COMMENTS AND RESPONSES

TO THE EDITOR: Kramer and colleagues (1) conclude that “there is no healthy pattern of increased weight. ” However, all of the studies included in this analysis define unhealthy obesity as the presence of at least 2 components of the metabolic syndrome. Thus, by defini-tion, persons with just 1 risk factor (such as hypertension, elevated fasting glucose levels, or hypercholesterolemia) would be considered “metabolically healthy. ” It is not surprising that this group has an elevated risk for cardiovascular events. We believe that this meta-analysis adds to the confusion on the topic by defining “healthy obesity ” by criteria that we would consider anything but healthy. Previous studies that have used a far more stringent definition of “healthy obesity”—that is, the absence of any medical, mental, or functional risk factors or limitations associated with excess weight (Edmonton Obesity Staging System stage 0) (2–4)—show virtually no increased mortality risk in overweight and obese persons, even over a 200-month follow-up period. In contrast, obese persons with just 1 metabolic or other risk factor are considered to have Edmon-ton Obesity Staging System stage 1 or 2 obesity and have clearly elevated mortality risk (3, 4). Mislabeling “unhealthy obese individuals ” as supposedly “healthy ” further promotes weight bias and reinforces the widespread misconception that health can be measured simply by stepping on a scale. Rather, we should not assume that everyone with excess body fat is at high risk and in immediate need of treatment. Instead, we should look at individual risk factors (smoking, high blood pressure, dysglycemia, dyslipidemia, and others) to determine whether a given person needs medical attention. After all, 1 size does not fit all