Can You Be Overweight and Healthy?

Recently Lori, a client of mine, called me angry, upset and discouraged. She had just returned from her yearly physical, which she had been eagerly anticipating.  Though she hadn't reached her weight-loss goal, Lori had made many lifestyle changes to promote good health.  She had begun exercising on a regular basis, made some subtle shifts in her dietary habits that made her feel better, and had even begun a weekly yoga/meditation class to manage stress
The results of the physical demonstrated her efforts had been paying off.  Her blood pressure was in the normal level for the first time in years, her blood sugars had dropped, and her cholesterol profile had greatly improved. However, once the exam was complete and she was sitting with her physician in his office, rather than commenting on the improvements, he stated, "Lori, I was really hoping you would have dropped a lot more weight since our last visit.  If you don't get serious about taking off the extra pounds, your risk of early disease will continue.  Have you tried dieting?"
There is an overwhelming presumption in our country that if an individual is overweight they are also unhealthy.  Research clearly supports that being overweight is a major health risk factor, contributing to an increase in cardiovascular disease, diabetes, stroke, and many types of cancer.  So can we assume that if you are hauling around extra pounds that classify you as overweight or obese, it will destine you to a future filled with illness and disease? 
Not necessarily.
An intense debate has emerged in the last few years amongst obesity researchers, asking the question, "Can people be overweight but still be healthy?"  Is the number on the scale the only thing that counts, or should we take other factors into consideration?  Scientists are now dueling over the relative importance of "fatness vs. fitness" when it comes to determining the health of an overweight individual.
A small but vocal group of researchers have been challenging conventional wisdom. They argue that not only is it possible to be both fat and fit, but fitness is actually a more significant measure of health than body weight.  The first major fatness versus fitness study was conducted by researchers at the Cooper Institute, a nonprofit fitness organization in Dallas. In a study of 22,000 men ages 30–83, the researchers measured subjects' body composition (the proportion of fat to muscle) and put them through treadmill tests.   They concluded if you are fit, being overweight doesn't increase mortality risk.
Steven N. Blair, who heads the Cooper Institute, defends the role of fitness as a major determinant of health regardless of one's weight.  "We've studied this from many perspectives in women and in men and we get the same answer: It's not the obesity—it's the fitness," Blair said. "Fitness can substantially reduce, if not eliminate, the high risk of being obese."
Results of studies done by Mary Fran Sowers and Judith Wylie, obesity researchers at the University of Michigan, showed that thin, unfit people can develop heart-related problems that fat but fit people often do not.  Kelly Brownell, Director of the Yale Center for Eating and Weight Disorders, concluded in a 2003 study that heavy people that are fit have a lower risk of heart disease than thin people who are unfit.
However, others are concerned that sending this message will be misunderstood, giving overweight and obese individuals the message that weight doesn't matter; an excuse to accept the extra pounds as unimportant and not to be worried about diet as long as they exercise.
"Being overweight has a clear association with important health problems, and even modest weight loss has important health benefits," said Walter Willett, an expert on nutrition and health at the Harvard School of Public Health. "To tell people it doesn't matter is really misleading. It does make a difference. It makes a huge difference."
The Nurses' Health Study, which since 1976, has been looking at the lifestyle habits and mortality rates of approximately 238,000 nurses, found that being a little active and a little fat wasn't such a bad combination.  But physical activity didn't completely eliminate the risks that were associated with being overweight or obese. In fact, when the nurses were grouped by how active they were, the heavier nurses were more likely to have died than the lighter ones at every activity level.
Despite the differences in these studies, they all suggest that physical activity will offset some of the effects of excess weight, if it's just a few extra pounds. No one is debating that there is a marked difference in disease rates in the obese vs. the overweight.  When assessing overall health risk, we need to look at many factors, not just the number on the scale.
There are many ways to assess overall health and mortality risk, and it's time to look at all these factors together before putting a stamp of "healthy" or "unhealthy" on anyone.  The most common measure used to determine if a person's weight puts them at a health risk is the BMI, which is a measurement of the ratio of weight to height.  Healthy individuals fall within a BMI range of 18.5-24.9; overweight between 25-29.9; and obese above 30.  However, the problem with the BMI is that it does not take into account body composition.  Since muscle is more dense than fat is, a person with a high percentage of lean muscle mass may end up in the overweight category, despite being lean and fit.
Although the BMI has value, it should be looked at along with other factors.  Among healthy weight individuals, people with larger waists and pot bellies have a greater incidence of increased blood pressure and increased cholesterol.  Women with a waist circumference over 35, and men over 40, have an increased risk of obesity related diseases.
Metabolic syndrome, which is a disorder of growing proportion in this country, is marked with a greater risk for coronary artery disease and diabetes.  According to the Mayo Clinic, it is diagnosed when an individual has at least three of the following symptoms: 
CRP test, a simple blood test that measures C-reactive protein, is also a strong indicator of heart disease risk.  And of course, a health profile would be incomplete without looking at other risk factors such as cigarette smoking and family history.
With all of this information, what does it mean for individuals like Lori who overweight, but active, and not displaying many of the measurements of increased health risk?  Should the emphasis be on taking the pounds off, improving fitness, or both? 
The healthcare industry may be missing the mark and doing a disservice to our overweight clients and patients with the typical approach of focusing so heavily on nutritional changes. We've looked at exercise as a modality to help take the extra pounds off, but the main emphasis has been on diet.  If the goal is to improve the overall health profile of the individual, could we do this by looking at fitness first?
There is no debate that taking off excess pounds improves health.  It is a well known documented fact that losing as little as 5% of overall body weight results in significant improvement in the markers that determine health.  And it is true that manipulating dietary intake results in faster weight loss than exercise alone.  We certainly know that the best approach is dietary changes and exercise together.  But this total overhaul of lifestyle can be overwhelming and extremely difficult for people to adopt.  It takes patience, perseverance, support and education.  Not everyone is ready to embark on all of these changes at once. 
For most, the first attack on excess pounds is "going on a diet."  Unfortunately, this usually brings up feelings of deprivation, boredom, and a serious lack of confidence in permanent success.  "Dieters" often focus on everything they no longer can eat.  Too many end up feeling badly about themselves when they have lapses in willpower and are unable to completely eliminate "bad foods." Rather than dieting, a lifestyle approach that includes dietary changes is essential.  
Similarly, if the main reason exercise is encouraged is to help with weight loss, you may be sorely disappointed. But when you view exercise as a means to improve health and well-being, rather than something you have to do in order to lose weight, you can measure success from a different parameter.  Once adopted, exercise often leads to marked improvements in emotional outlook, physical strength, and self-esteem—no matter what your size.  Ironically, when an individual embarks on an exercise program, they often report feeling more in control of their dietary habits.  They suddenly want to eat healthier to fuel the new active lifestyle.
So apart from any weight-loss goals you've set for yourself, it's important to exercise regularly. However, it's salient to realize exercise isn't going to magically erase all the health risks of being heavy--especially if you're doing a minimal amount of exercise. Inconsistent physical activity isn't enough to keep you healthy at any size. Neither will doing just the minimum requirments (or less). Regular exercise that includes cardiovascular (aerobic), flexibility and strength components and adds up to at least 150 minutes per week is essential. To find out just how fit you are, try these four fitness tests you can do at home to assess your current fitness level. Weight has no factor on these results, but if your fitness scores are poor or below average, that would be an indication that you need to step it up in the exercise department if you hope to offset the risks associated with being overweight.

