Can you be overweight and healthy? In a word, yes. But that comes with some caveats.
Weight gain has implications regarding our general health including a higher risk for diabetes and cardiovascular disease among others. However, the company that our weight keeps has a lot to do with whether we are healthy. In other words, if our weight is associated with sleep apnea, diabetes, hypertension, elevated cholesterol, then our health has already been compromised and we need to work toward being healthy. But if being overweight is your only major health concern, and you are very active an d “physically fit” then you can technically be healthy. When weighed against one another (pun intended), being physically fit and exercising is likely to be more important at reducing health concerns than weight is to raising them. Remember though, this is all relative and makes answering this question somewhat difficult.
What does it mean to be physically fit?
Physical activity, exercise, and physical fitness are often used interchangeably.
Physical activity is just that, activity. Everyone has some, they just vary in degree.
Exercise is a type of physical activity that can lead to physical fitness. It can be defined in many ways though generally thought of as an activity that requires effort and is sustained, to bring about an improvement in your overall health.
Physical fitness has been defined by the Department of Health and Human Services as “The ability to carry out daily tasks with vigor and alertness, without undue fatigue and with ample energy to enjoy leisure-time pursuits and meet unforeseen emergencies.” (DHHS, 2018). In other words, it’s a general term that carries with it a sense of degree. How physically fit are you? That’s why it’s so tough to nail down and define.
The bottom line of most research that’s been published however would imply that the greater the fitness, the lower the risk of health concerns and the better the health.
How is weight linked to health?
There have been several studies that show a high degree of correlation with weight gain and significant health problems.
With each inch of circumference, you gain around your midsection, there is an incremental rise in your risk of cardiovascular events.
A study performed at the University of Oxford, published in the Journal of the American Heart Association, showed that both elevated waist to hip ratios and waist circumference directly correlated with a higher risk of heart attacks, more so than did BMI.
A 2018 study published here in the US revealed that being obese was associated with a shorter lifespan and increased risk of death from heart disease. It also revealed that there was an increased risk of developing heart disease at an earlier age if you were overweight compared to those who were not.
How long you’re obese for, and when it happens to you during your life span, makes a difference in how long you remain alive.
How do I know if my weight is affecting my health?
Diabetes, sleep apnea, hypertension, elevated cholesterol (or triglycerides), GERD (heartburn), or heart disease all have the potential to be directly weight-related. If you have developed any of these typical weight-related health concerns, then you should be consulting your healthcare provider.
When should I be worried about my weight ?
- If your clothes are fitting tighter or you have to buy new ones to fit your increasing waistline
- If you can’t walk up a flight of stairs or walk a few blocks without getting fatigued
- If you find yourself breathing heavily with “usual” activities such as housework or work around the house, carrying groceries, etc…
- If your waist circumference is greater than 35 inches for women, or greater than 40 inches for men (see below)
- If you have any of the above conditions (Diabetes, sleep apnea, hypertension, elevated cholesterol (or triglycerides), GERD (heartburn), or heart disease)
Does it matter where I gain or carry weight?
Subcutaneous fat, which is located in places other than your waist (thighs, arms) is not usually associated with health concerns.
Weight gain that is central, or involving fat at the waist level is referred to as visceral fat and is considered a greater danger to your health. It accumulates around the abdominal cavity which means it is also associated with fatty deposits around your organs such as liver and pancreas. This type of fat accumulation can increase your risk of having a heart attack, developing diabetes, and elevated cholesterol.
A study published in the Journal of the American Heart Association found that both men and women were affected by the location of fat deposition on their bodies, in fact, women were affected greater than men. Higher waist circumferences and waist‐to‐hip ratios mean a higher risk of developing a heart attack, more so in women than in men, but applicable to both genders.
What is BMI?
As defined by the CDC: “Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in meters.”
BMI was thought of in the 1930s by a mathematician, NOT a physician. He looked at people who were overweight and came up with a formula that fit the numbers he thought it should reflect. It was not based on scientific data or a validated process relating to health.
Is BMI helpful in defining risk of cardiac disease?
BMI has been thought to be a helpful tool in defining obesity and what is healthy versus what is not, but it turns out it’s a poor predictor and probably should not be utilized as the sole indicator of obesity or weight-related health concerns. You can have a high BMI, be an athlete, and not be obese nor at risk for heart disease. It’s by no means a perfect tool.
Waist circumference, waist to hip ratios, and waist to height ratios are much better predictors of diabetes and cardiovascular events than the BMI is. A study performed in Europe showed these parameters to be potent predictors of risk than were previously thought. Dr. Margaret Ashwell, former science director of the British Nutrition Foundation, explained at the 19th Congress on Obesity in Lyon, France, May 2012, explained that “keeping your waist circumference to less than half your height can help increase life expectancy for every person in the world.”
In other words, if you’re a 6 foot (72 inches) tall man then your waist size should be below 36 inches. If you’re a 5’4” (64 inches) tall woman then your waist size should be below 32 inches.
In absolute terms, if you’re a woman and your waist size is greater than 35 inches then you’re in the highest risk range for developing cardiovascular disease. If you’re a man, the same holds true for a waist size of greater than 40 inches. Waist size is a more powerful predictive tool for cardiac health and diabetes development than BMI ever was.
The powers that be should be revising their guidelines.
So can I really be overweight and physically fit?
Yes. Remember the “overweight” label has been traditionally applied using the flawed BMI calculation. If you wanted a single measure of your weight relative to yourself I would use the waist to height ratio or waist to hip ratio as discussed above. If your weight is less than half of your height then that’s a great start. If it’s not, then you need to get it there.
Additionally, if you can jog a mile, go up several flights of stairs without gasping for air, accomplish your daily tasks without fatigue, and perform activities such as carrying heavy objects (groceries) and performing housework, then you are in all probability, reasonably fit.
It’s a rare patient that I tell to stop exercising or working on their fitness. No matter who you are, you could likely do better.