Can obese people be healthy and not develop say, hypertension?

A new study has questioned the concept that people can be both obese and healthy. In fact, at least over the long-term, obesity may even confer a small increased risk of death.

In the new study, published in the journal Annals of Internal Medicine, the researchers analyzed information from eight previously published studies involving more than 61,000 people, most around 40 and 50 years old. Follow-up of participants varied depending on the study, from three to 30 years. About 9 percent of participants were obese, but were metabolically healthy ― meaning that their blood pressure, cholesterol, blood sugar and other measures of metabolic health were normal. Nevertheless, they were still 24 percent more likely to experience a heart problem, such as a heart attack, or to die over a 10-year period than normal-weight people who also had no metabolic problems.

Overall, people who were metabolically unhealthy — with conditions such as high blood pressure, high cholesterol and diabetes — were at increased risk of heart problems or death during the study period, regardless of their weight.

The researchers, from Mount Sinai Hospital in Toronto, said that their results “demonstrate that there is no ‘healthy’ pattern of obesity.” In an editorial published alongside the study, James Hill and Holly Wyatt, of the University of Colorado, said the findings are consistent with the idea that “obesity itself is a disease.” While not all experts agree, this controversial opinion was supported by the American Medical Association this year.

However, some experts disagree with the researchers’ conclusions. Pieter Cohen, an assistant professor of medicine at Harvard Medical School, stressed that the effects of metabolic conditions such as high blood pressure and high cholesterol are “much more important for long-term heart health than one’s weight.” He also said that when applied to the worldwide population, the findings translate to 1.4 million deaths or heart problems over a decade, meaning that obesity itself confers an extremely small risk of heart disease. It is also unclear from the study whether the mortality risk among those counted in the study was from obesity or worsening metabolic conditions themselves.
The study also did not account for whether participants were physically active or not.

Nevertheless, obesity presents other health risks, and weight loss is recommended regardless of whether they are metabolically healthy or not!

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