'''Metabolically healthy obesity''' or '''metabolically-healthy obesity''' ('''MHO''') is a disputed<ref name=Puri-2014/> medical condition characterized by [[obesity]] which does not produce [[Metabolic disorders|metabolic complications]].<ref name=lancet>{{cite journal|last1=Stefan|first1=Norbert|last2=Häring|first2=Hans-Ulrich|last3=Hu|first3=Frank B|last4=Schulze|first4=Matthias B|title=Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications|journal=The Lancet Diabetes & Endocrinology|date=October 2013|volume=1|issue=2|pages=152–162|doi=10.1016/S2213-8587(13)70062-7|pmid=24622321}}</ref>
| treatment = Lifestyle modifications (diet and physical activity)
| medication = Generally not required, supportive if metabolic health deteriorates
| prognosis = Controversial; some studies suggest potential long-term risks
| frequency = Estimates vary widely, 6–75%
| deaths = Usually related to eventual metabolic complications
}}
==Characteristics==
'''Metabolically healthy obesity''' ('''MHO'''), also known as '''metabolically-healthy obesity''', is a disputed medical condition characterized by [[obesity]] that does not result in metabolic complications commonly associated with excess weight. These complications include [[dyslipidemia]], [[impaired glucose tolerance]], and [[metabolic syndrome]].
No universally accepted criteria exist to define putative MHO,<ref name=lancet/> but definitions generally require the patient to be obese and to lack metabolic abnormalities such as [[dyslipidemia]], [[impaired glucose tolerance]],<ref name=Puri-2014>{{cite journal|last1=Puri|first1=Rishi|title=Is it Finally Time to Dispel the Concept of Metabolically-Healthy Obesity?|journal=Journal of the American College of Cardiology|date=June 2014|volume=63|issue=24|pages=2687–2688|doi=10.1016/j.jacc.2014.03.043|pmid=24794116}}</ref> or [[metabolic syndrome]].<ref name=mam>{{cite journal|last1=Denis|first1=Gerald V.|last2=Obin|first2=Martin S.|title='Metabolically healthy obesity': Origins and implications|journal=Molecular Aspects of Medicine|date=February 2013|volume=34|issue=1|pages=59–70|doi=10.1016/j.mam.2012.10.004|pmid=23068072|pmc=3583231}}</ref>
MHO individuals display less visceral [[adipose tissue]], smaller [[adipocyte]]s, and a reduced inflammatory profile relative to metabolically unhealthy obese individuals.<ref name=mam/><ref>{{cite journal|last1=Navarro|first1=Estanislau|last2=Funtikova|first2=Anna N.|last3=Fíto|first3=Montserrat|last4=Schröder|first4=Helmut|title=Can Metabolically Healthy Obesity be explained by diet, genetics and inflammation?|journal=Molecular Nutrition & Food Research|date=November 2014|pages=75–93|doi=10.1002/mnfr.201400521|pmid=25418549|volume=59|issue=1}}</ref><ref>{{cite journal|last1=Muñoz-Garach|first1=Araceli|last2=Cornejo-Pareja|first2=Isabel|last3=Tinahones|first3=Francisco J.|title=Does Metabolically Healthy Obesity Exist?|journal=Nutrients|date=1 June 2016|volume=8|issue=6|doi=10.3390/nu8060320|issn=2072-6643|pmc=4924161|pmid=27258304|page=320}}</ref> As a result, it has been argued that cardiometabolic risk might not improve significantly as a result of weight loss interventions.<ref>{{cite journal|last1=Bluher|first1=M.|title=MECHANISMS IN ENDOCRINOLOGY: Are metabolically healthy obese individuals really healthy?|journal=European Journal of Endocrinology|date=10 July 2014|volume=171|issue=6|pages=R209–R219|doi=10.1530/EJE-14-0540|pmid=25012199}}</ref>
== Characteristics ==
