Metabolic He althy Obesity (MHO) is a type of obesity in which, despite excess body fat, the patient has normal blood test results. What is metabolically "he althy" obesity? Can obesity really be "he althy"?

Obesityis a chronic disease, the symptom of which is excess body fat. In people suffering from obesity, excess body weight increases the risk of serious diseases such as myocardial infarction, ischemic stroke, hypertension, type 2 diabetes, or cancer. But is it all? Information that obesity may be "he althy" has caused a storm in the medical community. However, does "he althy" obesity really exist?

Contents:

  1. What is "metabolically he althy" obesity?
  2. "Metabolically he althy" obesity - epidemiology
  3. "He althy" obesity vs "unhe althy" obesity - differences
  4. "Metabolically he althy" obesity - causes
  5. "Metabolically he althy" obesity and the risk of diseases
  6. Does metabolically he althy obesity really exist?

What is "metabolically he althy" obesity?

The concept of the so-called Metabolic He althy Obesity (MHO) appears quite frequently in the scientific literature. Although the very idea of ​​MHO was created in the 1980s, so far neither the definition nor the criteria for diagnosing this type of obesity have been established. It is known that people with MHO, despite the BMI above 30 kg / m2, do not observe abnormal blood test results, such as: excessively high levels of glucose, insulin or lipid profile, or they are slightly above the norm. Hence the conclusion was drawn that excess body fat does not seem to disturb metabolic functions in people with MHO and theoretically does not affect the risk of developing complications of obesity.

"Metabolically he althy" obesity - epidemiology

Research shows that up to 1/3 of Americans can be classified as having MHO. However, the lack of a precise definition and the use of various criteria of the respondents' qualifications in research make it difficult to estimate this phenomenon. Therefore, depending on the studied population, the prevalence of MHO in the obese group ranges from 10% to 76%. Preliminary epidemiological data indicate that MHOit occurs more often in women than in men, but the older the patients (of both sexes), the less frequent MHO is.

"He althy" obesity vs "unhe althy" obesity - differences

"Metabolically he althy" obesity Metabolically unhe althy obesity
insulin sensitivity (no insulin resistance)insulin resistance (insulin resistance)
normal fasting glucose levelsabnormal fasting glucose levels
low visceral fat and higher subcutaneous fathigh in visceral fat and lower in subcutaneous fat
low blood levels of CRP (an inflammatory marker)high blood levels of CRP (an inflammatory marker)
high HDL cholesterollow HDL cholesterol
low triglycerideshigh triglyceride levels
no fatty liverfatty liver
normal blood pressureabnormal blood pressure
high levels of adiponectinlow adiponectin

"Metabolically he althy" obesity - causes

The causes of MHO are still unclear. However, several scientific hypotheses have arisen to explain the metabolic differences in obesity patients. The "chronic inflammation" hypothesis is currently leading. Research shows that people with MHO have significantly lower levels of inflammatory markers such as C-reactive protein (CRP), which high blood levels are characteristic of obese people who are metabolically "unhe althy". This hypothesis assumes that long-term, chronic inflammation is very low in people with MHO without causing metabolic disturbances.

Another cause of metabolic differences in the group of people suffering from obesity may be the distribution and type of adipose tissue. It is well known that viscellular or visceral tissue that accumulates around internal organs has a very high "pathogenic" potential. And its content in the body correlates with an increased risk of obesity-related diseases. Perhaps the small amount of viscellular tissue found in people with MHO is responsible for the lack of deviations in metabolic parameters.

Some scientists also explain significant metabolic differences in people with obesity by the presence of genetic polymorphisms related to the metabolism of adipose tissue, e.g. genes encoding receptors activated byperoxisome proliferators, (PPAR).

"Metabolically he althy" obesity and the risk of diseases

The latest clinical studies show that despite apparently undisturbed metabolic parameters, people with MHO have an increased risk of developing diseases classified as complications of obesity. This thesis is confirmed by the latest meta-analysis of literature data, which showed that people with MHO have an increased risk of cardiovascular (cardiovascular) diseases compared to people with normal body weight.

In the case of type 2 diabetes, the studies are more divergent. However, meta-analyzes of literature data from 2014 showed that adults with MHO are more than 4 times more likely to develop type 2 diabetes than people with normal body weight. Even so, the risk was half that of people with metabolically "unhe althy" obesity. In the case of other obesity-related diseases, clinical trials are still needed to clearly assess the risk of their occurrence in people with MHO.

Does metabolically he althy obesity really exist?

Most scientists agree that people with MHO should receive weight loss treatments, even though people with MHO appear to be metabolically “he althy”. Some of them even believe that the use of the term MHO should be discontinued and replaced with the termpre-metabolic syndromeas it is highly probable that MHO is a transitional state prior to the appearance of this syndrome. It is emphasized that a person may be MHO at one time, and their condition may change over time, because excessive body weight itself is a factor contributing to the development of diseases, and pathological changes may appear in everyone at a different time. Some studies have shown that up to 30-40% of people with MHO change their metabolic status to "unhe althy" within a few years.

In this context, it is also worth mentioning the phenomenon ofmetabolically obese normal-weight(MONWmetabolically obese normal-weight ). However, as in the case of MHO, its definition and diagnosis criteria have not been precisely established. People with MONW, despite the correct values ​​of the BMI index, are characterized by a metabolic profile characteristic of an obese person, i.e. they have an elevated blood glucose level, an abnormal lipid profile, arterial hypertension and insulin resistance. In addition, people from MONW are several times more likely to develop the same diseases as people with obesity. This fact further emphasizes the complexity of obesity and its complications.

References:1. Eckel N. et al .:Transition from metabolic he althy to unhe althy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses' He alth Study): 30 year follow-up from a prospective cohort study .Lancet Diabetes Endocrinol. 2022, 6 (9), 714-724.2. Alam I. et al.Does inflammation determine whether obesity is metabolically he althy or unhe althy? The aging perspective.Mediators Inflamm. 2012, 456456.3. Primeau V. et al.Characterizing the profile of obese patients who are metabolically he althy . Int J Obes (Lond). 2011, 35 (7), 971-81.4. Sourya A. and Samarth S.Metabolic He althy Obesity-A Paradoxical Fallacy?Journal of Clinical and Diagnostic Research, 2022, 12 (10), OE07-OE10.5. Soriguer F. et al.Metabolically he althy but obese, a matter of time? Findings from the prospective Pizarra study . J Clin Endocrinol Metab 2013, 98, 2318-2325.6. Jung C.H. et al.Metabolically he althy obesity: a friend or foe?Korean J Intern Med. 2022, 32 (4), 611-621.

Important

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Obesity