Researchers from Aarhus University Hospital in Denmark have discovered that individuals who are underweight face nearly a threefold higher risk of dying compared with those who are overweight or even moderately obese, challenging long-held beliefs about body weight and health.
A large Danish study has found that being slightly overweight—or even mildly obese—may not shorten life expectancy, while those who are underweight or at the lower end of the “normal” range face greater risks.
The study, presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria, suggested that being “fat but fit” could be less deadly than being underweight.
Researchers followed nearly 86,000 people, most of them women in their mid-60s, over five years, comparing their body mass index (BMI) to mortality rates.
Typically, a BMI between 18.5 and 24.9 is considered “normal”, 25 to 29.9 is “overweight”, and 30 or above is “obese”.
The results showed that people with BMIs categorised as “overweight” often had outcomes as good as, or better than, those with lower BMIs.
Researchers observed a U-shaped curve when plotting BMI against mortality, meaning that those with the lowest and highest BMIs were at the greatest risk of death.
People with a BMI below 18.5 were nearly three times more likely to die prematurely than those with a BMI between 22.5 and 24.9.
Even within the “normal” range, risks were elevated. BMIs between 18.5 and 19.9 doubled the likelihood of death, while those between 20 and 22.4 carried a 27% higher risk of early death compared with the reference group.
Carrying extra weight did not always translate into greater risk, as those with BMIs between 25 and 35—typically classed as “overweight” or “obese”—showed no significant increase in mortality compared with the reference group.
Only those with a BMI of 40 or above experienced a substantially higher risk, with mortality more than doubling (2.1 times).
These findings add weight to growing evidence that challenges the societal association between thinness and health. Instead, they suggest that being underweight poses significant risks, particularly in older age.
According to the researchers, factors such as body fat distribution and underlying health conditions play a major role in overall health.
The lead researcher also pointed to the concept of “reverse causation”. Some people lose weight because they are already ill, which may make it appear that being thin causes poor outcomes, when in fact it is the illness driving both weight loss and risk.
While BMI is not a perfect measure of health, the study contributes to the growing body of research suggesting that society may need to rethink what a “healthy body” truly looks like. Health, the researchers conclude, is not simply about being slim, but about balance, body composition, and overall well-being.
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