Overweight and healthy: the concept of metabolically healthy obesity

Patrick J. Skerrett, Former Executive Editor, Harvard Health

Carrying too many pounds is a solid signal of current or future health problems. But not for everyone. Some people who are overweight or obese mange to escape the usual hazards, at least temporarily. This weight subgroup has even earned its own moniker—metabolically healthy obesity.

Health professionals define overweight as a body-mass index (BMI) between 25.0 and 29.9, and obesity as a BMI of 30 or higher. (BMI is a measure of weight that takes height into consideration. You can calculate your BMI here.)

Most people who are overweight or obese show potentially unhealthy changes in metabolism. These include high blood pressure or high cholesterol, which damage arteries in the heart and elsewhere. Another harmful metabolic change is resistance to the hormone insulin, which leads to high blood sugar. As a result, people who are overweight or obese are usually at high risk for having a heart attack or stroke, developing type 2 diabetes, or suffering from a host of other life-changing conditions.

But some people who are overweight or obese manage to avoid these changes and, at least metabolically, look like individuals with healthy weights. “Obesity isn’t a homogeneous condition,” says Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health. “It appears that it doesn’t affect everyone in the same ways.”

Dr. Hu and three colleagues wrote a “Personal View” article in Lancet Diabetes and Endocrinology reviewing what is known about metabolically healthy obesity. They identified several characteristics of metabolically healthy obesity. These include a high BMI with

  • a waist size of no more than 40 inches for a man or 35 inches for a woman
  • normal blood pressure, cholesterol, and blood sugar
  • normal sensitivity to insulin
  • good physical fitness

BMI isn’t perfect

BMI is not a perfect measure of weight or obesity. It often identifies fit, muscular people as being overweight or obese. That’s because muscle is more dense than fat, and so weighs more. But muscle tissue burns blood sugar, a good thing, while fat tissue converts blood sugar into fat and stores it, a not-so-good thing.

“Further exploration of metabolically healthy obesity could help us fine-tune the implications of obesity,” says Dr. Hu. “It supports the idea that we shouldn’t use BMI as the sole yardstick for health, and must consider other factors.”

Genes certainly play a role in how a person’s body and metabolism respond to weight. Some people may be genetically protected from developing insulin resistance. Others are genetically programmed to store fat in the hips or thighs, which is less metabolically hazardous than storing fat around the abdomen.

The concept of metabolically healthy obesity could be used to help guide treatment. Currently, exercise and a healthy diet are the foundation for treating obesity. When those efforts aren’t enough, weight-loss surgery (bariatric surgery) is sometimes an option. Such surgery is appropriate for people with metabolically unhealthy obesity, the authors suggest, but for people with metabolically healthy obesity it might make more sense to intensify the lifestyle approach rather than have surgery. This idea, however, needs to be tested in clinical studies, says Dr Hu.

Don’t rest easy

Metabolically healthy obesity isn’t common. And it may not be permanent, warns Dr. Hu. Just because a person has metabolically healthy obesity at one point doesn’t it will stay that way. With aging, a slowdown in exercise, or other changes, metabolically healthy obesity can morph into its harmful counterpart.

It’s also important to keep in mind that obesity can harm more than just metabolism. Excess weight can damage knee and hip joints, lead to sleep apnea and respiratory problems, and contributes to the development of several cancers.

Bottom line? Obesity isn’t good, even if it’s the metabolically healthy kind.


  1. Hs

    This information are very useful,thank you.

  2. Harriet W. Tabron

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  3. sumeet kaul

    havrd health is awesome

  4. Andrew - Sleeppro

    With regard sleep apnoea recent research conducted in France shows that if a person suffers from obstructive sleep apnoea, (OSA), they will have a much higher chance of developing diabetes.

    Sleep apnoea can mean that a person will stop breathing many times during the night, often complaining the next day of a poor night’s sleep. Often people are not aware of having stopped breathing during their sleep.

    The University of Angers, in western France, concluded that sleep apnoea is more often than not undiagnosed and therefore goes untreated, and it could well be one of the key causes in the development of diabetes.

    If this sounds similar to your situation seek professional medical advice.

  5. John

    There is also the opposite problem of many people being underweight and struggling to put on weight. There is a lot of attention in society being put on people being overweight and on the concept of fat in general, but it is forgotten that there are people who would love to put on weight, but have problems doing it. In my opinion being obese is for most people a lifestyle choice (even if an subconscious one). Except for the minor percentage of people who are obese because of medical reasons, most people are obese because they eat junk, don’t do any physical activity and generally don’t take care of themselves.