Rather than going on a diet, eat for good health and energy.  By de-emphasizing the number on the scale, and looking at all the measures of health risk, you'll feel empowered to be proactive about their health.  Ironically, when this healthy lifestyle pattern becomes habitual, excess pounds often disappear as a result.
So what was my advice to Lori?  Continue to exercise, eat for good health and vitality, pay attention to all the health parameters—not just the number on the scale—and lastly, find a new, more compassionate and knowledgeable physician!
Is It Okay to be Fat if You're Fit?, The Harvard Medical School Family Health Guide.
Do You Know the Health Risks of Being Overweight?, Weight-control Information Network.
Myth: You Can't Be Overweight and Healthy, An Epidemic of Obesity Myths.
Metabolic Syndrome, Mayo Clinic.

This article has been reviewed and approved by SparkPeople's nutrition expert, Becky Hand, M.S., Licensed and Registered Dietitian, and SparkPeople's fitness expert, Nicole Nichols, B.S., Certified Personal Trainer.
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Member Comments

thanks Report
Interesting article. Report
Great article! Report
Great article Report
My advice is not to get discouraged. Keep doing what you are doing. It will soon pay off. Report
I understand how frustrating this can be. Report
The last line of the article is so true, finding the right physician is so important. Report
This is a very frustrating topic. I fit in the same category as "Lori" and, despite losing 210 lbs and going from a size 56-58 to a size 10-12, I am still considered medically obese. It really messes with your head when you work so hard and are still being admonished by "professionals" for not doing enough. Report
I'm seem to be in a very bad position. I am "medically technically" obese, but I never had or have diabetes (on both sides of family and sugars are perfect) , high blood pressure, cholesterol or nothing to indicate being unhealthy except being overweight. Within the last 6 months I swim 5 days a week for 2 hours each and cut my calorie intake to less than 1,000 calories a day and have actually gained weight. I guess the good news is my doctor is happy to see that I have become more toned but is still trying to see why I haven't been losing the weight. I'm also tried of being laughed and pointed at as that has been the norm for my life.I just wish what size I feel like should be what I look like. I am way more in shape than my sister who is half my size. Depressed , even tried suicide Report
Thank you for this! I am overweight thanks to an underactive thyroid that was undiagnosed at a time when I spent 3 months in a wheelchair and a further 9 months in rehab following an accident. I am otherwise a very healthy individual who has never been a fast or processed food eater - I have never like soft drinks either. My biggest food issue and it is one I am still working on, is portion size. My blood pressure is good, my cholesterol is good, my blood sugar is fine. I am trying to lose weight because I know that it will be easier on my joints and because I know that in the longer term it will be better for me.

