The results of a review and meta-analysis published on December 2, 2013 in the Annals of Internal Medicine suggest that so-called "healthy obesity," characterized by an obese body mass index (BMI) in the absence of adverse metabolic features such as disordered lipids, elevated blood glucose or hypertension, is not as healthy as was once believed.
Researchers from Mount Sinai Hospital and the University of Toronto selected twelve observational studies that included a total of 67,127 subjects for their review. Studies included those that evaluated all-cause mortality and/or cardiovascular events, BMI, and metabolic status as defined by the presence of metabolic syndrome components. While normal weight, overweight and obese subjects that were considered metabolically unhealthy had an elevated risk of mortality and/or cardiovascular events in comparison with metabolically healthy subjects over the course of the studies, those who were metabolically healthy but obese had a 24% greater risk of dying from all causes over ten years or more of follow-up compared to metabolically healthy normal-weight individuals.
"These data suggest a model in which excess weight is associated initially with the development of subclinical metabolic and vascular dysfunction that ultimately leads to an increased incidence of cardiovascular events and mortality over the long term," Caroline K. Kramer, MD, PhD, and her coauthors write. "In this regard, previous reports that evaluated metabolically healthy obese individuals over short-term follow-up or that compared these individuals to control groups not fully characterized for cardiovascular risk might have contributed to the concept of a 'benign obesity' phenotype that is not associated with adverse outcomes. Our results do not support this concept of 'benign obesity' and demonstrate that there is no 'healthy' pattern of obesity."
The authors of an editorial published in the same issue of the journal remark that physicians should focus on treating the obesity in the same manner as any other chronic disease that requires long term treatment.
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