I don't think that you need to go to medical school to answer this question. The answer is obvious -- no! Being overweight or obese, no matter what your metabolic profile (we'll get into what that means in a moment) jeopardizes your health. There you have it. Carrying around extra weight is bad for your health. And this new study proves it.
Why Is This Controversial?
At first glance, many readers will wonder why this is news at all; the answer seems obvious. So let me explain the controversy.
Over the last decade, a large number of medical studies have suggested that certain overweight and obese people are actually as healthy as their thinner counterparts. According to these short-term studies, some individuals carry extra pounds but seem to incur no excess risk of health problems like heart attack, stroke or death. In fact, some reports even suggest that excess weight protects people from bad outcomes when they develop serious health issues like cancer or heart disease; this has been termed the "obesity paradox."
Looking more closely at this issue, doctors proposed an explanation: They hypothesized that there is a group of people who are "metabolically healthy" even though they are obese. While most obese people have an unhealthy metabolic profile, members of this unusually lucky group satisfy criteria for obesity (body mass index greater than 30), but have normal cholesterol and glucose levels and do not suffer from high blood pressure. In short-term studies (note the phrase "short-term," as this is the key), these so-called metabolically healthy individuals did not appear to suffer excess heart attacks or strokes. Based upon this data, some experts concluded that it's okay to be obese, as long as you are "metabolically healthy."
The New Study: Metabolically Healthy Obesity Is Not Healthy
Not so fast. The new study looks at people over the long haul, a 10-year period. This enables us to assess the long-term impact of metabolically "healthy" obesity (obesity with normal blood pressure and blood tests). And this long-term follow-up is the reason that the study made the news. Over a 10-year period, those with "metabolically healthy" obesity faced a 24 percent increase in their risk of serious cardiovascular illness or death. This is the answer we have been waiting for. It backs up our strong advice to try to lose excess weight, even if your other numbers are good. Normal cholesterol levels and blood pressure do not erase the number displayed on the scale if that number indicates that you are obese.
What If You Are Not Overweight or Obese?
The media did not pay much attention to this part of the study. But I did. And so should you. Obese or not, you need to know where you stand health-wise; you and your doctor need to fill out the chart below, which includes both your weight status and your metabolic health.
First figure out your BMI, or body mass index. Do that right now by clicking on the hyperlink. A BMI of 18.5-24.9 is normal, 25 to 29.9 is overweight, and 30 or greater indicates obese. Although the "overweight" category is not as bad as the "obese" category, it still puts people in an unfavorable position, in part because overweight is often a precursor to obesity. So if your BMI comes out "overweight," use that information to spur you to get in shape.
Next you need to find out if you are metabolically healthy. Even if your BMI is normal, you want to know the numbers that dictate metabolic health. While being overweight or obese substantially increases your risk of having "bad" numbers, being normal weight does not guarantee that your numbers are good.
Which numbers do you need to know? Your blood pressure, your cholesterol and triglyceride levels and your blood glucose are important. This means a trip to the doctor and a blood test, a minor inconvenience. But it is worth your while as this information could save your life.
With your numbers in hand, you and your doctor need to assess your health. Your BMI determines your weight status, and your blood tests determine whether you are metabolically healthy or unhealthy. Which box are you in?
People say that nobody can predict the future. But you can. If you don't find yourself in the green at the intersection of normal weight and metabolically healthy, make a plan with your doctor to get there. Your future is in your hands.
Dr. Marc's Medical Minute
Dr. Marc Gillinov is a cardiac surgeon at the Cleveland Clinic and author of Heart 411: The Only Guide to Heart Health You'll Ever Need. He provides expert analysis of the latest medical news and spells out what it means to you.