There is no universally accepted definition for MHO. However, diagnostic criteria generally include:
* Obesity as defined by a [[body mass index]] (BMI) of ≥30 kg/m²
* Absence of significant metabolic abnormalities such as:
** Normal blood lipid levels
** Normal glucose tolerance
** Absence of [[insulin resistance]]
==Epidemiology==
Individuals with MHO typically demonstrate:
Prevalence estimates of MHO have varied from 6 to 75 percent,<ref>{{cite journal|last1=Rey-López|first1=JP|last2=de Rezende|first2=LF|last3=Pastor-Valero|first3=M|last4=Tess|first4=BH|title=The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used.|journal=Obesity Reviews|date=October 2014|volume=15|issue=10|pages=781–90|pmid=25040597|doi=10.1111/obr.12198}}</ref> and it has been argued that between 10 and 25 percent of obese individuals are metabolically healthy.<ref>{{cite journal|last1=Blüher|first1=Matthias|title=The distinction of metabolically 'healthy' from 'unhealthy' obese individuals|journal=Current Opinion in Lipidology|date=February 2010|volume=21|issue=1|pages=38–43|doi=10.1097/MOL.0b013e3283346ccc|pmid=19915462}}</ref> One study found that 47.9% of obese people had MHO, while another found that 11% did.<ref name=mam/> It seems to be more prevalent in women than men, and its prevalence decreases with age.<ref>{{cite journal|last1=Blüher|first1=Susann|last2=Schwarz|first2=Peter|title=Metabolically healthy obesity from childhood to adulthood — Does weight status alone matter?|journal=Metabolism|date=September 2014|volume=63|issue=9|pages=1084–1092|doi=10.1016/j.metabol.2014.06.009|pmid=25038727}}</ref><ref>{{cite journal|last1=van Vliet-Ostaptchouk|first1=Jana V|last2=Nuotio|first2=Marja-Liisa|last3=Slagter|first3=Sandra N|last4=Doiron|first4=Dany|last5=Fischer|first5=Krista|last6=Foco|first6=Luisa|last7=Gaye|first7=Amadou|last8=Gögele|first8=Martin|last9=Heier|first9=Margit|last10=Hiekkalinna|first10=Tero|last11=Joensuu|first11=Anni|last12=Newby|first12=Christopher|last13=Pang|first13=Chao|last14=Partinen|first14=Eemil|last15=Reischl|first15=Eva|last16=Schwienbacher|first16=Christine|last17=Tammesoo|first17=Mari-Liis|last18=Swertz|first18=Morris A|last19=Burton|first19=Paul|last20=Ferretti|first20=Vincent|last21=Fortier|first21=Isabel|last22=Giepmans|first22=Lisette|last23=Harris|first23=Jennifer R|last24=Hillege|first24=Hans L|last25=Holmen|first25=Jostein|last26=Jula|first26=Antti|last27=Kootstra-Ros|first27=Jenny E|last28=Kvaløy|first28=Kirsti|last29=Holmen|first29=Turid|last30=Männistö|first30=Satu|last31=Metspalu|first31=Andres|last32=Midthjell|first32=Kristian|last33=Murtagh|first33=Madeleine J|last34=Peters|first34=Annette|last35=Pramstaller|first35=Peter P|last36=Saaristo|first36=Timo|last37=Salomaa|first37=Veikko|last38=Stolk|first38=Ronald P|last39=Uusitupa|first39=Matti|last40=van der Harst|first40=Pim|last41=van der Klauw|first41=Melanie M|last42=Waldenberger|first42=Melanie|last43=Perola|first43=Markus|last44=Wolffenbuttel|first44=Bruce HR|title=The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies|journal=BMC Endocrine Disorders|date=2014|volume=14|issue=1|pages=9|doi=10.1186/1472-6823-14-9|pmid=24484869}}</ref>
* Lower levels of [[visceral adipose tissue]]
* Smaller [[adipocytes]] (fat cells)
* A reduced [[inflammatory]] profile compared to metabolically unhealthy obese individuals
==Outcomes==
Due to these characteristics, it has been proposed that [[cardiometabolic risk]] might not significantly improve following weight loss interventions in MHO individuals.
