Open questions about metabolically normal obesity

Abstract

Subsets of obese subjects without any cardiometabolic risk factors have been repeatedly described. This raises questions whether obesity 'per se' enhances the risk for cardiovascular or metabolic diseases and whether healthy obese subjects would benefit from a medical treatment. In order to answer these questions, as a first step, an expert consensus should be reached for the definition of metabolic normality. In fact, up to now, different parameters related to the metabolic syndrome and/or to insulin sensitivity have been utilized across studies. Once an agreement is reached, population-based studies should be undertaken to establish the incidence of metabolic normality among obese subjects. Furthermore, many other parameters such as age, sex, race, fat distribution and physical activity should be monitored to obtain results representative of a general population. Longitudinal studies aimed at investigating the evolution of the cardiometabolic profile of healthy obese subjects are also needed. In conclusion, data from the literature strongly suggest that a regular surveillance of the cardiometabolic parameters and a prevention of any further weight gain should be applied to healthy obese individuals, whereas possible benefits of a weight loss treatment are still a matter of debate.

Pleiotropic effects of obesity-susceptibility loci on metabolic traits: a meta-analysis of up to 37,874 individuals

“…To summarise, the genetic pleiotropic associations may in part explain why some obese individuals remain metabolically healthy despite having excessive accumulation of body fat [48][49][50][51][52][53]. This phenomenon is described in the current literature as 'healthy obesity' and, to date, little is known about the factors that protect obese individuals from metabolic disturbances [54].…”

Role of plasma adiponectin /C-reactive protein ratio in obesity and type 2 diabetes among African Americans

“…A unique subset of obese individuals appears to be protected from developing the metabolic disturbances typically associated with obesity. These individuals, despite being obese display normal to high insulin sensitivity and favorable cardiovascular risk profiles [39][40][41][42][43] . Thus, it is important to characterize differences between these groups to uncover additional mechanisms connecting obesity and health risk.…”

Does metabolic health in overweight and obesity persist? – Individual variation and cardiovascular mortality over two decades

“…Problems consistently raised in commentaries on MH OW and OB have included the lack of an agreed definition of metabolic health and the fact that a continuum of variation in metabolic disturbance extends across all levels of adiposity (5,6,7,8). Nevertheless, if a pragmatic definition of MH could be agreed, it might yet be used to identify OW or OB individuals who need not benefit from intensive weight loss.…”