Disconcerting to hear the extremely high percent of the population that has metabolic diseases based on how many fit into either "overweight" or "obese" catagories. The real issue is the inflammation and IR, and other issues that are not so visible.
I agree, the real issue is metabolic health, not whether someone is or is not overweight. Yes, there are going to be some people who are metabolically healthy despite having a BMI that puts them into the "overweight" or "obese" category. And, there are going to be some people who are not metabolically healthy despite having a "normal" or even "below normal" BMI.
That said, there IS a high degree of correlation (note, I said correlation, NOT causation) between BMI and metabolic health. Suppose you picked 1,000 people, totally at random, and then ran all the usual tests on them to determine their metabolic health and found the say 473 of them were not metabolically healthy. Then you put all 1000 of them into a big room and told me to go thru and see if I could pick out the 473 who were not metabolically healthy WITHOUT looking at any of the data you had collected on them.
If I simply went thru and picked out the 473 who looked to me to be the most obese, with the most jiggly lard, etc., I suspect I'd get close to 90% correct BECAUSE of the high degree of CORRELATION between obesity and metabolic unhealth.
Thus, it doesn't bother me to hear scientists make estimations that a high percentage of Americans are NOT metabolically healthy because so many of us fit into the obese and overweight categories. Regardless of whether obesity causes metabolic disorders or metabolic disorders cause obesity, a country (such as ours) that has a large percentage of people who are visibly obese is very likely to have a similarly large percentage of people who have metabolic disorders. Meanwhile, in a country where very very few people are visibly obese, the percentage of people with metabolic disorders is very likely to be much much smaller.
This has NOTHING to do with blaming people for being overweight or discounting their health issues as being caused by them being overweight. It is simply to say that when a severely overweight person walks into the doctor's office, the doctor OUGHT to instantly be hyper-vigilant to the possibility that this patient may have, and probably does have, metabolic disorders.