Can you be overweight and healthy?

a woman exercising

There’s a lot of talk lately about body positivity, a movement where people whose bodies may not be seen as acceptable by society feel good about themselves and their looks. It requires them to overcome adversity that often comes with being in a body that may be traditionally viewed as unhealthy or unattractive.

The movement has sparked many discussions about weight, chronic illnesses and disabilities, and how those things relate to a person's health. As researchers learn more and medical progress is made, these conversations are important to keep in mind when treating patients.

Doctors and a nutritionist from the University of Chicago Medicine’s new Center for Weight and Metabolic Health support body positivity, saying they treat each patient without judgment and don’t dismiss their concerns or symptoms.

Here are their thoughts on body positivity and other hot-button topics related to weight and health.

Is it possible to be overweight and healthy?

Silvana Pannain, MD: Yes, you can be overweight and metabolically healthy. At the same time, we know that obesity is a disease that affects the body in many different ways. Thirteen types of cancer and 200 other health conditions are related to obesity. The relationship between obesity and other diseases is complex and there are many unknowns. How can we predict which individuals with obesity will be affected? By cancer? COVID-19? Complications from surgery? We have treatments for obesity, so why do we want to wait and see what happens?

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Does the number on the scale matter?

Jessica Schultz, MS, RD, LDN, CSOWM, clinical dietitian and nutritionist: Not necessarily. At the Center for Weight and Metabolic Health, it’s about setting goals. If a patient came in and wanted to be able to play with his grandkids without getting short of breath, then the goal wouldn’t be a certain number on the scale, but to feel OK while playing with the grandkids. It’s more about how it can improve your quality of life. It’s not about what you lose, it’s about what you gain. What you see on the scale does not always signal success.

Mustafa Hussain, MD: The number on the scale is just one data point. It’s part of a bigger picture. I believe in body positivity. At the same time, I also want to be real with patients. Those numbers directly correlate to life expectancy. If you’re 50 pounds overweight, your likelihood of dying of any cause is twice as high as someone who is not overweight. If you’re 100 pounds overweight, it’s three times higher. We want to be supportive and give people options. But we also don't want to shy away from something that’s as serious a problem as cancer.

Is BMI an accurate measure of health?

Hussain: It is not perfect at all. BMI is a measure of body fat based on height and weight. We need to use BMI in conjunction with a variety of different factors – sex and gender, ethnicity and muscle mass. BMI is still a useful tool to generally assess a person’s life expectancy and risk of developing diseases like diabetes or cancer. It’s the best we’ve got and an easy number to calculate. While there are other tests that are more involved and accurate, like measuring the percentage of body fat or water, BMI is still very useful because anyone can calculate it based on height and weight.

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Are more weight loss medications going to be available to consumers soon?

Pannain: Yes. This field is exploding and it’s going to change the way we treat obesity. There’s a huge interest and a growing demand for obesity drugs that are safe. New medications are coming on the market and some have helped patients lose 20% of their body weight or more. Patients are hearing the news and more doctors are prescribing these drugs, including us.

Does boosting your metabolism speed up weight loss? And if so, how do you speed up your metabolism?

Hussain: Metabolism is about your cellular function and how your cells interact with each other. Your weight, or obesity, directly impacts that. Metabolism can slow down or speed up certain processes. To speed it up, we don’t subscribe to anything you’d read in a supermarket magazine. We’re the University of Chicago. We’re very scientific. What we’re doing is not a fad. We’re doing things that are scientifically proven, centered around extending your life and preventing disease. Individuals have different metabolic rates. We do believe that certain foods and certain diets can help, but our new Center for Weight and Metabolic Health is more interested in meeting patients where they are at and creating individualized plans to help them.

Mustafa Hussain, MD, is Director of the Center for Weight and Metabolic Health at UChicago Medicine, the Director of the Center for the Surgical Treatment of Obesity and the Associate Program Director for General Surgery. Silvana Pannain, MD, is an endocrinologist at UChicago Medicine, the Obesity Medicine Director at UChicago Medicine’s Center for Weight and Metabolic Health and the Director of Chicago Weight. Jessica Schultz, MS, RD, LDN, CSOWM, is a licensed clinical dietitian and nutritionist at UChicago Medicine specializing in pre- and post-bariatric surgery patients and weight management.

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