Birch Grove #23

Clean Up the “Healthy Obesity” Talk, Please

Healthy obesity is the subject of yet another pair of new publications, this time in Obesity Reviews. So far, in this year alone, you can find 160 scholarly publications on the specific subject of “healthy obesity.”

Rey-López and colleagues completed a systematic review of the prevalence of metabolically healthy obesity. They found prevalence estimates ranging from 6% to 75% of people with obesity having “metabolically healthy obesity.” The range is impressive, but not in a good way. They found an enormous variation in both criteria for obesity and for metabolic health.

Likewise, Samocha-Bonet et al just published a thorough review of the research on metabolically healthy and unhealthy obesity, also in Obesity Reviews. They state very plainly:

The main obstacle in advancing our understanding of the metabolically healthy obese phenotype and its related long-term health risks is the lack of a standardized definition.

If we’re going to work on this, it would indeed help to get definitions right.

Obesity is a disease of excess adiposity, so the terminology of “healthy obesity” is inherently confusing — an oxymoron. What we’re really talking about here is metabolic health at a high BMI. A high BMI is not the same thing as obesity. If someone is truly metabolically healthy at a BMI over 30, then they don’t have obesity. They’re just big.

Next, can we talk about magic realism?

Click here for the publication by Rey-López et al and here for the publication by Samocha-Bonet et al.

Birch Grove #23, photograph by Judy Dean, licensed under CC BY-SA 2.0

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6 Responses to “Clean Up the “Healthy Obesity” Talk, Please”

  1. July 28, 2014 at 10:03 am, Gerald Denis said:

    Sorry. You’re wrong.
    Obesity is carefully defined as a BMI of 30 kg/m2 or more. To use your language, a high BMI is exactly the same thing as obesity.

    • July 28, 2014 at 2:55 pm, Ted said:

      Thanks for sharing your opinion, Gerald. As you may have detected, I don’t share that opinion. I think that CDC expressed my view well in their FAQ on BMI:

      “BMI is used as a screening tool to identify possible weight problems for adults. However, BMI is not a diagnostic tool. For example, a person may have a high BMI. However, to determine if excess weight is a health risk, a healthcare provider would need to perform further assessments. These assessments might include skinfold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings.”


      Thanks again for taking the time to read and comment.

  2. August 01, 2014 at 5:21 pm, Marilyn Wann said:

    A colleague in social justice activism alerted me to this article and asked for my opinion, so I thought I’d also leave a comment here. The attempt to pathologize weight diversity both derives from prejudice and promotes currently rampant levels of weight prejudice and discrimination. The most intense weight discrimination happens in discussions of health and in medical settings. I suggest that people here rethink the admonishment to first, do no harm. There’s a much safer, vastly more effective and beneficial approach, which actually expands social justice for people of all sizes rather than contributing to the hate that fat people like me face. It’s called Health At Every Size®.

    • August 01, 2014 at 5:53 pm, Ted said:

      Thanks for sharing your view, Marilyn. I agree with your concerns about weight prejudice and discrimination. Diversity in weight and size is normal.

  3. August 01, 2014 at 8:18 pm, Marilyn Wann said:

    The term “obesity” itself is used for weight discrimination in medical care. Fat people have been denied health insurance because of this term. (Me included. Good thing I’ve been healthy!)

    Fat people have been denied access to diagnostic equipment because of this term, have been denied needed surgeries and coerced into unneeded mutilations of healthy internal organs because of this term, have been denied placement on organ transplant lists because of this term, have been denied the option of being a bone marrow donor because of this term.

    The levels of weight bias and barriers to care are so intense for fatter people that I have to wonder if already-weak correlations between weight and morbidity/mortality have anything at all to do with weight and everything to do with the poor quality of care that fat people receive, not to mention other powerful confounding variables like fitness, dieting history, the health impact of living with stress and discrimination and internalized oppression and social isolation, poverty (which correlates with weight), and so many more. And that doesn’t begin to consider the impact of environmental toxins and the possibility that weight gain is a protective response, that weight loss releases health-damaging enviro-toxins into the body. Or that people are fatter now because of wholly good factors like increased maternal and child nutrition, and access to vaccines and antibiotics.

    The whole framing of weight as a focus of health is going to be debunked. It is not possible to show concern about weight prejudice and discrimination and refuse to acknowledge the central role that medical bias plays in creating and promoting it.

    • August 01, 2014 at 10:49 pm, Ted said:

      Thanks for writing and sharing more of your thoughts. I agree with your concern about weight bias and discrimination. And I agree that weight bias and discrimination in medical care is prevalent and deplorable. Words that are misused are indeed harmful. And real, serious harm comes from weight bias and discrimination.