Healthy obesity is a myth -- an oxymoron.
Even with blood pressure, cholesterol and blood sugar in the normal range, those who are obese already have biological processes underway that will lead to health problems in the following decade.
What signals it is the fact that those who are obese might have healthy blood pressure, cholesterol and blood-sugar levels but they typically are in the high range of normal.
A study published online last week in the Annals of Internal Medicine found nothing healthy about obesity, although it remains unclear whether people who are overweight without any additional health problems may be able to avoid cardiovascular events and other health consequences by maintaining that weight.
Still, weight gain for adults generally is unhealthy.
"As you gain weight, your risk factors rise," said Caroline K. Kramer, an endocrinologist who specializes in diabetes at the Mount Sinai Hospital's Lunenfeld-Tanenbaum Research Institute in Toronto and who led the study.
"There is no healthy pattern of increased weight. All groups of people who were overweight or obese with abnormalities have increased risk of death and cardiovascular disease."
The study is equally direct with its conclusions.
"Our results do not support this concept of 'benign obesity,' and demonstrate that the pattern of cardiovascular risk factors -- elevated blood pressure and waist circumference, low HDL or good cholesterol and insulin resistance -- that progressively increase from normal weight to overweight to obese."
"Obesity is related to several metabolic problems, including high blood pressure and blood sugar and higher levels of inflammation markers and growth factors," Dr. Kramer said. "So obese people have a higher rates of cancer and some changes in hormone production."
The U.S. Centers for Disease Control and Prevention say about 33 percent of the American population is overweight with another 36 percent being obese.
For those carrying too much weight, she said, being in the high range of normal signals "that something is going wrong. If you have excess weight, in time you will have problems."
The study analyzed data from eight studies involving 61,386 people over a 10-year span, which was long enough to ferret out an association of body mass index and metabolic indicators of blood pressure, cholesterol and blood sugar with total mortality and cardiovascular events.
"The most interesting finding in the study was that metabolically healthy people with obesity were also at increased risk for health problems.
However, the risk was observed only in studies with more than 10 years of follow-up," states an editorial that accompanies the study.
It says study results "are consistent with the notion that obesity is a disease."
"Obesity affects almost all aspects of human function and physiology that go beyond total mortality and cardiovascular events," and can include a higher risk of type 2 diabetes, kidney disease and some types of cancer, with links to orthopedic problems, reproductive problems, depression, asthma, sleep apnea, renal disease, back pain, skin infections and cognitive decline.
"It would be a mistake to label obese persons as healthy on the basis of only the presence or absence of risk factors for cardio-metabolic disease," the editorial states.
Vicki March, an internist at Magee-Womens Hospital of UPMC, said the study is well done, hard to refute and important to understanding trends in weight gain and obesity.
"Even if they are metabolically healthy, the tendency is for those things to go up and become abnormal as weight goes up. People who are overweight are at risk for gaining weight and becoming obese."
Dr. Kramer said the study should convince people with excess weight to start thinking about making changes at least to stabilize and preferably to lose weight.
Even if successful, people must continue using weight loss and control methods the rest of their lives or the problem quickly can return.
"They don't need to be big changes, but you have to be more active and make healthier food choices and lose weight over time," she said.
David Templeton: email@example.com or 412-263-1578.