Skip to main content
SpringerLink
Log in

Normal-Weight Obesity: Implications for Cardiovascular Health

  • Clinical Trials and Their Interpretations (JR Kizer, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

We sought to review the epidemiological features and clinical implications of normal-weight obesity. The concept of normal-weight obesity has been recently reported as an important risk factor for cardiovascular disease, metabolic dysregulation, and poor functional outcomes. However, in clinical practice, normal-weight obesity is not commonly recognized. In this review, we examine the clinical significance and important epidemiological outcomes of normal-weight obesity and describe other variants of adiposity and adiposity-related metabolic status. The incorporation of measures of body fat content and distribution in the clinical setting could allow more accurate identification of adiposity-related long-term risk. This could in turn lead to early lifestyle changes and behavioral modifications that are essential to the treatment of obesity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as • Of importance

  1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491–7.

    Article  PubMed  Google Scholar 

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2012. NCHS Data Brief. 2013;131:1–8.

    PubMed  Google Scholar 

  3. Encyclopaedia Britannica Online. Obesity. 2010. Available from: http://www.britannica.com/EBchecked/topic/423747/obesity

  4. Flegal KM, Kit BK, Orpana H. Association of all-cause mortality. JAMA. 2013;309:71–82.

  5. Weigley ES. Average? Ideal? Desirable? A brief overview of height-weight tables in the United States. J Am Diet Assoc. 1984;84:417–23.

    CAS  PubMed  Google Scholar 

  6. Quetelet MA. A treatise on man and the development of his faculties. William and Robert Chambers, eds. Edinburg 1842. 57–67.

  7. Florey CV. The use and interpretation of ponderal index and other weight-height ratios in epidemiological studies. J Chronic Dis. 1970;23:93–103.

    Article  PubMed  Google Scholar 

  8. World Health Organisation (WHO). Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ. Tech Rep Ser. 1995;854:1–452.

    Google Scholar 

  9. Mechanick JI, Garber AJ, Handelsman Y, Timothy Garvey W. American Association of Clinical Endocrinologists’ position statement on obesity and obesity medicine. Endocr Pract. 2012;5:642–8.

    Article  Google Scholar 

  10. National Institutes Of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998;6:51S–209S.

    Article  Google Scholar 

  11. National Institutes Of Health. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998;158:1855–67.

  12. Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. The concept of normal weight obesity. Prog Cardiovasc Dis. 2014;56:426–33. This is a very thorough review of normal weight obesity and its direct pathophysiological and clinical consequences including metabolic dysregulation and mortality.

    Article  PubMed  Google Scholar 

  13. Diaz-Melean CM, Somers VK, Rodriguez-Escudero JP, Singh P, Sochor O, Llano EM, et al. Mechanisms of adverse cardiometabolic consequences of obesity. Curr Atheroscler Rep. 2013;15:364.

    Article  PubMed  Google Scholar 

  14. Després J-P, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444:881–7.

    Article  PubMed  Google Scholar 

  15. Fu S, Watkins SM, Hotamisligil GS. The role of endoplasmic reticulum in hepatic lipid homeostasis and stress signaling. Cell Metab. 2012;5:623–34.

    Article  Google Scholar 

  16. McGown C, Birerdinc A, Younossi ZM. Adipose tissue as an endocrine organ. Clin Liver Dis. 2014;18:41–58.

    Article  PubMed  Google Scholar 

  17. Yadav A, Kataria MA, Saini V, Yadav A. Role of leptin and adiponectin in insulin resistance. Clin Chim Acta. 2013;417:80–4.

    Article  CAS  PubMed  Google Scholar 

  18. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, et al. Obesity and cardiovascular disease: Pathophysiology, evaluation, and effect of weight loss. Arterioscler, Thromb, Vasc Biol. 2006;26:968–76.

    Article  CAS  Google Scholar 

  19. Lopez-Jimenez F. Speakable and unspeakable facts about BMI and mortality. Lancet Elsevier Ltd; 2009;373:1055–6.

    Article  Google Scholar 

  20. Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96.

