Long-Term Prognosis of Healthy Obesity Is Metabolic Deterioration, Study Shows

Michael O’Riordan

January 05, 2015 LONDON, UK — Over the course of two decades, more than half of individuals previously identified as “healthy obese” had a worsening of their metabolic health and would now be considered obese and unhealthy, according to an analysis of data from the Whitehall II study^[1].
Of the obese individuals considered metabolically healthy at baseline, just 10% had lost weight and were healthy after 20 years, report investigators.
“Healthy obese adults were nearly eight times more likely to progress to an unhealthy obese state after 20 years than healthy nonobese adults, and these subjects were consistently more likely to make this adverse transition than unhealthy nonobese adults,” write Joshua Bell (University College London, UK) and colleagues in a brief report published in the January 6/13, 2015 issue of the Journal of the American College of Cardiology.
In their review, metabolically healthy was defined as having less than two of the following risk factors: HDL cholesterol <1.03 mmol/L for men and <1.29 mmol/L for women, blood-pressure >130/85 mm Hg or use of antihypertensive medications, fasting plasma glucose levels >5.6 mmol/L or use of antidiabetic medications, triacylglycerol level >1.7 mmol/L, and a homeostatic model assessment (HOMA) of insulin resistance >2.87.
The analysis included 2561 individuals aged 39 to 62 years at baseline. Of these, just 66 were obese and metabolically healthy. At 5, 10, 15, and 20 years follow-up, 21, 27, 23, and 34 individuals remained obese but had a worsening of their cardiometabolic profile such that they were now considered unhealthy. In contrast, the proportion of healthy obese individuals who lost weight and were healthy at 5, 10, 15, and 20 years was 6.1%, 4.5%, 6.1%, and 10.6%, respectively.
Given the long follow-up, the researchers conclude that the “natural course of healthy obesity is [a] progression to metabolic deterioration.”
Recent studies, including those reported by heartwire , have challenged the concept of healthy obesity, with studies suggesting these individuals have a significantly higher risk of dying from all causes and developing cardiovascular disease compared with healthy nonobese individuals. Other studies have shown that metabolically healthy but obese subjects have evidence of subclinical atherosclerosis while others have shown they are at an increased risk of developing diabetes.
The authors report they have no relevant financial relationships.

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