I would wager that most people with hypertension have it because they are fat. I would also wager that if someone looks healthy, like a soccer player, there is a good chance they don't have any of the conditions now classified as "metabolic disorder." They might have brain cancer, or a cold, or even type 1 diabetes, but they probably don't have high blood pressure or type II diabetes. High cholesterol I know nothing about, so I wouldn't make any bets about that. I have other wagers about skinny people with hypertension, but it's getting too far off topic now.
I agree with your instinct about the cause of most hypertension. Most Americans are fat; obesity causes hypertension; therefore, most Americans who are hypertensive are so because of their obesity. With regards to your point about the soccer player, I cannot agree. You listed plenty of fine caveats to your point - in fact, the caveats outweigh your argument, in my opinion. These caveats only increase as you transition from a 25-y/o soccer player to a 50-y/o soccer player who "looks" 25. But perhaps that is just my American physician-style bias - to err on the side of caution. Most diseases that you and I will ever need to worry about do not have dermatological findings, so just looking at a person and noting a lack of obesity or other derm findings is a pretty poor screening test for ruling out disease.
High cholesterol primer: it is the most important disease based on the objective criterion of "causes the most deaths," has no physical findings, except for the 1/1000 who have recessive mutations that will cause them to have a heart attack in their 20s-30s unless they take statins. 80% of the cholesterol in your body is produced by your body, so you cannot typically blame diet for hypercholesterolemia.
Your post seemed to imply that Type II diabetes is caused only by obesity; this is not true, but it feels true because the recent obesity epidemic has made obesity the most important cause of T2D. Unfortunately for the patients, it's not the only cause.
The metabolic syndrome is a rule-based diagnosis: you must meet 3 out of 5 criteria, only one of which is obesity. Thus, you can have the metabolic syndrome without being obese. These patients are actually very interesting, because it suggests that they naturally have the same maladaptive gene expression profile that is caused by obesity. This is an opportunity for research into the molecular biology of obesity-induced diseases.
As an aside, we do treat obese hypertensives with ACE inhibitors and other proven medications, even though we know their hypertension is caused by obesity. Doing so still reduces their cardiovascular disease and kidney damage. If they lose weight and are no longer hypertensive, then we stop the meds. In the meantime, we do what we can to protect their vital organs.
Oh, also - congrats on losing so much weight! Most people have a devil of a time losing even 1/3 of that (and keeping it off for an appreciable amount of time is another story entirely.) What was your trick for losing it, and for keeping it off?
My trick for losing weight was that I stopped eating cheese, pasta, burritos, and pizza. I also quit drinking beer. I kept it off by not eating or drinking those things.
