Is it possible to be healthy if you have overweight or obesity?

Say you’re training for a 10K, haven’t eaten red meat since high school, and almost always get at least seven hours of sleep a night — but according to your doctor, you have overweight. Does that mean you’re not healthy? Or what if your BMI puts you in the obesity range, but outside of that you always get good news from your annual physical?

It’s…complicated. Overweight — and obesity in particular — are linked with a host of health concerns, from diabetes to heart disease. But those classifications alone can’t tell you all that much about what’s going on inside your body. Here’s what the experts want you to know.

What does it even mean to be healthy?

It’s impossible to debate whether you can be healthy at any weight without first understanding what makes you healthy. While there’s no singular definition, it’s an outdated idea that health is simply the absence of disease.

“I don't think anyone thinks that anymore,” says Dr. Robert Kushner, M.D., professor of medicine and medical education at Northwestern University Feinberg School of Medicine in Chicago. Instead, Kushner says health is now best characterized as optimizing your wellbeing — given your situation and resources.

“You always have to put it in the frame of what is accessible,” says Kushner. “Then, we can define health for that individual person.” For many, that means being metabolically healthy, meaning you don’t have any concerning markers, like elevated levels of blood sugar, blood pressure, or cholesterol, according to Dr. Matthew Poplin, M.D., a lead physician at WeightWatchers Clinic and diplomate of the American Board of Obesity Medicine. For others, it’s about having an extended healthspan, which is how long you live without serious chronic conditions. Or maybe, Kushner adds, being healthy is about how your body functions. Can you chase your kids around the yard without getting out of breath? Are you able to do all the activities that make you happy? Do you tend to feel good in your body on a day-to-day basis?

As you’ll see, it’s entirely possible to meet these definitions of health at a higher weight — it just may be harder to maintain that health in the long-run due to the impact fat has on bodily functions. And that’s why so many doctors put such emphasis on whether or not you have overweight or obesity when determining how healthy you are.

How overweight and obesity are measured

Overweight and obesity are used as shorthand for excess body fat, and they’re traditionally based on your body mass index (BMI). Keep in mind that your BMI does not actually measure body fat, it’s only an estimate of how much excess fat you may have by comparing your weight to your height.

BMI has its merits. It’s a great (and inexpensive) screening tool, especially if you’re looking at big demographics, like an entire country. But it falls short on measuring an individual person’s health. For one, it’s prone to underestimate the amount of body fat in people at a normal weight, and in people who are tall. It tends to overestimate body fat in people who are short, and in people with high muscle mass, like athletes.

“BMI also doesn’t reflect body fat distribution,” says Poplin. This is key since visceral fat, which is usually found in the abdomen and surrounds the organs, can be much more harmful than fat elsewhere in the body. “What we really want to know is who has excess body fat — and in those people, whose excess body fat is causing harm to their health?” says Kushner. And that’s something BMI just can’t reveal.

New approaches to measuring body fat

Because of the shortfalls of BMI, experts are increasingly looking towards other ways to determine how healthy someone is. And the first step is changing how BMI is used. In January 2025, The Lancet Commission on the Definition and Diagnostic Criteria for Clinical Obesity recommended that doctors stop using BMI as an end-all, be-all and instead rely on it as a screening tool.

Per the new guidelines, if your BMI places you in the “overweight” or “obesity” ranges, then the next step would be for your doctor to turn to other tools to measure body fat. These include skinfold measurements, waist circumference calculations, and (painless) electrical current devices, as well as your waist-to-height ratio.

These measurements can provide a more in-depth picture of whether or not your excess fat could be impacting your health than BMI alone. Kushner notes that usually body fat percentages over 25% for males or over 35% for females are considered to be in excess. “If waist circumference is used, it will vary by sex and race,” he says. “If waist-to-height ratio is used, [excess] is greater than 0.5.”

How excess fat can affect your health

If, after further evaluation, it’s determined that you do have excess fat — especially visceral fat — it does have the potential to influence your health in some big ways. It can elevate your blood sugar, which can lead to type 2 diabetes, as well as raise your blood pressure and bad cholesterol. (And this is just a sample: There are more than 200 conditions associated with obesity.) While you might still feel healthy and strong even with these markers coming back on tests, they could lead to bigger issues down the road that eventually interfere with your daily function. And that’s when your state of “healthy” can start to waver.

Why does excess fat create so much internal chaos? One way is through inflammation — the more fat cells you have, the greater the inflammation in your body. On top of that, fat cells add physical weight that can lead to mechanical wear and tear, says Dr. Holly Lofton, M.D., professor of medicine and surgery at NYU Grossman School of Medicine and the director of the Medical Weight Management Program at NYU Langone Health in New York City. “Having a large amount of fat cells can cause the knees to have stress on them, which can cause arthritis,” she says. “And having even a small amount of fat around an organ, such as the heart, can lead to dysfunction with heart pumping and thus circulation.”

The latter is a new phenomenon called Cardiovascular-Kidney-Metabolic (CKM) syndrome. It’s a newly coined metabolic syndrome in which excess body fat causes inflammation throughout the body. But on top of that, “fat becomes deposited in other organs, like the heart or the liver or the kidney,” Kushner says. “This is called ectopic fat — meaning fat is in parts of the body it shouldn't be in.” There, the fat can increase the inflammation in the affected organ and upend its functions.

That said, things like arthritis, fatty liver disease, CKM syndrome, and the like don’t happen to everyone with overweight or obesity. While excess body fat can definitely increase your risk of many conditions, it doesn’t mean they’ll definitely occur. And, of course, all of these conditions can be present in individuals who don’t have excess body fat, says Poplin.

So, is it possible to be healthy at any weight?

Now for some good news: “You can have excess body fat and no signs or symptoms that it's harming your health, which means you are healthy,” says Kushner. “You don't have diabetes or arthritis, you're happy, and you're feeling well.”

Under the new Lancet Commission guidelines, this state of being healthy despite having a high BMI is considered preclinical obesity. And it’s actually more common than you might think. In fact, roughly 35% of people with obesity are considered metabolically healthy, according to research from the American Journal of Clinical Nutrition. “These individuals are considered to be at a lower risk of obesity-related complications compared to those with obesity and an obesity-related condition like type 2 diabetes,” says Poplin. They do, however, still have a higher risk of developing complications compared to people without excess fat.

On that note, keep in mind that while being healthy with overweight or obesity is possible, it’s not a long-term guarantee. Given enough time, “you are at higher risk of developing harm to your health if you continue to have excess body fat,” Kushner says. “And that's been documented in many, many studies.”

And that is why many clinicians will recommend weight loss for people with excess fat. It’s not to get them to be a certain size; it’s to reduce their risk of future health issues. For some people that might be accomplished through diet and exercise, for others that may not be enough. “The intensity and degree of treatment should be personalized,” says Poplin.

One way that could happen is with a weight-loss medication like a GLP-1. For someone with excess body fat who’s tried to lose weight through lifestyle changes and hasn’t seen success, it could be worth considering. “If they qualify, I may say, ‘Have you thought about escalating or becoming more intensive in your therapy, such as using medication?’” says Kushner.

GLP-1s in particular are unique in that they can target fat accumulation around the organs that contributes to so many health complications. In fact, the GLP-1 can “start to reduce the inflammation and the fat from the liver, as an example, or from the heart,” Kushner explains. “So it improves all these organs — not just by losing weight, but also affecting the health of those organs.”