Can You Be Fat and Healthy?


According to the latest headlines, you can’t be fat and healthy.

I imagine you’ve seen/heard those headlines in recent days. They’re about a study that was just published looking at the question of whether a person can be healthy at higher weights.

  • “Fat and healthy is a myth” (LA Times)
  • “New research disputes fat but fit claim” (NBC News)
  • “There’s no such thing as healthy obesity” (CNN)

Should we believe the headlines? Not if you want to know the truth.

The Study Doesn’t Really Show What They’re Saying It Does

The study compared groups of people of different body sizes with and without metabolic syndrome factors, looking at the incidence of cardiovascular incidents or death. The conclusion was that metabolically-healthy “obese” persons are at higher risk for disease and death than metabolically-healthy “normal-weight” persons.  This suggests that a higher weight automatically increases health risks.

But here’s the thing:

  • What this study actually tells us is very different from the headlines and the study conclusions. The study does suggest that people who fall in the “obese” category may have a slightly elevated risk over lower weight individuals — but barely enough to be significant. And that is only when the researchers looked at studies that lasted over 10 years. When they looked at all the studies included in their analysis, there was no increased risk.

    when they looked at all the studies included in the analysis, there was no increased risk.

More significantly — and here’s what you’d think the headlines would be shouting — the study showed that normal-weight individuals with metabolic risk factors had the highest risk of all the groups.  

According to psychologist and study-interpreter-extraordinaire Deb Burgard, PhD, the study showed that “it is 214% more likely that someone thin with those risk factors will have an event in 10 years than someone thin without them. And the thin people are more likely than the fat people with risk factors to have a problem.” She is also careful to point out that overall, the risk is still low, even for thinner people who are metabolically unhealthy.

The Study Doesn’t Even Really Answer the Question of Whether You Can Be Fat and Healthy

A little education about these types of studies:

  • The study was a meta-analysis and meta-analyses don’t prove cause and effect. The researchers took a number of studies, lumped them together, and based their conclusions on associations, aka correlations, they were able to identify.

“Studies like these are considered ‘dirty’,” says Alan H. Wayler, PhD, executive director of Green Mountain at Fox Run. “There are just too many variables that aren’t accounted for that could influence the results observed. You can’t make definitive conclusions from them.”

 So we can’t tell from this study that weight was a factor in the differences seen among the groups.

 One thing that is clear: the researchers didn’t consider the level of physical fitness among study participants. That makes the study basically irrelevant. It’s just too critical of a factor in health to not consider.

There Are Plenty of Studies that Do Answer the Question — and the Answer is Yes!

In the interests of not giving you more technical details to slog through, I refer you to an excellent overview of the research on weight and health by Linda Bacon, PhD, and Lucy Aphramor, PhD, RD.

I’ll also end with a quote from Dr. Bacon, one that places the focus on the real factors in the development of disease for anyone but especially for people of size. She asks,

“When are these researchers going to start asking the more important questions raised by their data?  One good question I would like them to consider: whether their weight stigmatization contributes to increased mortality/morbidity? Whether they (the researchers) are manufacturing disease.”

There’s good evidence it does and they are. But that’s fodder for another post.

In my next post, however, I’m going to talk about the danger of basing advice on studies like these – which is going on as we speak as well-intended but misinformed health professionals around the country encourage people to lose weight because of the conclusions drawn in this study.

In the meantime, I’d love to hear your thoughts about it all.

2 responses to “Can You Be Fat and Healthy?”

  1. wendy nickerson says:

    Thank you so much for clearing this up. I have often noticed that the media likes to jump on a sensationalized view of research outcomes and then extrapolate wildly on what everyone should then do about it. A year later when other results come out, they recommend some other conflicting extreme reaction. Remember the “don’t eat any fat” years? Or the eggs/no eggs cholesterol advice, or the all oatmeal all the time advice? This particular media story sadly will likely fuel anti-obesity behaviors. How can the truth be given a bigger public microphone?

  2. Cindy says:

    Thank you (once again) for separating the wheat from the chaff, Marsha. These articles seem to always miss the point. The fact that the study was a meta-analysis is a huge consideration.

    Eat well, move more, rest up, find joy. And if you’re not getting to any or all of those things (regardless of your weight), ask yourself why not? Maybe that’s the beginning of a real conversation.

Leave a Reply

Your email address will not be published.

About the Author

Marsha Hudnall, MS, RDN, CD

If you’re looking for an embodiment of dedication disguised as obsession, look no further. Marsha is a registered dietitian who has spent the last four decades working to help women give up dieting rules and understand how to truly take care of themselves. Her mission in life is to help women learn to enjoy eating and living well, without worries about their weight. She encourages women to embrace their love of food, which you might call being a foodie. If so, it’s appropriate because being a foodie means you pay attention when you eat. That’s a recipe made in heaven for eating well. Marsha is the President and Co-Owner of Green Mountain at Fox Run.

View Author Page