Is Being Overweight Always that Bad?

With new fad diets popping up more regularly than work emails when you’re on holiday, it seems that everyone is watching their weight – and usually ours too, whether we asked them to or not. It can feel like we’re at risk of developing a killjoy obsession with the scales, but is this fixation justified? What does it mean to be overweight, and is topping the scales always a sign of ill health?

What is ‘overweight’, anyway?
Generally, a person is considered overweight if their Body Mass Index is 25 plus, and obese if over 30. The World Health Organisation estimates that 1.9 billion adults across the globe are overweight, with 600 million clinically obese.[1]

It’s commonly accepted that being overweight poses a health risk, with the NHS linking obesity to concerns ranging from type 2 diabetes to cancer and strokes.[2] An international study spearheaded by the Institute for Health Metrics and Evaluation claimed that 4 million deaths worldwide could be linked to a high BMI, 40% of which were people who were overweight, but not obese.[3] However, other research has painted a more complex picture of the relationship between our weight and our health.

The Obesity Paradox
Despite the received wisdom that being overweight is a sign of poor health, there is also the long-standing puzzle of what has come to be known as The Obesity Paradox – the findings by several studies which suggest that being overweight may actually protect certain groups of people against chronic diseases.

One such study was published in 2013 by the American Diabetes Association. It reached the seemingly counterintuitive conclusion that a ‘higher BMI may be associated with a lower mortality and a better outcome in several chronic diseases and health circumstances.’[4]

Can this paradox be explained?
With conflicting reports on the dangers of being overweight, should you be donning the lycra and hopping on your bike, or allowing yourself that extra portion or two at meal times?

The truth behind the Obesity Paradox may lie in criticisms of BMI as a method for determining a person’s health. For example, a 2016 study published in the British Journal of Anaesthesia highlighted BMI’s inability to distinguish between lean muscle and fat mass – meaning a person can have a high BMI due to muscle rather than fat, but a normal BMI made up of too little muscle and too much body fat.[5] Research is increasingly evidencing that it is, in fact, our body composition which affects our health rather than our overall weight, with fingers pointing towards visceral fat as being the true health threat.

For example, in a recent study of 50,000 middle aged and older Canadians, Dr William Leslie of the University of Manitoba found a correlation between a high percentage of body fat and a low BMI with an increase in mortality. [6] This supports findings indicating that visceral, intra abdominal, fat is the greatest weight-related risk to our health.

 Hip-to-waist ratio is now being championed as a more accurate alternative to the traditional BMI.

The most intriguing outcome of these findings is that being skinny doesn’t necessarily mean the same thing as being healthy – if you’re thin with a bit of a belly, that could be just as dangerous as being obviously overweight. Visceral fat may not even be visible at all from the outside, so if you’re naturally slim but don’t exercise, you could actually be at a greater risk than someone larger who hits the gym a few times a week. These findings stress the importance of doing regular exercise for everyone – especially because our tendency to accumulate fat round the middle increases as we age and our metabolism slows.

Obviously, this increasing body of research doesn’t indicate that being fat is healthy – but it does seem to imply that your skinny friends may have less cause to be smug than previously believed. So next time your svelte buddy is boasting about how he “just has a fast metabolism”, get him to get his body fat composition tested to see if his appearance tells the whole story – then tell him you’ll see him on the cross-trainer at the gym.

The Wellman Clinic is the UK’s first dedicated private men’s health clinic in London, with over 25 years of experience. From health screening to testosterone replacement therapy, we offer tailored, professional medical advice to men in a friendly and confidential environment. Please get in touch to arrange a consultation.

[1] http://www.who.int/topics/obesity/en/

[2] http://www.nhs.uk/Conditions/Obesity/Pages/Introduction.aspx

[3] http://www.nejm.org/doi/pdf/10.1056/NEJMoa1614362

[4] http://care.diabetesjournals.org/content/36/Supplement_2/S276

[5] https://academic.oup.com/bja/article/116/3/319/2566140/Limitations-of-body-mass-index-as-an-obesity

[6] http://annals.org/aim/article/2499472/relationship-among-body-fat-percentage-body-mass-index-all-cause

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