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‘Metabolically healthy obesity’ is on the rise, but still not common

‘Metabolically healthy obesity’ is on the rise, but still not common


Emerging evidence suggests that the proportion of Americans with “metabolically healthy obesity” has risen with the rise in general obesity over the past two decades, but that “healthy” numbers remain low. suggested by the data.

According to figures from the National Health and Nutrition Examination Survey (NHANES), “metabolically healthy obesity” is defined as obesity without associated metabolic disturbances such as hypertension or elevated blood sugar levels, 1999–2018. This indicates that the population as a whole has more than doubled over the years. However, obesity accounted for only a small portion of the overall growing population.

Furthermore, the increase in “metabolic-healthy” obesity occurred primarily among people over age 60, males, Caucasian adults, and those with high income, private insurance, or Class 1 obesity.

Also, over the study period, the overall prevalence of obesity rose from 28.6% to 40.9% of the population, with a corresponding increase in ‘metabolically unhealthy’ obesity.

“We observed a low prevalence of [metabolically healthy obesity] and a large and growing burden [metabolically unhealthy obesity]….These results highlight the need for effective strategies to prevent obesity-related complications among obese people, especially vulnerable subpopulations,” Huazhong University of Science and Technology, Wuhan, China. said Jiang-Shui Wang, MBBS, and colleagues. , published their findings on March 9, 2023 JAMA network opened.

Asked for comment, former Obesity Association President Steven B. Heimsfield, M.D., said: medscape, “Metabolically healthy obesity is kind of a warning light. is not a law of nature.You are bringing obesity into your body.Your genetic make-up, and that can vary greatly from person to person.…Also having metabolic syndrome and a perfectly normal weight can.

Is ‘metabolically healthy obesity’ a useful concept?

Heymsfield explained that the concept of “metabolically healthy obesity” is of limited utility because a person’s risk factor profile can change over time.

“The definition of health is based on a person’s physical appearance at the moment and various risk factors. Obesity is a disease of long gestation. It remains asymptomatic for years. To see something clinically apparent that you didn’t see when you were 30…you see it in many people, not everyone.”

Furthermore, he pointed out that many people may have a high body mass index (BMI) because they have relatively little body fat mass due to large bone structure and/or large muscle mass. A range of BMI around 30 kg/m is not that uncommon.2, especially young people. A BMI of 30 has a very wide range of body fat. ”

As such, he advises clinicians to measure not only waist circumference, which is recommended but less clinically practiced, but also hip circumference to determine waist-to-hip ratio (WHR). increase.

this measurement is supported As a more accurate assessment of obesity than BMI by the World Health Organization (WHO), but also better predictor Heymsfield, of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, said cardiovascular risk (a WHR of 0.90 cm or greater in men and 0.85 cm or greater in women identifies a significant metabolic risk, according to WHO). rice field.

So if you have a BMI of 30kg/m2 “The person is probably not obese or overfat. It’s probably muscular. It may not be entirely obvious on the surface,” he observed.

Metabolic-healthy obesity is on the rise, but remains low in prevalence

NHANES is a series of nationally representative U.S. surveys conducted on a two-year cycle, and researchers examined data from 1999-2000 and 2017-2018.

‘Metabolically healthy obese’ was defined as a BMI of 30 kg/m.2 Without or above metabolic disturbances such as hypertension, increased fasting plasma glucose, or lipid changes, based on established cut-offs.

It included 20,430 adult participants, of whom 7,386 were obese. Across the study population, the age-standardized prevalence of obesity increased significantly from 28.6% in 1999–2002 to 40.9% in 2015–2018 (P. trend < .001).

At the same time, the age-standardized prevalence of metabolically healthy obesity nearly doubled, rising from 3.2% to 6.6% (P. < .001).

And in obese people alone, the prevalence in metabolically healthy people increased from 25.4% to 34.3% (P. < .001).

“Our results suggest that the overall increase in metabolically healthy obesity was driven primarily by a decrease in dyslipidemia in obese adults,” says Possibly, increasing awareness and treatment. As a result, Wang and colleagues note.

The rise in blood pressure remained stable and the rise in fasting plasma glucose increased, leading the researchers to conclude that “strengthening glucose control and reducing insulin resistance in obese patients should be a priority.” emphasized.

This work was supported by grants from the National Natural Science Foundation of China, the Fundamental Research Fund of Central University, and the Shanghai Municipal Science and Technology Key Project. The authors report no further relevant financial relationships. Heymsfield sits on Novo Nordisk’s advisory board, owns shares in Merck, and receives research funding from Pfizer and her Versanis.

JAMA network opened. Published online on March 9, 2023. Full text.

Miriam E. Tucker is a freelance journalist based in Washington, DC. She is a regular contributor to her Medscape, and her other work appears in her The Washington Post, her Shots blog on NPR, and Diabetes Forecast magazine. She is on Twitter @MiriamETucker.

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