Video | Metabolically Healthy Obesity | Metabolic Flexibility | Healthier Fat? | Are You Better Off?

Can a person be overweight or obese and still have a healthy metabolism? A study published in 2020 shows that while you can’t deny that obesity contributes to reduced life expectancy, impaired quality of life, and disabilities, there are people who have markers of a healthy metabolism despite having a high BMI.

Could this be you? If so, are you better off in the long run? Those questions are answered in this blog post.

Metabolically Healthy Obesity [Video]

Are You Metabolically Healthy?

Metabolically Healthy Obesity is a concept that was born out of the observation that there are individuals with obesity who do not overtly exhibit cardiometabolic abnormalities.

So, a person with metabolically healthy obesity would have a high BMI (30 or higher). However, they would not exhibit insulin resistance or have high blood sugar, blood lipids, or blood pressure, and their cardiorespiratory fitness would be good. 

This is not a rare occurrence. According to the study, the prevalence across different gender and age groups is between 10 and 30% (1).

The goal of the study was to discover what made a metabolically healthy obese person different from a metabolically unhealthy person. In other words, if two people have the same amount of body fat, what makes one of them healthier than the other?

Metabolic Health = Metabolic Flexibility

To gain understanding, we need to look at metabolism. Many people think that metabolism is either good or bad. You were either blessed or cursed. In reality, metabolism is best viewed as a spectrum ranging from inflexible to flexible.  

A healthy metabolism is a flexible metabolism, meaning that it can efficiently switch between burning carbs and fats for energy based on which one is available and your body’s energy needs. 

This conversion of food to energy happens within your cells in tiny powerhouses called mitochondria. When mitochondria struggle, your body can’t switch efficiently, impacting your metabolic health and potentially leading to the cardiometabolic abnormalities mentioned earlier. 

Those markers will improve with a low-sugar, low-processed diet and exercise. Your doctor can assess your progress through yearly or semi-yearly physicals and blood tests.

Healthier Fat? 

So, individuals with metabolically healthy obesity likely have more metabolic flexibility. How did they get that flexibility? Is it purely a difference in how they eat and live, or were they graced with a genetic advantage? The investigators don’t know the complete answer to that question, but it is likely a bit of both. 

We know that consuming a healthy diet and exercising improves metabolic health, even in the absence of weight loss. 

So, an obese individual who eats an excessive but whole-food diet and exercises regularly may be more metabolically fit than a sedentary obese individual who eats a lot of processed foods.

But again, why? 

The researchers split obese individuals into two groups based on their metabolic health. They matched the groups for gender, BMI, and body fat percentage. They found that those with metabolically healthy obesity had healthier fat tissue.

Healthier fat tissue has a greater capacity to store lipids and fatty acids, accumulates in safer areas of the body, and creates less inflammation. 

To broaden our understanding of those benefits, when fat tissue efficiently stores lipids and fatty acids, those components are not circulating around the body, where they can cause problems.

How fat is distributed in the body also plays a significant role in metabolic health. Individuals with metabolically healthy obesity store more fat in their legs and less in the liver and belly. 

Leg fat is subcutaneous fat, meaning it accumulates just beneath the skin. This type of fat acts as an energy reserve and does not interfere significantly with organ function. In contrast, fat stored in the liver and abdomen is visceral fat. It surrounds internal organs and is linked to increased inflammation. 

There is evidence that genetics play a role in fat distribution, as does gender. Generally, men are more prone to fat accumulation in the belly, and women are more prone to leg fat.

This natural tendency may protect women, and the study pointed out that “metabolically healthy obesity seems to be more prevalent in women than in men.”

Are You Better Off? 

It is now well-accepted that there are people with obesity who do not exhibit metabolic complications. However, metabolically healthy obesity is not a safe, worry-free condition for three reasons. 

First, it is likely a transient state, meaning that the disease markers are just not showing up yet. In other words, the adage that you can’t outrun a poor diet holds up. Continuing to live a sedentary life and eating a highly processed diet will catch up with you.

Second, while a metabolically healthy obese individual may enjoy a reduced risk of developing disease compared to an obese person with unhealthy markers, that advantage is lost in comparison to a healthy lean individual. So, weight loss should still be a goal. 

And lastly, obesity is strongly linked to general health concerns, such as joint pain, arthritis, depression, and cognitive decline – all of which impact your quality of life. 

Takeaway

If you currently have a high BMI, I hope you leave this blog post feeling encouraged. While you do want to bring your BMI into the healthy range (18.5 and 24.9), changing to a low-sugar, low-processed foods diet and adding regular exercise can improve your metabolic health even before your ideal weight goal is reached. 

Reference:

(1) Blüher, Matthias. “Metabolically healthy obesity.” Endocrine reviews 41.3 (2020): bnaa004.

About the Author

Becky Gillaspy, DC, is the author of The Intermittent Fasting Guide and Cookbook and Zero Sugar / One Month. She graduated Summa Cum Laude with research honors from Palmer College of Chiropractic in 1991.