'Healthy Obesity' Turns Unhealthy Over Time

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In the past half decade, about every six months there’s a headline telling us that obesity is healthy, leaving us wondering “what the heck” since everything we’ve been taught our whole lives has said that extra pounds are your enemy. 

The research has indicated that a person can be both medically obese and still considered biologically healthy. But a new paper out today from a team of researchers at University College London (UCL) has essentially debunked that theory, stating that so-called “healthy obesity” almost always turns into unhealthy obesity.

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The UCL study first looked at 2500 obese individuals over a period of 20 years — the longest period of time any study on healthy obesity has looked at a given population.

When the study began, 66 of these 2500 people were “healthy” obese as determined by their cholesterol, blood pressure, triglyceride levels, fasting glucose levels, and insulin resistance. At the end of the study, more than half of those who had begun the study as “healthy obese” had become “unhealthy obese,” while only 6 percent of individuals lost enough weight to no longer be considered obese.

Researchers then studied a group of 389 “healthy obese” individuals; after 20 years, 48% of those subjects had become “unhealthy obese” and 10% had lost weight to be categorized as non-obese.

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The study’s primary researcher, Joshua Bell, tells Forbes that while previous studies on healthy obesity over a shorter timespan “showed about one-third of healthy obese adults progress to unhealthy obesity” his new research “with at least 10 years longer follow-up, indicates that this tendency gets stronger with time, with about half making this transition after 20 years….These results indicate that healthy obesity is often just a phase.”

Furthermore, the researchers found that the tendency for adults to progress to unhealthy obesity gets stronger with time. Healthy obese adults tend to get worse, not better, and healthy obesity should still be considered a high risk state — the harmful effects may just be delayed.

A less intensive study published in 2013 in the Annals of Internal Medicine reached a similar conclusion, finding that, when compared with metabolically healthy normal-weight individuals, “obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight.”

And yet a smaller study published last week out of Washington University School of Medicine in St. Louis looking at how additional weight gain impacts those already categorized as obese drew a slightly different conclusion. The researchers there found that those without health problems before the additional weight gain stayed healthy, while those with health problems saw those issues exacerbated by the additional weight gain.

The Wash U team concluded that perhaps some individuals are “protected from the adverse effects of moderate weight gain” regardless of their current weight. That is, for many, certain kinds of medical conditions — like blood pressure — might have more to do with a person’s genetics than their weight.

“This observation is important clinically because about 25 percent of obese people do not have metabolic complications,” says Dr. Samuel Klein, director of the Washington University Center for Human Nutrition in a statement to the American Association for the Advancement of Science. 

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