faults of the Kramer study. Even Dr. Kramer points out another limitation in that the studies for which she did a meta-analysis did not include how long the subjects had been obese.

As I say in my blog, the concept of "healthy obesity" is still open to question, and no study, to date, has answered the controversy completely. The important point I was making in my blog entry is that people who are obese but do not have metabolic abnormalities at one point in time should not be complacent and should not assume they will necessarily remain metabolically normal over an extended period of time.

Post new comment

The content of this field is kept private and will not be shown publicly.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Allowed HTML tags: <a> <em> <strong> <cite> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Lines and paragraphs break automatically.
  • You may quote other posts using [quote] tags.

More information about formatting options

Sylvia R. Karasu, M.D., is Clinical Professor of Psychiatry at Weill Cornell Medical College and senior author of The Gravity of Weight.


Subscribe to The Gravity of Weight

Current Issue

Dreams of Glory

Daydreaming: How the best ideas emerge from the ether.