Healthy obesity does not exist. A new publication in “Diabetologia” reveals that having a normal metabolic profile does not mean that a person with obesity is healthy, since they have a higher risk of diabetes, heart disease, stroke and respiratory diseases.
The research, conducted by Frederick Ho and his colleagues at the University of Glasgow (UK), has examined whether people who had obesity and a normal metabolic profile, what is called healthy obesity, were healthy or actually had an increased risk of develop obesity-related health problems.
It is estimated that globally there are more than 300 million people with obesity, and if current trends continue, this number will likely exceed 1 billion people by 2030 and comprise 20% of the world’s adult population. And it is known that type 2 diabetes, hypertension, cardiovascular disease and many other serious health problems are linked to obesity.
Obesity involves metabolic problems, characterized by high blood sugar levels, increased blood pressure, insulin resistance, and other adverse metabolic changes. These effects are not universal and some obese people have normal blood pressure, healthy fats in the blood, little or no systemic inflammation, and a healthy insulin level.
This is what is called metabolically healthy obesity, also commonly called fofisanos, and its incidence is estimated to be 3% to 22% in the entire general population.
When analyzing the association between healthy obesity and mortality For all causes, type 2 diabetes, heart attack, stroke, heart failure and respiratory diseases, including chronic obstructive pulmonary disease (COPD), researchers have found that this concept does not really exist.
The study defined healthy obesity if the following criteria were met: a body mass index (BMI) of 30 kg / m2 or higher and at least four of the six metabolically healthy criteria – blood pressure and 5 blood biomarkers: C-reactive protein, triglycerides (fats), low-density lipoproteins (LDL / ‘bad’ cholesterol) and high-density lipoproteins (HDL / ‘good cholesterol’), and glycated hemoglobin.
Based on their obesity and metabolic status, participants were classified as: metabolically healthy non-obese, metabolically healthy obese, metabolically ill non-obese, and metabolically non-obese.
In total, they analyzed 381,363 people during a mean follow-up period of 11.2 years who were part of the UK Biobank project.
The results showed that, compared to the metabolically healthy without obesity, the metabolically healthy obese were 4.3 times more likely to have diabetes, 18% more likely to have heart attack or stroke, 76% more risk of heart failure, 28 % more respiratory diseases and 19% more likely to suffer from COPD. And compared to metabolically ill people without obesity, they were 28% more likely to have heart failure.
The authors caution that people with metabolically healthy obesity were at increased risk of ‘diabetes, heart attack and stroke, heart failure, respiratory disease, and all-cause mortality compared to people who were not obese and with a healthy metabolic profile.
Additionally, the team also found that, in a subset of participants with obesity and metabolic follow-up data, a third of those with metabolically healthy obesity at the beginning of the study period became metabolically insane within 3-5 years.
The researchers conclude: “Metabolically healthy obese people are unhealthy as they have a higher risk of heart attack and stroke, heart failure and respiratory diseases compared to non-obese people who have a normal metabolic profile.”
And they advise that «the term metabolically healthy obesity should be avoided in medicine as it is misleading, and different strategies to define risk should be explored ”.