Metabolically healthy obesity – is it time to lay the myth to rest?

  • Victor Grech

Abstract

Metabolically healthy obesity (MHO) has been defined as a condition wherein obesity does not produce metabolic complications such as dyslipidemia, impaired glucose tolerance, or metabolic syndrome.1-2 These individuals also have less visceral adipose tissue, smaller adipocytes, and a reduced inflammatory profile when compared to metabolically unhealthy obese individuals, and their cardiac and metabolic risk does not improve as a result of weight loss interventions.xxdenis,1-3

Metabolically healthy obesity (MHO) has been defined as a condition wherein obesity does not produce metabolic complications such as dyslipidemia, impaired glucose tolerance, or metabolic syndrome.1-2 These individuals also have less visceral adipose tissue, smaller adipocytes, and a reduced inflammatory profile when compared to metabolically unhealthy obese individuals, and their cardiac and metabolic risk does not improve as a result of weight loss interventions.1-3

However, the latest studies suggest that so-called MHO individuals may still be at an increased risk of cardiovascular disease.4-6 For example, a very recent study tracked the health of 90,257 women in the United States for up to 30 years. Those with excess weight were likelier to have a stroke or heart attack, even if they fit the criteria of MHO.7 The researchers specified that this was an association rather than cause and effect, as this was mainly found in white women, so that these findings cannot be readily generalised to other ethnic groups or to men. However, the authors concluded that "healthy obesity is not a harmless condition".7

Furthermore, the study showed that women who were of normal weight but metabolically unhealthy were two-and-a-half times likelier to develop cardiovascular disease than women of the same weight who were metabolically healthy. And unsurprisingly, for women who were overweight and obese, the risk was even higher.7

Perhaps it is indeed “finally time to dispel the concept of metabolically-healthy obesity?”12

References

  1. Denis GV, Obin MS. 'Metabolically healthy obesity': origins and implications. Mol Aspects Med. 2013 Feb;34(1):59-70.
  2. Navarro E, Funtikova AN, Fito M, Schroder H. Can metabolically healthy obesity be explained by diet, genetics, and inflammation? Mol Nutr Food Res. 2015 Jan;59(1):75-93.
  3. Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012 Jul;97(7):2482-8.
  4. Munoz-Garach A, Cornejo-Pareja I, Tinahones FJ. Does Metabolically Healthy Obesity Exist? Nutrients. 2016 Jun 1;8(6). pii: E320.
  5. Stefan N, Häring HU, Hu FB, Schulze MB. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol. 2013 Oct;1(2):152-62.
  6. Lavie CJ, Deedwania P, Ortega FB. Obesity is rarely healthy. Lancet Diabetes Endocrinol. 2018 May 30. pii: S2213-8587(18)30143-8.
  7. Eckel N, Li Y, Kuxhaus O, Stefan N, Hu FB, Schulze MB. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses' Health Study): 30 year follow-up from a prospective cohort study. Lancet Diabetes Endocrinol. 2018 May 30. pii: S2213-8587(18)30137-2. doi:
  8. Janssen I, Katzmarzyk PT, Boyce WF, Vereecken C, Mulvihill C, Roberts C, Currie C, Pickett W; Health Behaviour in School-Aged Children Obesity Working Group. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev. 2005 May;6(2):123-32.
  9. Grech V, Aquilina S, Camilleri E, Spiteri K, Busuttil ML, Sant'Angelo VF, Calleja N. The Malta Childhood National Body Mass Index Study: A Population Study. J Pediatr Gastroenterol Nutr. 2017 Sep;65(3):327-331.
  10. Cuschieri S, Vassallo J, Calleja N, Pace N, Abela J, Ali BA, Abdullah F, Zahra E, Mamo J. The diabesity health economic crisis-the size of the crisis in a European island state following a cross-sectional study. Arch Public Health. 2016 Dec 12;74:52. doi: 10.1186/s13690-016-0164-6. eCollection 2016.
  11. Grech V, Farrugia Sant'Angelo V Body mass index estimation in a school-entry aged cohort in Malta. Int J Pediatr Obes. 2009;4(2):126-8.
  12. Puri R. Is it finally time to dispel the concept of metabolically-healthy obesity? J Am Coll Cardiol. 2014 Jun 24;63(24):2687-8.

Figure

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Issue
Vol. 2 No. 2 (2018): MMSG
Section
Editorial
Published
11-06-2018

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