Big boned, thick or obesity – how thick is too unhealthy?

Can someone be "big boned" and still be healthy? Should everyone aim to be the lightest weight possible? Where is the line between being “thick” and obesity? Dr. Ty breaks all of this down with two obesity experts… including the shocking link between carrying extra weight and COVID-19!

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The terms “big boned” and “thick” are often used colloquially within African-American communities to describe people who weigh heavier than others. But, is being “big boned” a real thing? And, is it different from having a diagnosis of excess weight or obesity?

According to Dr. Fatima Cody Stanford, an obesity medicine physician at Massachusetts General Hospital and Harvard Medical School, it is not.

“This concept of ‘big boned’ is actually a fallacy. Individuals that carry more excess weight, their bones are actually smaller. So this idea of it just being about bone size is actually completely wrong,” says Stanford, who also authored Facing Overweight and Obesity: A Complete Guide for Children and Adults.

There is, however, a very real obesity crisis in America, with the CDC reporting that three out of every four Americans ages 20 and older have overweight or obesity, and Stanford wants people to realize that obesity is about more than just size.

Black woman steps on weighing scale
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“It’s important for us to note that it is actually a disease,” Stanford says. “And often what people will tell me is that, ‘oh, well, I don’t really have any issues, I just am heavier.’ Well that heaviness, that excess weight, is actually a disease process.”

Despite the Centers for Disease Control and Prevention’s focused efforts against the obesity epidemic since 1999, almost three times as many adults have overweight or obesity than in the early 1990s. Black women have the highest rates of obesity of any other group in the United States. And as the rates have risen for adults, the rates of childhood obesity has also risen.

Dr. Kathi Earles, an Atlanta-based physician who specializes in both pediatrics and obesity medicine, is not surprised.

“What the parents do directly affects what happens in the family and what happens with the children,” says Earles.

Nearly 20 percent of American children have obesity as well, according to the CDC, with Black and Hispanic children affected at higher rates than white and Asian children. Recognizing when a child has overweight or obesity is a must, says Earles, due to its immediate and long-term health risks.

“We know that as children grow, the older they become, if they continue to carry this excess weight, the more likely they are to carry it on to adulthood,” Earles continues. “Therefore, the outcome is often worse.”

To determine if someone is carrying excess weight or has obesity, start by calculating Body Mass Index, or BMI. The CDC has an online Child & Teen BMI calculator based on height, weight and age, and one for adults. Pediatricians and other primary care doctors can also calculate BMI at regular checkups. However, simply losing as much weight as possible or becoming as skinny as possible is not the goal.

“We tell patients that we want to get them to the happiest, healthiest weight for them,” says Stanford.

She adds that she has never given her patients a target weight to aim for.

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“I can use different medications and people respond differently,” says Stanford. “If I were to put us on the same medication, one person may lose a fourth of an ounce, which is basically nothing. Somebody else may lose 20 pounds, and the other loses 50 pounds. Does it mean one of us is worse than the other? No, it just means that the way our biology works with [the treatment] is different.”

Earles agrees, and adds that genetics plays an important role in a person’s weight, as people are more likely to be heavier if it runs in their family. And excess weight alone does not automatically mean a person is unhealthy.

“It’s how healthy you are from a medical perspective, not just the weight, but your actual health,” says Earles. “Let’s say if your body mass index is above 30, but you’re able to exercise 200 minutes a week of physical activity and your lab values are all normal – your cholesterol is normal, your LDL is normal, your blood pressure is normal, then I think we consider that to be a heavier weight, but in a healthy perspective. From a genetic predisposition, they may just be larger.”

Stanford suggests having a physical examination including blood pressure and lab tests with a primary care physician to help gauge whether excess weight might be causing a health issue. Those who desire a consultation with a physician who specializes in excess weight or obesity can search the Obesity Medicine Association’s directory by zip code to find one near them.

Watch the entire video above to learn more about weight and health, including the relationship between COVID-19 and obesity, and why losing weight is not always as simple as willpower!

Dr. Tyeese Gaines is a physician-journalist with more than 20 years of print and broadcast experience, and an emergency medicine physician based in New Jersey. Follow her on Twitter and Instagram. Check out more Black America’s Health context on YouTube!

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