I actually have the opposite problem to the author's client in that my doctor is not as concerned about my weight loss as I am - he basically told me that I am healthy and that some people are just naturally heavier! I do not accept that as there is no family history of weight gain later in life so I continue on my journey to lose weight and keep moving. Report
I see health and fitness as different aspects of a greater whole. I'm not fit, but I am healthy, I eat a healthy balanced diet, and don't suffer from any problems related to obesity, I had two fabulous, sickness free, pregnancies and relatively simple births (daughter just took her time, she still does!) I have friends, who are much smaller than me and are plagued with health issues, which are usually related more to someone my size and shape. I'm HEALTHY. Now I want to continue to lose weight because I want to maintain my health and gain fitness as I get older (40 next year). These same friends are fitter than me without a doubt. But I'd prefer, my health and a little excess weight (which I working to reduce), than their size and high blood pressure/pre-ecla
mpsia/diabetes. And yes that poor lady, who should be praised for working her butt off (literally) definitely needs a new GP! Report
This happened to me as well ... and I had lost some weight. My doctor just didn't think it was enough. However, all my blood levels (glucose, cholesterol, etc) and blood pressure are completely normal (and actually always have been). It's very discouraging ... not only to be assumed unhealthy, but also to be doing the right things and not losing more weight. Report
My thoughts vary here. First, I DO think that you can be healthy even if your weight doesn't fall into the range considered "healthy" for your age and height. My reasoning for this opinion is simple. There are LOTS of factors that affect the number we see on a scale. Body fat percentage, muscle mass, water weight percentage and bone mass can all affect that number. Knowing this, I think it is important look at one's body fat percentage, visceral fat percentage (the percentage of your fat that is held in the torso / abdomen / belly area, which surrounds your vital organs), muscle mass and body water percentage / ratio. You can learn a lot about a person's true level of health from these measurements as well as from assessing their overall fitness and endurance level.

For example, I am currently around 188 lbs. However, I do not "carry" my weight in the same way that others who are the same weight do. I have muscle definition and I hold slightly less fat in my torso / abdomen / belly region than some others with the same weight. I am also fairly flexible and may have better posture than some of the same weight, which can (in some cases) be an indication of one's cardiovascular health. I have "curves" as opposed to some others in the same weight range. Knowing this, should I be considered as having the same level of health as someone who weighs the same but perhaps has less muscle or holds more fat in their torso / abdomen / belly region? I don't think so. And there are likely plenty of people who weigh 188 lbs right now who are in better health and shape than I am!

The thing to understand is that human beings are not the same. We have all kinds of factors that can cause standard measurements to mean different things for each person across the board. The accuracy of BMI in determining and diagnosing obesity has been debatable for a LONG time. I don't think BMI is the only thing that should be taken into consideration. The problem is that the medical industry seems to want to hold to a standard measurement that can be used for everyone a... Report
think some people just have larger body types than others, but saying that it's okay to be fat is a dangerous path to go down. The vast majority of overweight/obese people need to lose weight to increase their health and fitness levels, but articles like this give people an excuse to be lazy. Like everything, there are exceptions to the rules, but as a whole, if you are labelled obese due to your BMI, losing some weight isn't going to hurt you. Report
This is what I don't understand. A super skinny person who eats junk food and never exercise in their lives are never told that their lifestyle will eventually cause them harm. However, someone with great muscle tone but slightly bigger than normal but eats really healthy is deemed as unhealthy. Stop judging people. We live in a society where people run from judgement but those same people are judgmental. I thought doctors were smart? Take into account the WHOLE LIFESTYLE and not just what you see on a freaken scale. I'm tired of hearing about this nonsense. We live in such a superficial world. Take care of your inside first and foremost...the outside is just the icing to the glorious cake.



About The Author

Ellen G. Goldman
Ellen G. Goldman
Ellen G. Goldman founded EllenG Coaching, LLC to help individuals struggling with health issues that can be impacted by positive lifestyle change, such as weight loss, stress management and work-life balance. As a national board-certified health and wellness coach and certified personal trainer, Ellen holds a B.S. and Masters in physical education and is certified by ACSM, AFAA and Wellcoaches Corporation. She is also the author of "Mastering the Inner Game of Weight Loss." and You can visit her at and pick up a copy of the "Busy Person's Guide to Healthy Eating on the Go."