Compared to healthy weight controls, those classified as healthy obese were more likely to develop health issues later at the end of the study.



  • Healthy obesity should not be used, according to the study. People who think can you be healthy and obese are at risk for health-related issues later in life.
  • Those people with more body fat tend to have more health-related issues later in life.
  • Those with greater lean muscle mass had lower all-cause mortality, despite having a high BMI.


Some claim to be healthy obese (i.e., high body mass index BMI) in which they are overweight but do not suffer any metabolic complications. Metabolic complications include hypertension (i.e., high blood pressure), diabetes (i.e., high blood sugar levels), elevated blood lipids, kidney disease, etc. There are many questions regarding whether a person can be obese and healthy, similar to a person who can have high cholesterol and still be healthy.

Living a long life with high cholesterol is still possible, provided you follow a heart-healthy lifestyle and take medication if needed. Some recent studies have found that heart disease is a multi-factorial condition with many factors such as inflammation, LDLs, homocysteine, etc.

Weight gain over the course of the years combined with lack of physical activity and excess calories (i.e., increased sugars, trans fats, saturated fats, etc.) puts an individual at risk of developing type 2 diabetes, sleep apnea, etc. For example, pacific islanders are ranked one of the most obese countries in the world due to their increased consumption of cheap, processed foods instead of their traditional diet of fish, coconut, breadfruit, etc.


In a recent cohort study on obesity, researchers compared healthy obese (i.e., metabolically healthy with no symptoms of type II diabetes, hypertension, elevated blood lipids, heart disease, etc.) to unhealthy obese (i.e., had hypertension, diabetes, etc.) people over 11 years. Compared to healthy weight controls, those classified as healthy obese were more likely to develop health issues later at the end of the study. 

Healthy obese were 4.3 times more likely to have type 2 diabetes; 18% more likely to suffer a heart attack or stroke; 76% more likely to develop heart failure; 28% more likely to have a respiratory disease; and 19% more likely to have COPD. Worse yet, for those considered healthy at the start of the study, a third became metabolically unhealthy within three to five years. (1) The author concluded that using the term healthy obese is misleading and should be avoided.


Many people use BMI as a marker of obesity, but its ability to accurately determine adiposity is doubtful because individuals of the same age, height, and weight (thus having the same BMI) can have different body shapes and compositions. BMI does not specifically indicate body fat or abnormal fat accumulation.(2) Most large-scale studies have shown that a normal BMI or Body Mass Index is associated with the lowest risk of death.(3-5)

BMI measures healthy weight based on height and weight. Lambert Adolphe Jacques Quetelet, a Belgian astronomer, developed the BMI scale over 100 years ago. Yes, you read that correctly; he was not a physician but a mathematician and statistician.

The problem with this formula used by all medical practices today is that it does not account for muscle or fat. It does not distinguish between a sedentary person eating McDonald’s every day and six feet tall and weighing 230 pounds and a shotput athlete who exercises every day and is also six feet and weighs 230 pounds. As you know, muscle is important for health.

Number 1 Reason Healthy Obese is a Myth

Several large-scale studies have shown that muscle strength is associated with decreased mortality.(6, 7). Researchers examined those BMI but also performed DEXA measurements (i.e., measurements of lean muscle mass and fat mass) of 11,687 participants and studied them several years after. Despite having a lower BMI, participants with low muscle mass had higher % body fat, and waist circumference were more likely to die from diabetes and had an increased risk of death. Higher skeletal muscle mass was associated with lower mortality despite having a high BMI.

In sum, higher BMI was associated with reduced death risks among participants with preserved muscle mass.(8) Those with low muscle mass and a high BMI made death risk skyrocket. BMI was not meant to be used for athletes but rather for sedentary people who don’t exercise.

It should be no surprise that bodybuilders are often considered overweight or obese because of their extreme muscle mass. In a study of bodybuilders, the average BMI was 25, which is considered overweight.(9)


  • Those people with more body fat tend to have more health-related issues later in life.
  • There is no such thing as a healthy obese person according to the study
  • Those with more lean muscle mass had lower all-cause mortality, despite having a high BMI.


1.         Zhou Z, Macpherson J, Gray SR, Gill JMR, Welsh P, Celis-Morales C, et al. Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants. Diabetologia. 2021;64(9):1963-72.

2.         Adler C, Steinbrecher A, Jaeschke L, Mähler A, Boschmann M, Jeran S, et al. Validity and reliability of total body volume and relative body fat mass from a 3-dimensional photonic body surface scanner. PLOS ONE. 2017;12(7):e0180201.

3.         Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-96.

4.         Berrington De Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, Macinnis RJ, et al. Body-Mass Index and Mortality among 1.46 Million White Adults. New England Journal of Medicine. 2010;363(23):2211-9.

5.         Di Angelantonio E, Bhupathiraju SN, Wormser D, Gao P, Kaptoge S, De Gonzalez AB, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. The Lancet. 2016;388(10046):776-86.

6.         Artero EG, Lee D-c, Ruiz JR, Sui X, Ortega FB, Church TS, et al. A prospective study of muscular strength and all-cause mortality in men with hypertension. J Am Coll Cardiol. 2011;57(18):1831-7.

7.         Metter EJ, Talbot LA, Schrager M, Conwit R. Skeletal Muscle Strength as a Predictor of All-Cause Mortality in Healthy Men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002;57(10):B359-B65.

8.         Abramowitz MK, Hall CB, Amodu A, Sharma D, Androga L, Hawkins M. Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study. PLOS ONE. 2018;13(4):e0194697.

9.         Karpik A, Machniak M, Chwałczynska A. Evaluation of Protein Content in the Diet of Amateur Male Bodybuilder. American Journal of Men’s Health. 2020;14(6):155798832097026.

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