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Review
. 2025 May 30;14(1):50.
doi: 10.1007/s13679-025-00641-z.

Normal Weight Obesity Overview and Update: A narrative review

Antonino De Lorenzo #  1 , Paola Gualtieri #  1 , Giulia Frank  2   3 , Roselisa Palma  2   3 , Rossella Cianci  4   5 , Leonardo Romano  2 , Lucilla Ciancarella  2 , Glauco Raffaelli  2   3 , Laura Di Renzo  1
Affiliations
Review

Normal Weight Obesity Overview and Update: A narrative review

Antonino De Lorenzo et al. Curr Obes Rep. .

Abstract

Purpose of review: This review synthesizes current knowledge on Normal Weight Obesity (NWO), a condition characterized by excess body fat despite having a normal Body Mass Index (BMI). It highlights recent findings on diagnostic methods, pathophysiological mechanisms, and health implications associated with NWO.

Recent findings: Individuals with NWO have an increased risk of developing chronic inflammation, cardiometabolic disorders, insulin resistance, and sarcopenia. Genetic factors, including polymorphisms in IL-6, IL-1Ra, IL-15Ra, and MTHFR genes, play a significant role in determining susceptibility. Lifestyle behaviors, reduced physical activity and frequent intake of ultra-processed foods, further elevate metabolic risks. Advanced diagnostic techniques, particularly Dual-Energy X-ray Absorptiometry (DXA), are essential for accurate identification of NWO, as traditional BMI measurements fail to adequately detect this phenotype. Recognition and management of NWO require shifting from BMI-based classifications to detailed body composition analyses. Incorporating DXA into clinical practice is essential for accurately identifying individuals at metabolic risk. Further research should develop targeted strategies for preventing and treating this specific obesity phenotype.

Keywords: Body composition; Dual-Energy X-ray Absorptiometry (DXA); Inflammation; Normal Weight Obesity; Obesity Phenotype.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

References

    1. Jastreboff AM, Kotz CM, Kahan S, et al. Obesity as a disease: the obesity society 2018 position statement. Obesity (Silver Spring). 2019;27:7–9. https://doi.org/10.1002/oby.22378 . - DOI - PubMed
    1. De Lorenzo A, Soldati L, Sarlo F, et al. New obesity classification criteria as a tool for bariatric surgery indication. World J Gastroenterol. 2016;22:681–703. https://doi.org/10.3748/wjg.v22.i2.681 . - DOI - PubMed - PMC
    1. De Lorenzo A, Gratteri S, Gualtieri P, et al. Why primary obesity is a disease? J Transl Med. 2019;17:169. https://doi.org/10.1186/s12967-019-1919-y . - DOI - PubMed - PMC
    1. De Lorenzo A, Bianchi A, Maroni P, et al. Adiposity rather than BMI determines metabolic risk. Int J Cardiol. 2013;166:111–7. https://doi.org/10.1016/j.ijcard.2011.10.006 . - DOI - PubMed
    1. Souza ACDAH, Troschel AS, Marquardt JP, et al. Skeletal muscle adiposity, coronary microvascular dysfunction, and adverse cardiovascular outcomes. Eur Heart J. 2025;46:1112–23. https://doi.org/10.1093/eurheartj/ehae827 . - DOI - PubMed

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