Can You Be Healthy At Every Size?

We take on a controversial question: is obesity a disease, a risk factor, or simply a normal human variation. We explain metabolically healthy obesity, why fat location matters more than BMI alone, and how small, sustainable weight loss can restore metabolic health for many people.
• obesity stigma versus obesity as a medical disease
• why not everyone with obesity needs treatment
• visceral fat as the higher-risk fat type
• fatty liver disease as an early warning sign
• organ fat links to insulin resistance, sleep apnea, kidney strain, and heart failure risk
• subcutaneous fat and why liposuction does not improve metabolic function
• practical ways to estimate fat distribution, including waist circumference and DEXA
• how metabolically healthy obesity can shift over time
• the “tipping point” concept and individualized risk
• why a 10% weight loss can improve labs and symptoms
• finding a doctor who personalizes obesity medicine care
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Transcript

Welcome And Medical Disclaimer

Dr. Lindsay Ogle 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Olgill, Ford Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

Is Obesity A Disease

Dr. Lindsay Ogle 0:44

This is going to be a controversial topic, and this gets to the heart of whether obesity itself is a disease, or if it's a risk factor, or if it's nothing at all, if it's just a phenotype meaning a normal variant of human beings. I'm going to dive into this deeper by talking about something that is called metabolically healthy obesity and what it actually means. But first, who am I? My name is Dr. Lindsay Ogle. I'm a board certified family medicine and obesity medicine physician, and I founded Missouri Metabolic Health where I help patients improve their metabolic health by optimizing their lifestyle, achieving healthy and sustainable weight maintenance, and treating their chronic medical conditions. So this topic is extremely interesting to me. Essentially, do we need to treat everybody who has obesity? I don't think that we do. There's a movement, Healthy at Every Size, which aims to destigmatize obesity, which I think is a great thing. And us in the obesity medicine field are trying to do the same work as well. The big difference in obesity medicine is that we see obesity as a disease, something that negatively impacts the health. And that's both from an adiposity, or we call it sick fat disease, where the actual cells themselves are secreting inflammatory markers and endocrine signals to the rest of the body to cause dysfunction, to cause inflammation, insulin resistance, to name a few, increasing risk of other conditions like type 2 diabetes, cardiovascular disease, blood clot, stroke, etc. The extra weight can also cause fat mass disease, which is when the extra tissue itself, the weight of the tissue, can cause conditions such as osteoarthritis. But we, I think, all know people who fit in the obesity category and are healthy and feel great and fine, which is wonderful, and we don't need to worry about that. But there's a key difference of people who meet obesity based on BMI and are metabolically healthy, and people who meet obesity with BMI criteria and are not healthy. I want to go over some of those differences here.

Visceral Fat Versus Subcutaneous Fat

Dr. Lindsay Ogle 3:14

One of the main ones is where they carry weight. We know that the most dangerous type of fat is visceral fat. So this is fat disposition in our organs. Most commonly we think of fatty liver disease. This is becoming more and more common, and often it gets ignored, and it may be one of the first signs of metabolic dysfunction and is quickly becoming the leading cause of people who need a liver transplant. This is something that absolutely should not be ignored and should be addressed. Fat disposition happens in other organs as well, like the pancreas, which is likely leading to insulin resistance. Fat can get placed on the kidneys, which can affect kidney function and blood pressure. Fat can deposit around our throats and cause sleep apnea. It can also deposit around the heart and lead to heart failure. So that type of fat accumulation is obviously dangerous, but the fat accumulation just under the skin doesn't tend to be as damaging as the visceral fat. We call the fat under the sit the fat under the skin subcutaneous fat. That's the type of fat that's removed if somebody has liposuction. Liposuction will help somebody lose weight, might make them look better in a bikini, but it's not going to improve their metabolic function. It's not going to change their overall health. So, how do you know where you're carrying your fat? You can get a fancy DEXA scan, which at some locations costs around $100. You can do a body composition analysis. Some obesity medicine clinics have it, some gyms have them. Their accuracy varies, so it's something that you want to be aware of. You can also take a waist circumference. If you are carrying a lot of your weight in your belly around your waist, then it is more likely that you have more visceral fat. If most of the weight that you're carrying is in your thighs or hips or butt, that's most likely subcutaneous and less likely to cause an issue. So we think of body types like the round body type or the pear shape, and the pear shape is less likely to affect your health than the around or apple body type.

How Healthy Fat Turns Harmful

Dr. Lindsay Ogle 5:49

We also see that over time, people who met the metabolically healthy obesity category, over time, many of them turned the corner to metabolically unhealthy. So there definitely is a time component, how long you have obesity, how it impacts your health. Now I don't want to get too much into the weeds here because it's not clinically relevant, meaning that we can't really measure these things. But these are things that are studied in scientific studies and research. And I'm going to show you here the difference between somebody who has excess adiposity or obesity and it is healthy obesity versus somebody who has excess adiposity or obesity that is metabolically unhealthy. And you'll see that the one that is healthy has more fat cells and they're smaller and they're insulin sensitive. And they have what's called normal angiogenesis, meaning that they have plenty of blood vessels to supply them energy, nutrients, oxygen, allowing them to function well. They're dividing normally, and that's the normal adipogenesis. But either over time or due to genetic causes or reasons we're still trying we're still learning, the fat cells, the adipocytes, change. They start to become larger and block their blood supply, which decreases the amount of oxygen that they have. They start to be stressed out and release inflammatory markers, and they can die and become scarred. They start to cling on to organs. This can lead to the metabolically unhealthy obesity. And what's very interesting is this is a fluid process. Here is an example of somebody who has gone back and forth from metabolically unhealthy obesity to metabolically healthy obesity, back to unhealthy, and then back to healthy again. And what we do see is that it was the weight loss and gain that was the variable here, which leads us to assume that there is a tipping point for most people, that they can be metabolically healthy until a certain BMI, and that can be different for everybody based on their genetics, their nutrition, their environment, their medical conditions, the just different exposures that they've had, it can vary from person to person, but they'll hit that tipping point and they'll start to have signs of metabolic dysfunction. Their cholesterol will be abnormal, blood pressure goes up, blood sugar goes up, they have increased inflammation or puffy, less energy, poor sleep.

Finding Your Healthy Weight Target

Dr. Lindsay Ogle 8:48

But the good news is weight loss, even a 10% weight loss, so if somebody weighs 200 pounds, that's 20 pounds, dropping that 10% body weight can bring somebody back to the metabolically healthy state. You don't have to have a normal BMI to be healthy, but there is a healthy weight for you. So you really need to find a doctor who understands this and is going to treat you in an individualized way. There is no one size fits all. Our goal is to find your best weight, the weight that you feel healthiest in, that you are healthiest in, and that we can sustain over time. If you're looking for somebody, I see patients in Missouri, but I'll also include a link where you can find an obesity-trained physician near you who can help you achieve this metabolic health that you deserve. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast and they may also improve their metabolic health. I look forward to our conversation next week.