Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep;64(9):1963-1972.
doi: 10.1007/s00125-021-05484-6. Epub 2021 Jun 10.

Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants

Ziyi Zhou  1 , John Macpherson  1 , Stuart R Gray  2 , Jason M R Gill  2 , Paul Welsh  2 , Carlos Celis-Morales  1   2   3 , Naveed Sattar  2 , Jill P Pell  1 , Frederick K Ho  4
Affiliations

Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants

Ziyi Zhou et al. Diabetologia. 2021 Sep.

Abstract

Aims/hypothesis: People with obesity and a normal metabolic profile are sometimes referred to as having 'metabolically healthy obesity' (MHO). However, whether this group of individuals are actually 'healthy' is uncertain. This study aims to examine the associations of MHO with a wide range of obesity-related outcomes.

Methods: This is a population-based prospective cohort study of 381,363 UK Biobank participants with a median follow-up of 11.2 years. MHO was defined as having a BMI ≥ 30 kg/m2 and at least four of the six metabolically healthy criteria. Outcomes included incident diabetes and incident and fatal atherosclerotic CVD (ASCVD), heart failure (HF) and respiratory diseases.

Results: Compared with people who were not obese at baseline, those with MHO had higher incident HF (HR 1.60; 95% CI 1.45, 1.75) and respiratory disease (HR 1.20; 95% CI 1.16, 1.25) rates, but not higher ASCVD. The associations of MHO were generally weaker for fatal outcomes and only significant for all-cause (HR 1.12; 95% CI 1.04, 1.21) and HF mortality rates (HR 1.44; 95% CI 1.09, 1.89). However, when compared with people who were metabolically healthy without obesity, participants with MHO had higher rates of incident diabetes (HR 4.32; 95% CI 3.83, 4.89), ASCVD (HR 1.18; 95% CI 1.10, 1.27), HF (HR 1.76; 95% CI 1.61, 1.92), respiratory diseases (HR 1.28; 95% CI 1.24, 1.33) and all-cause mortality (HR 1.22; 95% CI 1.14, 1.31). The results with a 5 year landmark analysis were similar.

Conclusions/interpretation: Weight management should be recommended to all people with obesity, irrespective of their metabolic status, to lower risk of diabetes, ASCVD, HF and respiratory diseases. The term 'MHO' should be avoided as it is misleading and different strategies for risk stratification should be explored.

Keywords: Cardiovascular disease; Metabolically healthy obesity; Obesity.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Participant flowchart
Fig. 2
Fig. 2
Association between MHO and incident diabetes with MHN as reference group. Adjusted for each other and for age, sex, ethnicity, education, deprivation, smoking, alcohol drinking, television viewing, physical activity and intake of fruit and vegetables, oily fish, red meat and processed meat
Fig. 3
Fig. 3
Association between MHO and cardiovascular and respiratory outcomes with MHN as reference group. Adjusted for each other and for age, sex, ethnicity, education, deprivation, smoking, alcohol drinking, television viewing, physical activity, and intake of fruit and vegetables, oily fish, red meat and processed meat
Fig. 4
Fig. 4
Association of change of metabolic status with health outcomes. Adjusted for age, sex ethnicity, education, deprivation, smoking, alcohol drinking, television viewing, physical activity, and intake of fruit and vegetables, oily fish, red meat and processed meat
See this image and copyright information in PMC

References

    1. Zimmet P, Alberti K, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414(6865):782–787. doi: 10.1038/414782a. - DOI - PubMed
    1. Kelly T, Yang W, Chen C-S, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32(9):1431–1437. doi: 10.1038/ijo.2008.102. - DOI - PubMed
    1. Kromhout D, Geleijnse JM, Boer JM, Verschuren WM. Body mass index and waist circumference predict both 10-year nonfatal and fatal cardiovascular disease risk: study conducted in 20 000 Dutch men and women aged 20–65 years. Eur J Cardiovasc Prev Rehabil. 2009;16(6):729–734. doi: 10.1097/HJR.0b013e328331dfc0. - DOI - PubMed
    1. Hopps E, Noto D, Caimi G, Averna MR. A novel component of the metabolic syndrome: the oxidative stress. Nutr Metab Cardiovasc Dis. 2010;20(1):72–77. doi: 10.1016/j.numecd.2009.06.002. - DOI - PubMed
    1. Kim SH, Abbasi F, Reaven GM (2004) Impact of degree of obesity on surrogate estimates of insulin resistance. Diabetes Care 27(8):1998–2002. 10.2337/diacare.27.8.1998 - PubMed

Publication types