Is it possible to be fat and healthy?

One of my favourite bloggers, University of Alberta obesity chair Arya Sharma, recently proposed a new scoring system that he'd like to see replace body-mass index (BMI).

The Edmonton Obesity Scoring System was published in the Canadian Medical Association Journal. It tracked deaths over nearly two decades, and created a scoring system to predict morbidity that's more nuanced than BMI.

On his blog, Dr. Sharma talks about the "obesity-chronic disease paradox": weight and health don't actually seem to be as closely related as the current system believes. "Good health is possible over a wide range of BMI," says Sharma.

Sharma's system found that it's possible to be overweight according to BMI and healthy: Patients who were ranked stage zero or one (with no weight-related risk factors like high blood pressure, cholesterol or glucose levels, or subclinical risk factors and mild symptoms, like shortness of breath with moderate exercise, or occasional aches and pains) didn't have a higher chance of death than those with a normal BMI.

For those people, healthy lifestyles, like exercising and eating well, may be more important and weight maintenance, not loss, should be emphasized.

"Telling healthy large people to lose weight can be counterproductive, in that it can foster frustrations and despair, and lead to unhealthy behaviours focusing on weight loss rather than on healthy lifestyles, which are possible at almost any weight," he says.

For others who have significant health problems, the scale helps determine the appropriate level of intervention, be it behavioural, surgical or — and here's a sobering thought — palliative.

For the full chart of the rankings, click here.