    I would like there to be more research done into people who are underweight and how they can put on weight. Since this is a pretty large percentage of the population, however no attention is being paid to them. There are of course ways of gaining healthy weight, with eating more than your maintenance amount of calories (a good mix of carbohydrates, proteins and healthy fats), a rigorous exercise regime composed of heavy compound lifts and also living a healthy life by for example getting a proper deep night’s sleep.


  6. 360wellnesslab

    I agree with “Obesity isn’t good”

  7. Jonathan Warner

    sometimes it’s really easy to lose pounds. but for some time it turns out to see a specialist like me.

  8. Oscar

    It’s easy to gain weight but very difficult to lose weight. As much as I try, I have 6months 3 or 4 times a week to the gym to do cardio for 1 hour, and got at most 3 kilos. I eliminated all fat meals but still not lose weight with it.


    • Jonathan Warner

      It is not a rule! My wife was 98 Kg there are two months, she is now 87. But I want to reach 80 kg there three are years, I’m only 72.

  9. Urgent Care Locations

    I was actually just reading this morning through the various stats in each state about the % of their population that is obese. As scary as some of those statistics are (over 35% in Mississippi!), I still find it amazing how low of a threshold there is to be considered obese. I am 195 lbs and 5′ 9″ I and I am just on the boarder of being obese. Hard to believe because I have 34″ waist line! Seems like the continuum should allow for a bit more “give.”

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  11. Jen

    Nice article, I agree that obesity may lead to many issues in the future like diabetes and energy level. I think it is important to change the lifestyle and the eating habits. Try to eat low glycemic foods to keep the blood sugar balance and exercise regularly.

  12. shaqeia

    Nice article! here’s a tip to keep going: Have something to look forward to after you have exercised. If you really can’t find an activity you like, you may as well reward yourself with something nice after you have reached your targets. Complete your day’s exercise and THEN watch TV, listen to music, read or watch a film. Just try to avoid rewarding yourself with food or this will defeat the object of working hard to lose or maintain your weight.

  13. Salveo Andaman Noni

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  14. Sheik Abdur Rashid

    I am living in South Asia country known as Bangladesh.I am always in touch with Harvard health beat and receiving all the time some medical advise and exercise formula through where I can get physical fitness in all respect.But I am getting partial understanding instead of clear and complete clarification.So is it possible to discus more elaborately over those context by which I can get more benefit through your health beat discussion.Such as you are asking order for some special booklet over health beat. But I am unable to purchase.The world famous Harvard University can do me a favour. Is there any door open for me? waiting for your reply.

  15. victor

    fatties gonna fat

  16. Metabolism and Its Effects on Health and Fitness

    The best way to lose weight is to increase your metabolism. Your metabolism manages, how fast and effectively you burn up energy and process food. The higher metabolism burns calories more efficiently and lose weight faster. There are many factors that affect the metabolic rate which are out of your control, such as, age, genetics and endocrine glands etc. Except these out of control factors there are many ways to boost up the metabolic rate. Metabolism and its effects have two aspects on health and fitness. Some factors are discussed below which help you to boost up the metabolism.

  17. boxing exercises

    Agree with “Obesity isn’t good, even if it’s the metabolically healthy kind.” we never now where this obesity will lead to.
    muscle tissue can be enhance to be a burner fat machine when you find the right exercises combine with healthy diet plus healthy lifestyle.

  18. metabolically healthy unicorn

    Obesity isn’t good, but the issue here is that you still don’t know how to treat it properly because you are obsessed with the idea that long-term calorie restriction and strenous exercise is possible. Ask any long-term weight loss maintaner and most people slowly start to regain or have to dedicate their entire lives to fitness, usually by becoming a personal trainer. You can see this narrative over and over again. Obesity research is basically religion, and it will never be solved, as long as weight loss is the holy grail (not weight MAINTENANCE which is the hard part) and fat people aren’t seen as lazy, out of control gluttons.

    The Harvard health review had a good opportunity here to tell their overweight and obese readers that they should aim for health changes *independent* of weight loss, and to aim for being “metaobolically healthy” but instead chose to parrot once again, that the mere state of being obese is what they should change.

    Finally, most people who age — even if they are thin — have deteroriating health. That’s why it’s called aging. To imply that only fat people are at risk of this is wrong.