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The idea of “healthy obesity” — that there are obese people who are nevertheless in good health, with normal cholesterol levels, blood pressure and other metabolic risk factors — has gained traction in recent years. But a small study suggests this apparently healthy state of affairs does not last.

The analysis, published in the Journal of the American College of Cardiology, studied 2,521 people, including 66 obese adults who were in good health. Researchers examined them periodically over the next 20 years, assessing five measures of metabolic health: cholesterol, triglycerides, blood pressure, fasting glucose levels and insulin resistance.

As defined by abnormalities in two or more of the measures, the progression from healthy to unhealthy obesity steadily increased over time. By the end of the study, 51 percent of the healthy obese were unhealthy, and they were almost eight times as likely to arrive at unhealthy obesity as the healthy adults who were not obese.

“ ‘Healthy obesity’ is quite a misleading term,” said the lead author, Joshua A. Bell, a doctoral candidate at University College London. “It sounds safe, but we know that it’s only healthy in a relative sense. The healthy obese become unhealthy and progress into the highest risk group. This is a real challenge to the idea that the obese can be healthy in the long term.”