Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

The results of a study published in the Archives of Internal Medicine should not come as a shock to most people. Being overweight doesn't necessarily make you unhealthy, according to researchers in both the United States and Germany. Sports fans have known this forever; elite athletes can have an appearance ranging from tiny Olympic gymnasts to massive NFL linemen. Athletes at both extremes- and all those in between- are in shape and trained to perform at high levels.

The new research confirmed this. People who are overweight have a fifty-fifty chance of having high cholesterol, high blood pressure, or elevated blood sugar levels. Pretty good odds, but not as good as those for people who are within the normal weight range. They have a 75% chance of having normal results on blood tests for cholesterol and blood sugar. And for those who are obese, the chance of having normal results falls to one-third.

The definition of "ideal body weight" has been a thorn in the side of many people. Perceptions of how people appear, how their clothes fit, and how fat they are have permitted whole industries to flourish. Weight loss clinics, gyms and fitness centers, liposuction, and gastric bypass surgeries all were based at least partly on the presumption that being overweight equaled being at risk for heart disease and diabetes. The studies in the Archives of Internal Medicine found that there may be more to health than meets the eye.

There aren't many risk factors for heart disease and stroke, the big killers in the United States. Smoking, high blood pressure, high cholesterol, diabetes, and family history are the factors that decide who will develop atherosclerosis (narrowing of the arteries). Aside from family history, the rest of these factors can be controlled and therefore, risk minimized.

The key to risk management is not what you look like, but what the numbers say; that may require a person to take preventive action. You can't look in the mirror and see high blood pressure or high cholesterol; you need to take positive action and visit a health care provider.

The study reminds us that looking after the body is no different than car maintenance. You can look at the exterior of a car or truck and decide whether you like the shape and style, but its external appearance gives you little information on how the engine is holding up. Routine maintenance with an oil, lube, and filter, checking the fluid level, and changing the belts will the let the car run almost forever. The same principles apply to the body. Routine maintenance allows the body to function well and hopefully run forever.

Deciding about what constitutes an ideal weight using a scale or measuring body mass index (BMI) can be deceiving. Professional basketball players tend to have elevated BMI scores, but they carry significant muscle and little fat on their frames. Football players tend to be big, but their physical activity and training decreases their heart and stroke risk factors.

The bottom line remains the same. What we look like on the outside doesn't really matter; it's what's inside that really counts.

References: R.P. Wildman, PhD; P. Muntner, PhD; K. Reynolds, PhD; A. P. McGinn, PhD; S. Rajpathak, MD, DrPH; Ju. Wylie-Rosett, EdD; M. R. Sowers, PhD; "The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering." Arch Intern Med. 2008;168(15):1617-1624.

N. Stefan, MD; K. Kantartzis, MD; J. Machann, PhD; F. Schick, PhD; C. Thamer, MD; K. Rittig, MD; B. Balletshofer, MD; F. Machicao, PhD; A. Fritsche, MD; H. Haring, MD; "Identification and Characterization of Metabolically Benign Obesity in Humans." Arch Intern Med. 2008;168(15):1609-1616.