    Article  PubMed Central  Google Scholar 

  21. Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368:666–78.

    Article  PubMed  Google Scholar 

  22. Geliebter A, Atalayer D, Flancbaum L, Gibson CD. Comparison of body adiposity index (BAI) and BMI with estimations of % body fat in clinically severe obese women. Obesity (Silver Spring). 2013;21:493–8.

    Article  Google Scholar 

  23. Lichtash CT, Cui J, Guo X, Chen Y-DI, Hsueh WA, Rotter JI, et al. Body adiposity index versus body mass index and other anthropometric traits as correlates of cardiometabolic risk factors. PLoS One. 2013;6:e65954.

    Article  Google Scholar 

  24. De Schutter A, Lavie CJ, Gonzalez J, Milani RV. Body composition in coronary heart disease: how does body mass index correlate with body fatness? Ochsner J. 2011;11:220–5.

    PubMed Central  PubMed  Google Scholar 

  25. Ruderman N, Chisholm D, Pi-Sunyer X, Schneider S. The metabolically obese, normal-weight individual revisited. Diabetes. 1998;47:699–713.

    Article  CAS  PubMed  Google Scholar 

  26. Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J, et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J. 2010;31:737–46.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Marques-Vidal P, Pcoud A, Hayoz D, Paccaud F, Mooser V, Waeber G, et al. Normal weight obesity: relationship with lipids, glycaemic status, liver enzymes and inflammation. Nutr Metab Cardiovasc Dis. 2010;20:669–75.

    Article  CAS  PubMed  Google Scholar 

  28. Ruderman NB, Schneider SH, Berchtold P. The “metabolically-obese”, normal-weight individual. Am J Clin Nutr. 1981;34:1617–21.

    CAS  PubMed  Google Scholar 

  29. Batsis JA, Sahakyan KR, Rodriguez-Escudero JP, Bartels SJ, Somers VK, Lopez-Jimenez F. Normal weight obesity and mortality in United States subjects ≥60 years of age (from the Third National Health and Nutrition Examination Survey). Am J Cardiol. 2013;112:1592–8. This article studies the relationship between the normal weight obesity and cardiometabolic dysfunction and mortality in the elderly.

    Article  PubMed  Google Scholar 

  30. Karelis AD, St-Pierre DH, Conus F, Rabasa-Lhoret R, Poehlman ET. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab. 2004;89:2569–75.

    Article  CAS  PubMed  Google Scholar 

  31. Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men. J Am Geriatr Soc. 2014;62:253–60.

    Article  PubMed  Google Scholar 

  32. Prado CMM, Wells JCK, Smith SR, Stephan BCM, Siervo M. Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr. 2012;31:583–601.

    Article  CAS  PubMed  Google Scholar 

  33. Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci. 2000;904:437–48.

    Article  CAS  PubMed  Google Scholar 

  34. Succurro E, Marini MA, Frontoni S, Hribal ML, Andreozzi F, Lauro R, et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals. Obesity (Silver Spring). 2008;16:1881–6.

    Article  CAS  Google Scholar 

  35. Ortega FB, Lee D-C, Katzmarzyk PT, Ruiz JR, Sui X, Church TS, et al. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J. 2013;34:389–97.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Pouliot MC, Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, et al. Regional variation in adipose tissue lipoprotein lipase activity: association with plasma high density lipoprotein levels. EurJ Clin Invest. 1991;21:398–405.

    Article  CAS  Google Scholar 

  37. Terry RB, Stefanick ML, Haskell WL, Wood PD. Contributions of regional adipose tissue depots to plasma lipoprotein concentrations in overweight men and women: possible protective effects of thigh fat. Metabolism. 1991;40:733–40.

    Article  CAS  PubMed  Google Scholar 

  38. Ogorodnikova AD, Kim M, McGinn AP, Muntner P, Khan U, Wildman RP. Incident cardiovascular disease events in metabolically benign obese individuals. Obesity. 2012;20:651–9.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Mørkedal B, Vatten LJ, Romundstad PR, Laugsand LE, Janszky I. Risk of myocardial infarction and heart failure among metabolically healthy but obese individuals: HUNT (Nord-Trøndelag Health Study) Norway. J Am Coll Cardiol. 2014;63:1071–8.

