A recent study published in the Journal of Clinical Endocrinology and Metabolism suggests that “metabolically healthy obese”- a subset of obese individuals, who were initially thought to not be at high risk of heart and other chronic disease, still might be.
Study author Kristine Faerch from the Steno Diabetes Center in Copenhagen states that while it was once thought that it was not unhealthy to be overweight or obese if you lived a healthy lifestyle, research suggests differently. Overweight and obese individuals face an increased risk of type 2 diabetes and heart disease. To lower risk, keeping a healthy weight throughout the lifecycle is vital. 1
Faerch and her researchers evaluated data in over 6200 men and women that joined a Danish study where they were tracked for over 10 years. The subjects’ initial BMIs and 4 risk factors for heart disease including HDL (“healthy” cholesterol), high blood pressure, triglycerides and blood glucose were monitored. “Metabolically healthy” subjects had none of these risks, while “metabolically unhealthy” were defined as having at least one risk factor. In the follow up period, 323 subjects developed heart disease. Men who were metabolically healthy, but obese, had 3 x the risk of heart disease versus metabolically healthy men with normal weight. Women that were metabolically healthy but obese had double the risk. Overweight men that were metabolically healthy had equivalent risk as their normal weight counterparts. Overweight women at the outset had a slightly higher risk than normal weight subjects. The authors note that only 3% of male and female subjects were obese, but considered metabolically healthy. Over a 5-year period, 40% of those considered metabolically healthy because metabolically unhealthy. 1
Joshua Bell from the UK’s University of Bristol is not surprised. He and his colleagues published a paper in February nothing that obesity increases age-related disability and decline, even in metabolically healthy individuals. His research found that after 2 decades, physical ability declined two times more while pain increased 6 times more in obese individuals compared to normal weight individuals. He stresses that heart disease is not the only risk factor to consider in healthy aging. 2
Matthias Schulze at the German Institute of Human Nutrition in Potsdam-Rehbruecke, who did not participate in either study, believes other measurements such as waist-hip ratio, waist circumference and body fat could be looked at to determine “metabolically healthy” obese. 3 Healthy and obese can change to unhealthy and obese very quickly. More research is needed to find how to decrease disease risk in both groups.
1.Louise Hansen, MSc, Marie K Netterstrøm, MSc, Nanna B Johansen, MD, PhD, Pernille F Rønn, MSc, Dorte Vistisen, MSc, PhD, Lise LN Husemoen, MSc, PhD, Marit E Jørgensen, MD, PhD, Naja H Rod, MSc, PhD, DMSc, Kristine Færch, MSc, PhD. Metabolically healthy obesity and ischemic heart disease: a 10-year follow-up of the Inter99 study. J Clin Endocrinol Metab jc.2016-3346. Published March 7, 2017.
2. J A Bell1,2, S Sabia1,3, A Singh-Manoux1,3, M Hamer4 and M Kivimäki1, Healthy obesity and risk of accelerated functional decline and disability. International Journal of Obesity advance online publication 14 March 2017; doi: 10.1038/ijo.2017.51
3.Kristin Mühlenbruch, Tonia Ludwig, Charlotte Jeppesen, Hans-Georg Joost, Wolfgang Rathmann, Christine Meisinger, Annette Peters, Heiner Boeing, Barbara Thorand, Matthias B. Schulze. Update of the German Diabetes Risk Score and external validation in the German MONICA/KORA study. Diabetes Research and Clinical Practice. June 2014 Volume 104, Issue 3, Pages 459–466