Are there still healthy obese patients?

Area of Science:

• Metabolic Health
• Obesity Research
• Cardiovascular Health

Background:

• Obesity is a global epidemic linked to premature death and increased risk of metabolic disorders, hypertension, heart disease, stroke, and cancer.
• A distinct subgroup of obese individuals, termed 'healthy' obese, appears protected from obesity-related comorbidities.
• This review explores the underlying mechanisms contributing to this healthy obese subphenotype.

Purpose of the Study:

• To investigate the potential mechanisms responsible for the 'healthy obese' phenotype.
• To differentiate between metabolically healthy and unhealthy obese individuals.
• To inform stratified approaches to obesity treatment.

Main Methods:

• Review of recent studies on obesity and metabolic health.
• Analysis of factors contributing to protection against metabolic and cardiovascular comorbidities in obese individuals.
• Identification of key differences between metabolically healthy and unhealthy obese phenotypes.

Main Results:

• Up to 30% of individuals with obesity are metabolically healthy, exhibiting insulin sensitivity comparable to lean individuals.
• These individuals often have lower liver fat content and reduced carotid artery intima-media thickness compared to metabolically unhealthy obese counterparts.
• Protection against hepatic steatosis, ectopic fat deposition, visceral adipose tissue inflammation, and adipose tissue dysfunction are suggested mechanisms for healthy obesity.

Conclusions:

• Defining metabolically healthy versus high-risk obese phenotypes is crucial for stratifying obesity treatment.
• This stratification will aid in identifying individuals who would most benefit from early interventions such as lifestyle changes, bariatric surgery, or pharmacotherapy.