“More fat, a more metabolic disorder.” Isn’t that the popular observation as per scientific parlance? And yet there are people, who come under the obese category and do not have any metabolic disorder.
Is it really possible? Can you be obese and yet healthy? Well! It is rare but possible depending on the population and diagnostic criteria (1).
Studies have stated that there are people with long-standing obesity and morbid obesity who can be considered healthy. They are known as Metabolically healthy obese (MHO).
Intrigued? Keep reading.
What Does It Means to Be Healthy?
Let us first understand what is healthy? As per the dictionary, “health is a state of being free from illness and injury”.
There are people, who are obese but are free from illness. They have large quantities of fat mass or body weight but exhibit a healthy metabolic profile (2)
They are a subset of obese people who seem to be protected against obesity-related metabolic complications and lack a set of cardiometabolic abnormalities.
What are these factors used to diagnose metabolic syndrome?
If a person is diagnosed with three or more of these symptoms, they are metabolically unhealthy and diagnosed with metabolic syndrome (3). They are:
- Fasting blood glucose levels ≥ 100 mg/dL.
- A triglyceride level above 150 mg/dL.
- Excess body fat around the waist. Its 40 inches for men and 35 inches for women
- A blood pressure of 130/85 mm Hg or higher
- High density lipoprotein (HDL) levels below 40mg/dLin men and 50mg/dL for women.
Metabolically Healthy Obesity (MHO)
How it happens is yet to be confirmed. Many hypotheses based on studies have been charted out, but it still stays controversial.
Obesity is a major health problem. And yet there are people who defy the scientific jargon. MHO seems to have a phenotype that does not fit into this traditional phenotype of “more fat, more disease”.
These cases are about 10-34% depending on the criteria used (4).
1. MHO might have an improved ability to capture free fatty acids in adipose tissue. In other words, they have a different capacity for the adaptation of excess energy in adipose tissue. An increased ability to form new fat cells thereby effectively storing the excess fat.
2. MHO somehow has less inflammation than metabolically unhealthy obese (MUO).
3. They have low visceral fat, the type of fat that collects around the organ. For them, the fat might be accumulating subcutaneously. Therefore, their liver fat is minimal as compared to the MUO. This keeps them free from insulin resistance and the resulting metabolic disorders (5).
4. They have some kind of unique proteins that might have protective factors against the harmful effects of obesity. The circulating microRNA.
5. MHO may burn fat more effectively than the other obese people who are metabolically unhealthy.
Are They Truly Healthy?
Certain healthy habits such as not smoking, limiting their alcohol intake, incorporating sufficient fruits and vegetables in the diet, and getting some form of exercise daily can keep them healthy irrespective of their BMI.
It is more prevalent in young than old, women than men (6). Genetics definitely plays an important role and so does your lifestyle.
However, sadly the diagnostic criterion is only limited to cardiovascular risk factors. When other non-metabolic conditions such as orthopedic problems, pulmonary complications, and other physiological conditions are also considered, the healthy obese may not be healthy anymore.
They are more at risk of developing musculoskeletal problems, hormonal imbalance, reproductive problems, sleep apnea, and even some forms of cancer.
Therefore, if you are obese, speak to your doctor. Take the help and guidance of your nutritionist. Make an action plan that will help reduce your BMI and keep you healthy in every way.