    Article  PubMed  Google Scholar 

  40. Chang Y, Kim BB-K, Yun KE, Cho J, Zhang Y, Rampal S, et al. Metabolically healthy obesity and coronary artery calcification. J Am Coll Cardiol. 2014;63:24.

    Article  Google Scholar 

  41. Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, et al. Abdominal adiposity and coronary heart disease in women. Jama. 1998;280:1843–8.

    Article  CAS  PubMed  Google Scholar 

  42. Canoy D, Boekholdt SM, Wareham N, Luben R, Welch A, Bingham S, et al. Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: a population-based prospective study. Circulation. 2007;116:2933–43.

    Article  PubMed  Google Scholar 

  43. Walker SP, Rimm EB, Ascherio A, Kawachi I, Stampfer MJ, Willett WC. Body size and fat distribution as predictors of stroke among US men. Am J Epidemiol. 1996;144:1143–50.

    Article  CAS  PubMed  Google Scholar 

  44. Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359:2105–20.

    Article  CAS  PubMed  Google Scholar 

  45. Gelber RP, Gaziano JM, Orav EJ, Manson JE, Buring JE, Kurth T. Measures of obesity and cardiovascular risk among men and women. J Am Coll Cardiol. 2008;52:605–15.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Coutinho T, Goel K, de Corrêa SD, Carter RE, Hodge DO, Kragelund C, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of “normal weight central obesity”. J Am Coll Cardiol. 2013;61:553–60. This article proves that patients with coronary artery disease and central obesity with normal weight have the highest long term mortality compared with other presentations of adiposity.

    Article  PubMed  Google Scholar 

  47. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS. Guideline for the management of overweight and obesity in adults : a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society World Wide Web at : 2013 AHA / ACC. 2013

  48. Sahakyan K, Somers V, Juan RE, Thomas R, Sochor O, Singh P, et al. Normal-weight central obesity and cardiovascular mortality risk in hypertensive patients. J Am Coll Cardiol. 2013;61:E1399.

    Article  Google Scholar 

  49. Yusuf S, Anand S. Body-mass index, abdominal adiposity, and cardiovascular risk. Lancet. 2011;378:226–7.

    Article  PubMed  Google Scholar 

  50. Coutinho T, Goel K, De Corrêa SD, Kragelund C, Kanaya AM, Zeller M, et al. Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol. 2011;57:1877–86.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Virend K. Somers, Ondrej Sochor, and Francisco Lopez-Jimenez were supported by the European Regional Development Fund-Project FNUSA-ICRC (No. Z.1.05/1.1.00/02.0123).

Ondrej Sochor was also supported by the Internal Grant Agency Ministry of Health of Czech Republic (IGA MZČR), No. NT 13434-4/2012.

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Virend K. Somers has been a consultant to Neu Pro, Apnex Medical, Respicardia, Medtronic, and ResMed.

Nathalie Jean, Ondrej Sochor, Jose Medina-Inojosa, Ernesto Llano, and Francisco Lopez-Jimenez declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

N/A.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Nathalie Jean, Virend K. Somers, Ondrej Sochor, Jose Medina-Inojosa & Francisco Lopez-Jimenez

  2. International Clinic Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic

    Ondrej Sochor

  3. University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA

    Ernesto M. Llano

Authors
  1. Nathalie Jean
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Virend K. Somers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ondrej Sochor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jose Medina-Inojosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ernesto M. Llano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francisco Lopez-Jimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francisco Lopez-Jimenez.

Additional information

This article is part of the Topical Collection on Clinical Trials and Their Interpretations

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jean, N., Somers, V.K., Sochor, O. et al. Normal-Weight Obesity: Implications for Cardiovascular Health. Curr Atheroscler Rep 16, 464 (2014). https://doi.org/10.1007/s11883-014-0464-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-014-0464-7

Keywords

Search

Navigation