> I'd consider 5'8 and 210lbs morbidly obese. An average male at 5'8 should generally weigh about 150lbs and no more than 164lbs

You would consider incorrectly then.

This person has ~155 pounds of lean body mass. 164 would put him at roughly a body builder level of fat, which basically requires a part time job in cooking and nutrition to maintain.

For reference, I’m in a similar situation to this person. I’m 5’11” (180cm) and about 200 lbs (91kg) with about 170 lbs of lean body mass. My dexa scan says that I’m 15% body fat, but I get the same lectures from doctors about being obese and needing a lifestyle change, all based on BMI and (I assume) my size (I’m barrel chested). It’s completely absurd.

Dexas are notoriously inaccurate. Your dexa scan is probably wrong, and you are fatter than you think. I've been lifting over a decade, so I have far more muscle mass than the average person, and I am 6'1", yet am still easily over 20% BF if I'm 200 lbs or more. Don't believe me? Try to get truly shredded. You'll see for yourself that you will have to lose far more weight than you think. Everyone is fatter and less muscular than they think they are, even if they're active. Unless of course you are a heavy steroid user, in which case you may actually be muscular enough for that to be valid. But for the average natural trainee? Nobody who's truly lean is getting an obese or morbidly obese BMI. Overweight at worst, maybe.

BMI is definitely inaccurate for those with greater amounts of muscle mass, but not as inaccurate as many would like to believe.

I didn’t want to belabor the point in my original post, but since you went there…

The next steps at the doctor is that I show them my MyFitnessPal nutrition tracking, my dexascan, and (at some point) take off my shirt. I ask them what exactly it is I should change. 100% of the time the answer has been something like “Oh, sorry. Please continue as you are doing.”

They just aren’t used to seeing muscular 200 pound dudes at my height in my area at my age (btw, I’m in my 50s).

Also, someone can workout in the gym all they want, but I think most people will struggle with lowering their body fat percentage if they don’t focus on their nutrition.

I realize that my lean body mass (both bones and muscle) are decreasing, and that rate of decrease be higher each year. That said, I’m doing what I can to maintain whatever muscle and bone mass I have.

If I got rid of all of my fat and bones, I'd still weigh more than 150lbs. I have the most muscular 150lbs man inside of me.

Ideal body fat percentage is 18-24% - I'm at 25% (or was in November - might be +/- 2% since then - gained a few pounds weight, but not waist size).

So I would say I'm not morbidly obese or even regular obese based on the percentage of my body that is muscle vs fat.

You are fat, though. For a man, the ideal fat percentage is 15-20%. 20+%, let alone 25%, is not healthy at all.

Or that guy could be a burly bricklacker / concerete worker who can casually carry hundreds of pounds of weight all day every day in brutal conditions.

It's really hard to tell with the data provided.

burly - maybe, but I haven't done any hard labor most of my life. I ran track as a kid, and kept my high metabolism - (RMR: 2460kcal, TDEE: 3380kcal); well lost it when my thyroid failed, but medicated myself back to it. I eat what I want, but its a very high lean-meat diet (lots of chicken breast and turkey because my wife likes them), but I don't limit my carb intake either, as I mostly burn sugar for energy (according to my Respiratory Exchange Ratio).

Somehow my body is just amazing at working without any help from me. I don't even exercise much. Maybe a few pushups a day, up and down my stairs at my house a couple dozen times a day, and probably 5-10k steps a day max.