Is There Such a Thing as a ‘Healthy Weight’?

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Rethinking How Doctors Define ‘Healthy Weight’

So, what is a better way to more accurately define what a “healthy weight” looks like in any one individual?

Rekha Kumar, MD, an endocrinologist and obesity medicine expert at Weill Cornell Medicine in New York City, points to a tool called the Edmonton Obesity Staging System (EOSS). Rather than defining obesity by BMI, the EOSS determines whether — and to what degree — your weight is affecting your health and your quality of life. It uses a classification system of five categories that are based on how much the obesity-related issues impact your physical, functional, and mental health.

  • People with stage 0 disease have no obesity-related health issues (comorbidities).
  • People with stage 1 have some risk factors for obesity-related health issues and mild symptoms, such as borderline hypertension, prediabetes, or mild osteoarthritis.
  • People with stage 2 have established comorbidities and moderate symptoms, such as hypertension, depression, or type 2 diabetes.
  • People with stage 3 have significant obesity-related comorbidities that can reduce their quality of life, such as stroke, diabetic complications, or end-organ damage.
  • People with stage 4 potentially have “end-stage disease” and may be bed- or wheelchair-bound with severe functional limitations and a significant reduction to their quality of life.

Doctors try to determine if a person has excess fat on an individual level and if they have an increased risk of diseases related to excess fat, Dr. Kumar says. The EOSS scale helps account for this. “Having excess fat mass is not inherently unhealthy for every individual. What matters is whether that fat is causing organ-level dysfunction, driving inflammation, impairing hormonal signaling, or reducing functional capacity,” she explains. Researchers are working to learn more about this, while also rethinking the tools they use.

In 2023, the American Medical Association (AMA) acknowledged the dangers of using BMI alone to assess metabolic health. AMA’s updated policy recommends using BMI in conjunction with other measurements, such as waist circumference and body composition analysis (including body fat).

These other measurements aren’t perfect, but they offer a more complete picture of how a person’s metabolic health is affecting their weight — and whether someone’s current weight can be considered a “healthy” one, Hashmi says.

Waist Measurements

“We look at waist circumference and waist-to-height ratio as markers of [abdominal fat] because where fat is stored matters as much as how much fat you carry,” Kumar says. A waist size over a certain threshold — 35 inches for women and 40 inches for men — increases your risk of heart disease, type 2 diabetes, high blood pressure, breathing problems, and certain cancers.

You can measure your waist circumference with a tape measure, placing the end of the measuring tape at the midway point between the top of your hip bone and your rib cage (which should align with your belly button). Breathe out normally, wrap the tape around your waist (loose enough that you can fit one finger inside it), and check your measurement.

Your waist-to-height ratio is another way to assess abdominal fat. You can calculate your waist-to-height ratio by dividing your waist circumference (in centimeters) by your height (in centimeters). A ratio of 0.5 to 0.59 indicates a higher risk of health problems, and ratios of 0.6 and above have the highest risk for issues such as type 2 diabetes and heart disease.

Body Composition Analysis

A body composition analysis, ideally a dual X-ray absorptiometry (DEXA) scan, tells you how much muscle, fat, and bone you have, Kumar says. This full-body scan measures your total body fat percentage and your fat mass index (the total amount of fat you have relative to your height).

Functional Capacity

Certain functional markers can help doctors determine how your weight impacts your health. “[For example,] can you climb four flights of stairs without losing your breath? Can you carry your body weight through daily life without joint pain?” Kumar says. Your ability to complete certain everyday activities without straining means you can add more movement into your routine, which helps you maintain a healthy weight.

To determine your functional capacity, your doctor may have you complete certain tasks during your visit, or they may ask questions about how easy these tasks are.

Metabolic Vital Signs

Vital signs, including your blood pressure, blood sugar, and cholesterol levels, offer further insight into your metabolic health.

  • A normal blood pressure is a systolic reading (the top number) of less than 120 millimeters of mercury (mmHg) and a diastolic reading (the bottom number) of less than 80 mmHg.

  • A normal blood sugar level using an A1C blood test is below 5.7 percent.

  • Normal cholesterol levels include a total cholesterol level below 200, a low-density lipoprotein (LDL) level below 100, and a high-density lipoprotein (HDL) cholesterol level of 40 or above for men and 50 or above for women.



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