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Metabolically Healthy Obesity: Criteria, Epidemiology, Controversies, and Consequences

  • Metabolism (M Dalamaga, Section Editor)
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Abstract

Purpose of Review

To present a comprehensive overview regarding criteria, epidemiology, and controversies that have arisen in the literature about the existence and the natural course of the metabolic healthy phenotype.

Recent Findings

The concept of metabolically healthy obesity (MHO) implies that a subgroup of obese individuals may be free of the cardio-metabolic risk factors that commonly accompany obese subjects with adipose tissue dysfunction and insulin resistance, known as having metabolic syndrome or the metabolically unhealthy obesity (MUO) phenotype. Individuals with MHO appear to have a better adipose tissue function, and are more insulin sensitive, emphasizing the central role of adipose tissue function in metabolic health. The reported prevalence of MHO varies widely, and this is likely due the lack of universally accepted criteria for the definition of metabolic health and obesity. Also, the natural course and the prognostic value of MHO is hotly debated but it appears that it likely evolves towards MUO, carrying an increased risk for cardiovascular disease and mortality over time.

Summary

Understanding the pathophysiology and the determinants of metabolic health in obesity will allow a better definition of the MHO phenotype. Furthermore, stratification of obese subjects, based on metabolic health status, will be useful to identify high-risk individuals or subgroups and to optimize prevention and treatment strategies to compact cardio-metabolic diseases.

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  1. Department of Endocrinology, School of Health Sciences, University of Ioannina, 451 10, Ioannina, Greece

    Agathocles Tsatsoulis

  2. Division of Endocrinology and Diabetes, “Aghia Sophia” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Stavroula A. Paschou

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  1. Agathocles Tsatsoulis
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Appendix

Appendix

Box 1 Definition criteria of MS

The definition of MS is based on clustering of metabolic abnormalities in the same individual. Different sets of criteria have been proposed by different health organizations. All versions included central obesity by waist circumference, hypertension, and dyslipidemia. The first formal definition was proposed by WHO that, in addition to the three common criteria, included evidence of insulin resistance (by IGT, IFG, or T2DM) [9]. In 2001, the National Cholesterol Education Program Adult Treatment Panel III (ATP III) proposed a new set of criteria, requiring for the diagnosis 3 of the following 5 parameters: abdominal obesity, hypertriglyceridemia, reduced HDL, hypertension, and fasting hyperglycemia [11]. Insulin resistance was not included in the criteria. In 2005, the international diabetes federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), in an attempt to reconcile the different definitions, suggested waist circumference as prerequisite plus two of the criteria proposed by ATPIII for diagnosis [12]. There was a disagreement, however, regarding the definition of abdominal obesity by waist circumference threshold, and the IDF required a narrower waist circumference (WC) that would equate to BMI = 25 kg/m2, whereas the AHA/NHLBI required a larger WC threshold (BMI = 30 kg/m2) [13]. Recently, a unifying definition has been proposed by the IDF, AHA/NHLBI, WHO, International Atherosclerosis Society, and International Society for the Study of Obesity that includes 3 of the following 5 criteria: 1) elevated WC (specific thresholds based on population/country), 2) elevated serum TG (> 150 mg/dL) or medication, 3) reduced HDL (< 40 and < 50 mg/dL) in males and females, respectively, or medication, 4) elevated BP (systolic > 130, diastolic > 85 mmHg) or antihypertensive therapy, and 5) elevated fasting blood glucose (> 100 mg/dL) or medication [14]

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Tsatsoulis, A., Paschou, S.A. Metabolically Healthy Obesity: Criteria, Epidemiology, Controversies, and Consequences. Curr Obes Rep 9, 109–120 (2020). https://doi.org/10.1007/s13679-020-00375-0

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