Can You Be Overweight and Healthy?

How much you weigh may matter less than you think

Posted Jul 31, 2012

woman running for exercise

Exercise improves health even when overweight

It’s swimsuit season again, which means millions of overweight Americans are looking in mirrors feeling horribly inadequate, while those whose waistlines rival their magazine idols are flaunting their beach-ready bods. But could the bikini-wearing, ultra-thin have as much cause for concern when it comes to their health as those who are overweight or obese?

As it turns out, how much you weigh may matter less than you think. This month, researchers at UC Davis found that people who are overweight or obese had similar or even lower death rates than people of normal weight. Those who were severely obese did have a higher risk, but only if they also had diabetes or hypertension, and those who were underweight were nearly twice as likely to die as people of normal weight regardless of the presence of diabetes or hypertension.

This study is the latest addition to a growing body of research that suggests it is possible to be both overweight and healthy. While high blood pressure and cholesterol increase the risk of health problems, not all overweight and obese people suffer from these complications – and not all thin people are free of them. In fact, a study by University of Michigan researchers found that about half of overweight people and one-third of obese adults have normal blood pressure and cholesterol levels, while one-quarter of people in the recommended weight range suffered from some of the complications commonly associated with obesity.

Exercise Mediates the Effects of Obesity

One reason overweight individuals may be able to maintain good health is their level of physical activity. The research in this area is conflicting, but many studies suggest that exercise can mediate the health risks of carrying a few extra pounds:

• A study from the Cooper Institute was among the first to conclude that overweight, active people were less likely to die than those who are thin and sedentary.

• A 2004 study in the Journal of the American Medical Association found that lack of physical activity was a better predictor of an adverse cardiovascular event than weight.

• A 12-year study from the University of South Carolina found that fit overweight people outlive unfit normal-weight people.

Other studies have reached different conclusions. One 30-year study found that even in the absence of high blood pressure, cholesterol and blood glucose levels, being overweight was associated with a significantly higher risk of heart disease. Similarly, a 2008 study by Harvard researchers found that active but overweight women still had an elevated risk of coronary heart disease compared with active, normal-weight women.

It’s a sliding scale, according to a study in the New England Journal of Medicine, with thin and fit at the healthy end, fat and sedentary on the unhealthy end, and multiple variations in between. For example, lean but sedentary subjects had a 55 percent greater chance of dying prematurely than lean and active ones. Fat and active women fared worse, with almost twice the risk of dying as those who were thin and active.

A New Definition of Health

So what does it mean to be healthy? Scientists continue to be divided. What we know is it’s not as simple as being thin means you’re healthy or being fat means you’re unhealthy. Too often, people become consumed by the desire to reach a certain number on the scale. Ironically, the more we focus on the numbers, the fatter America becomes and the more overweight people are stigmatized.

If you’re overweight or obese, what is the best approach? Diet or exercise – or perhaps neither, or both?

Ideally, the answer is both. Exercise is important for overall health regardless of weight. Physical activity mediates, but does not eliminate, the risks of being overweight or obese.

Shedding excess weight – even just 5 percent of your body weight – may also improve your health. Being overweight can affect mental and physical functioning and has been linked to heart disease, stroke, cancer, sleep apnea and osteoarthritis, among other conditions. It’s especially important to consider losing weight if you’re over the age of 50; have a family history of diabetes, heart disease or other health problems; carry most of your weight in your stomach; your lifestyle is sedentary; or you have high blood pressure, cholesterol and/or blood glucose levels.

But being overweight is not necessarily the death sentence many have been led to believe, and the number on the scale is not the only, or best, gauge of health. You also have to consider your body type, ratio of muscle to fat, metabolic profile, exercise level, waist circumference, blood pressure and cholesterol levels, and other factors.

For many people, weight loss isn’t necessarily the first – or most important – step. If you’re overweight or obese, it may be important for your overall health and wellness to lose weight, but a “shed the pounds at all costs” approach marked by yo-yo dieting and deprivation is counterproductive.

Instead, set reasonable goals (e.g., losing one pound per week or walking 15 minutes per day), reduce portions and practice mindful eating. Yoga, meditation and other mind-body techniques may help you feel better and shed pounds without dieting or deprivation.

If you’re overweight or obese, you don’t have to set lofty goals or go to extremes to reach some thin ideal. You just need to reach a weight where you feel good and can enjoy your life to the fullest.