There was a brief golden age in which individuals who were obese but asymptomatic of cardiovascular disease got a pass on weight loss recommendations. A report published in 2012 in the European Heart Journal showed that obese people were at no greater risk of developing or dying from cardiovascular disease or cancer than their healthy weight counterparts. Science, however, is an iterative discipline of revision.

On April 30, researchers in Seoul, Korea, reported new findings that contradict the earlier findings. The study, described in a report published online in the Journal of the American College of Cardiology, reveals that obese individuals, compared with healthy weight controls, show much higher presence of arterial plaque, a precursor condition for heart disease. The results suggest that all obese individuals be informed of their risks for cardiovascular disease and steps toward lowering their weights.

In the study, researchers examined 14,828 metabolically healthy Korean adults aged 30 to 59 years of age. Based on estimated coronary artery calcium (CAC) scores, a measure of plaque buildup on artery walls, obese individuals had a much higher prevalence of plaque buildup.

“Obese individuals who are considered ‘healthy’ because they don’t currently have heart disease risk factors, should not be assumed healthy by their doctors,” said Yoosoo Chang, MD, lead author of the study and professor at Kangbuk Samsung Hospital Total Healthcare Center Center for Cohort Studies in Seoul, Korea. “Our research shows that the presence of obesity is enough to increase a person’s risk of future heart disease and that the disease may already be starting to form in their body. It’s important that these people learn this while they still have time to change their diet and exercise habits to prevent a future cardiovascular event.”

In an accompanying editorial published in the same issue, Rishi Puri of the Cleveland Clinic noted that an obese person with normal blood pressure, sugar levels, and cholesterol levels will not likely maintain them for long.

“People have been trying to work out whether there is a group of people that are obese and healthy,” wrote Puri. “We have an enormous challenge at a public health and individual level in dealing with obesity-related disorders. Being obese doesn’t just affect the heart. Being obese means you’re more likely to have joint disease, psychiatric disorders and cancers.”