Metabolically Healthy Obesity, Transition to Metabolic Syndrome, and Cardiovascular Risk

This study, published in the Journal of the American College of Cardiology, used data from 6,089 participants of the MESA study to see how having a healthy metabolic profile despite obesity, affects your risk of cardiovascular disease.

The debate over the risk of cardiovascular disease (CVD) associated with the three groups, metabolically healthy normal (MHN), metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO), stems from the apparent contradiction that an individual can be obese (BMI>30 Kg/m2) and yet be free of metabolic syndrome (MetS). This study found that for the vast majority of people, MHO was a transition state towards MUO, and that there was a dosing effect associated with obesity. With the risk of developing MetS being relative to cumulative obesity exposure. They found that almost one-half of those with MHO at baseline, developed MetS during follow-up. Higher MetS duration was also significantly associated with CVD, supporting the theory that risk from obesity is cumulative.

Very few individuals can stay metabolically healthy when continuously exposed to obesity, and the transition to MetS represents a massive increase in risk of CVD. Clinicians should see MHO as an opportunity for early intervention, to prevent later disease, rather than waiting for an unhealthy metabolic profile to develop, by which point, risk has already massively gone up.