Can a person be both obese and healthy?

That question is at the center of a new paper published in the Annals of Human Biology this month.

In the paper, Dr. William Johnson of the School of Sport, Exercise and Health Sciences, at Loughborough University in the United Kingdom, brought up the idea that the term “healthy obesity” should be retired.

Johnson writes, “It is undeniable that obesity is bad for health, but there are clearly differences between individuals in the extent to which it is bad.”

Johnson favors a more nuanced look at body mass index, or BMI, since there are numerous other contributing factors that determine a person’s health. These include whether they smoke and their likelihood of developing certain conditions later in life.

Currently, a BMI over 30 is considered obese.

Johnson explains that the term “healthy obesity” is flawed since people who are obese, even those who are “metabolically” healthy, are still at increased risk for a host of health conditions, including type 2 diabetes, chronic kidney disease, and overall increased risk of mortality.

“While the concept of healthy obesity is crude and problematic and may best be laid to rest, there is great opportunity for human biological investigation of the levels, causes, and consequences of heterogeneity in health among people with the same BMI,” Johnson said, pointing out people with the same BMI can have different health risks.

What is healthy?

The notion of whether “healthy obesity” is a flawed term remains controversial.

Sharon Zarabi, RD, the bariatric program director at Lenox Hill Hospital in New York, said it’s unhelpful to say a person who is obese can’t be healthy.

“I think we need to move away from using BMI as categorizing one as obese/overweight or unhealthy,” Zarabi told Healthline. “The real debate here is how do we define health? Is the vegetarian who has a BMI of 30, avoiding all saturated fats from meats and consuming a diet heavy in simple carbohydrates [and thus] reducing his risk of cardiac disease but increasing likelihood of elevated triglycerides and insulin, considered healthy?

“I think we need to redefine health and look at the overall person as a whole, taking into account fitness level, sleep patterns, joint pain, vitamin levels, breathing, strength, happiness, social connections,” she added.

She pointed out other tests can look at health more holistically, such as the “sit test” to determine if patients can get up out of a chair easily.

Rebecca Scritchfield, a registered dietician nutritionist and author of “Body Kindness,” said she was disappointed the paper made no mention of the stigma obese patients already face in the medical setting.

She pointed out there are few if any cases of obese people being told they’re healthy while overweight.

“The dominant impression is that if you are the higher weight, you are unhealthy,” Scritchfield told Healthline.

Scritchfield said that Johnson’s arguments presented his opinion as fact.

“[He said] it’s undeniable that obesity is bad for health, but that is an opinion,” Scritchfield said. “That is not necessary true because there’s just as much research out about how weight bias is harmful to health and may even shorten life expectancy.”

Obese people “tend to avoid their medical doctor because they… don’t want to get a lecture about their weight,” she said.

Scritchfield pointed out that while these people may be at risk for health complications such as type 2 diabetes, their weight doesn’t ensure that they will get those complications.

“You could have people do the same thing and they’re going to be a different weight, including weights that would be in the obesity category,” she said. “It’s not unthinkable that the term [healthy obesity] would exist.”

Getting proper treatment

Scritchfield said that debating the term “healthy obesity” isn’t likely to help people trying to stay healthy.

Instead, doctors should focus on making patients feel comfortable so they get treatment.

“I would say more doctors should be looking at the ways that they contribute to weight stigma without necessarily knowing it,” she said. “If you really care about improving the health and well-being for people, including the higher weight people, the best thing they can do is reduce the stigma.”

Scritchfield said there are ways physicians can interact with obese patients without making them feel shame so as to increase the likelihood that they will return for care.

She said physicians should ask a patient if they want to discuss their weight or diet and not assume that patient doesn’t exercise or take steps to eat healthy.

Scritchfield said that doctors should treat their obese patients as they would their patients who aren’t obese, and not focus all of their attention on weight or diet.

“Health is individual, and it depends on a number of factors for physical and emotional health; it is not weight dependent,” she said.