A systematic review and meta-analysis of observational studies published from 1950 until 2013 suggests that there is no such thing as being healthy and overweight, according to an article published in Annals of Internal Medicine. Persons in the same BMI category can have varied metabolic features, such as lipid profile, glucose tolerance, blood pressure, and waist circumference. Some obese individuals have normal metabolic features, despite their increased body fat. This profile has been described as “benign obesity” or “metabolically healthy obesity.” Similarly, some normal-weight individuals may have adverse metabolic features, despite having a healthy BMI. Researchers reviewed published research to assess the association between metabolic status and all-cause mortality and cardiovascular events in normal-weight (BMI, 18.5 to 25 kg/m2), overweight (BMI, 25 to 30 kg/m2), and obese adults. The research showed that metabolically healthy obese individuals were at increased risk for death and cardiovascular events over the long term compared with metabolically healthy normal-weight persons, suggesting that increased BMI without metabolic abnormalities is not a benign condition. The research also showed that regardless of BMI category, metabolically unhealthy individuals had increased risk for events compared with healthy normal-weight individuals. The researchers conclude that both BMI and metabolic status should be considered when evaluating an individual’s health risks. The authors of an accompanying editorial write that recognizing that there is no level of healthy obesity is the first step. Next, physicians need to focus on treating obesity as any other chronic disease that requires long-term attention.

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