The Metabolically Healthy Obese: Should You Worry If You Are Obese But Healthy? Navigating The Confusion. 

The metabolically healthy obese person is someone with a BMI of 30 or more who do not have any metabolic complications of obesity, such as abnormal blood glucose, or type 2 diabetes, raised uric acid levels, hypertension and fatty liver disease. 

metabolically healthy obese

During a routine visit for physical examination recently, a patient who newly joined our practice became upset and tearful.

She was literally sobbing and withdrawn. On further questioning, she said that her weight has remained a source of concern to her and she suffers untold social isolation.

“I really want to lose weight, but my former doctor told me that since I am healthy and active, with no diabetes, hypertension, or high cholesterol, I am okay and I do not need to do anything. I have tried everything possible to cut down on my weight but with no success”, she said, as more tears roll down her cheeks with bated breath.

Juliet is a 42 year old office manager with family history of type 2 diabetes, hyperlipidemia and early cardiovascular death in a first degree relative, and a BMI of 38. She suffers with lower back  and right hip pain. She is otherwise well in herself. She walks about 30 minutes up to 3 days a week and “I watch what I eat”.

About 1 in 10 persons in the general population do have what doctors refer to as the metabolically healthy obese (MHO) individuals. These are people with a BMI (body mass index) greater than 30, but who do not suffer with associated conditions like type 2 diabetes or abnormal blood glucose levels, hypertension, high levels of uric acid in their blood and abnormal cholesterol.

They do not have any obvious heart problems. There has been confusing opinions peddled around and propagated sometimes by healthcare providers that your weight does not matter, as long as you are active.

Some have even quoted scientific literature and pointed to studies, such as is reported recently in the journal of Clinical Obesity of July 12th 2018, with the headline, “Individuals with obesity but no other metabolic risk factors are not at significantly elevated all-cause mortality risk in men and women.”

So, if you find yourself confused as to whether you should do something about your weight despite being healthy, you should not despair.

We healthcare providers could be clearer with the information we provide our patients

The Truth About The Metabolically Healthy Obese

obese women

Obesity is a worldwide problem.

In a recent study, it is estimated that about 2 billion people are overweight and more than 600 million are obese worldwide.

Obesity, to be clear, is the excessive deposition of fat in the adipose tissue and body organs, to the point of being detrimental to one’s health.

So the question often arises: what is excessive deposition of fat and how can you know?

That is where the instrument of measurement called the BMI or body mass index comes in.

The BMI is simply a number that shows what the ratio of your weight for height is. It is calculated by dividing weight with the square of your height.

So, a normal BMI should be in the range between 18.9 and 24.9. If your BMI is anywhere between 25 and 29.9, then you would be classified as being overweight. Obesity is defined as a BMI of 30 or more.

Close to 10% of the general population, and about 30% of obese people are metabolically healthy obese.

As explained earlier, they are so called because they do not yet suffer with metabolic complications of obesity.

They nevertheless, are still at risk for:

  • Osteoarthritis,
  • Over 11 different types of cancers (hormone dependent cancers),
  • Obstructive sleep apnea,
  • Memory and mood disorders
  • Weight discrimination and more

Researchers now believe that the metabolically healthy obese are in a transitory phase, between being obese, yet normal to becoming metabolically unhealthy. The speed of such transition varies, depending on their epigenetics and lifestyle, going forward.

A study published in the Lancet journal of April 2009, looked at the relationship between BMI and mortality.

They studied 900,000 people with varying BMI. Their findings is consistent with what we see in real life today. The more your BMI over a long term, the more your risk of dying from a number of conditions.

They specifically found that for each additional 5 kg / m2 of BMI you put on, you increase your possibility of early death by 30%.

So, let's, be clear:

  • If you do have a BMI greater than 30 and yet have no metabolic disorder, you are still prone to other risks that obesity possess. 
  • It is well recognised that many people starts suffering with complications of obesity, at a BMI of 27 kg / m2, even before becoming officially obese. 
  • If you overweight or obese and active, with no metabolic complications, this s is something good. But you must take steps to work to control your weight. 
  • It won’t be long before you may start developing other complications like joint pain, sleep apnea and more.

The metabolically healthy obese patient is in a transitory phase, marching towards becoming a metabolically unhealthy obese. They require at the least, a well-structured exercise and dietary regimen, with behavioural therapy and possibly pharmacotherapy.

Juliet was counselled on obesity, the risks associated with this condition, and asked to run some tests to ascertain whether she is metabolically healthy or not, had tests to determine if has arthritis and started on a program of diet and exercises as well as prescribed orlistat.

She would be followed up appropriately and encouraged and supported to lose at least 10% of her body weight over the next 6 months. 

References:

  1. J. L. Kuk, M. Rotondi, X. Sui, S. N. Blair, C. I. Ardern. Individuals with obesity but no other metabolic risk factors are not at significantly elevated all-cause mortality risk in men and women. Clinical Obesity, 2018; DOI: 10.1111/cob.12263
  2. Y-C Hwang, T Hayashi, W Y Fujimoto, S E Kahn, D L Leonetti, M J McNeely and E J Boyko, Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype, International Journal of Obesity, 39, 9, (1365), (2015)
  3. Prospective Studies Collaboration Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009; 373: 1083-1096

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