Some research suggests that metabolically healthy obese individuals are at an increased risk of several adverse outcomes, including [[type 2 diabetes]],<ref>{{cite journal|last1=Bell|first1=JA|last2=Kivimaki|first2=M|last3=Hamer|first3=M|title=Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies.|journal=Obesity Reviews|date=June 2014|volume=15|issue=6|pages=504–15|pmid=24661566|doi=10.1111/obr.12157|pmc=4309497|url=https://dspace.lboro.ac.uk/dspace-jspui/bitstream/2134/19272/3/Bell_et_al-2014-Obesity_Reviews.pdf}}</ref> [[depression (mood)|depressive symptoms]],<ref>{{cite journal|last1=Jokela|first1=M|last2=Hamer|first2=M|last3=Singh-Manoux|first3=A|last4=Batty|first4=G D|last5=Kivimäki|first5=M|title=Association of metabolically healthy obesity with depressive symptoms: pooled analysis of eight studies|journal=Molecular Psychiatry|date=3 December 2013|volume=19|issue=8|pages=910–914|doi=10.1038/mp.2013.162|pmid=24296976|pmc=4921125}}</ref> and cardiovascular events.<ref>{{cite journal|last1=Kramer|first1=Caroline K.|last2=Zinman|first2=Bernard|last3=Retnakaran|first3=Ravi|title=Are Metabolically Healthy Overweight and Obesity Benign Conditions?|journal=Annals of Internal Medicine|date=3 December 2013|volume=159|issue=11|pages=758–69|doi=10.7326/0003-4819-159-11-201312030-00008|pmid=24297192}}</ref><ref>{{Cite journal |last=Eckel |first=Nathalie |last2=Meidtner |first2=Karina |last3=Kalle-Uhlmann |first3=Tamara |last4=Stefan |first4=Norbert |last5=Schulze |first5=Matthias B |title=Metabolically healthy obesity and cardiovascular events: A systematic review and meta-analysis |journal=European Journal of Preventive Cardiology |volume=23 |issue=9 |pages=956–966 |doi=10.1177/2047487315623884|pmid=26701871 |year=2016 }}</ref> Other research also suggests that although MHO individuals display a favorable metabolic profile, this does not necessarily translate into a decrease in mortality.<ref>{{cite journal|last1=Primeau|first1=V|last2=Coderre|first2=L|last3=Karelis|first3=A D|last4=Brochu|first4=M|last5=Lavoie|first5=M-E|last6=Messier|first6=V|last7=Sladek|first7=R|last8=Rabasa-Lhoret|first8=R|title=Characterizing the profile of obese patients who are metabolically healthy|journal=International Journal of Obesity|date=26 October 2010|volume=35|issue=7|pages=971–981|doi=10.1038/ijo.2010.216}}</ref> Research to date has produced conflicting results with respect to cardiovascular disease and mortality.<ref>{{cite journal|last1=Phillips|first1=Catherine M.|title=Metabolically healthy obesity: Definitions, determinants and clinical implications|journal=Reviews in Endocrine and Metabolic Disorders|date=9 August 2013|volume=14|issue=3|pages=219–227|doi=10.1007/s11154-013-9252-x|pmid=23928851}}</ref> MHO individuals are at a higher risk of cardiovascular disease compared to metabolically healthy non-obese individuals, but they are also at a lower risk thereof than individuals who are both unhealthy and obese.<ref>{{cite journal|last1=Roberson|first1=Lara L|last2=Aneni|first2=Ehimen C|last3=Maziak|first3=Wasim|last4=Agatston|first4=Arthur|last5=Feldman|first5=Theodore|last6=Rouseff|first6=Maribeth|last7=Tran|first7=Thinh|last8=Blaha|first8=Michael J|last9=Santos|first9=Raul D|last10=Sposito|first10=Andrei|last11=Al-Mallah|first11=Mouaz H|last12=Blankstein|first12=Ron|last13=Budoff|first13=Matthew J|last14=Nasir|first14=Khurram|title=Beyond BMI: The "Metabolically healthy obese" phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality -- a systematic review|journal=BMC Public Health|date=2014|volume=14|issue=1|pages=14|doi=10.1186/1471-2458-14-14|pmid=24400816|pmc=3890499}}</ref><ref>{{cite journal|last1=Fan|first1=Jingyao|last2=Song|first2=Yiqing|last3=Chen|first3=Yu|last4=Hui|first4=Rutai|last5=Zhang|first5=Weili|title=Combined effect of obesity and cardio-metabolic abnormality on the risk of cardiovascular disease: A meta-analysis of prospective cohort studies|journal=International Journal of Cardiology|date=October 2013|volume=168|issue=5|pages=4761–4768|doi=10.1016/j.ijcard.2013.07.230|pmid=23972953}}</ref> A 2016 meta-analysis found that MHO individuals were not at an increased risk of all-cause mortality (but were at an increased risk of cardiovascular events).<ref>{{cite journal|last1=Zheng|first1=R|last2=Zhou|first2=D|last3=Zhu|first3=Y|title=The long-term prognosis of cardiovascular disease and all-cause mortality for metabolically healthy obesity: a systematic review and meta-analysis.|journal=Journal of Epidemiology and Community Health|date=28 April 2016|doi=10.1136/jech-2015-206948|pmid=27126492|volume=70|issue=10|pages=1024–1031}}</ref> The relatively low risk of cardiovascular disease among people with MHO relative to metabolically unhealthy obese people has been attributed to differences in [[white adipose tissue]] function between the two groups.<ref>{{cite journal|last1=Badoud|first1=F|last2=Perreault|first2=M|last3=Zulyniak|first3=MA|last4=Mutch|first4=DM|title=Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals.|journal=FASEB Journal|date=19 November 2014|pmid=25411437|doi=10.1096/fj.14-263913|volume=29|issue=3|pages=748–758}}</ref>
==References==
== Epidemiology ==
{{Reflist|30em}}
Estimates of the prevalence of MHO vary widely, ranging from 6% to 75%. It is generally believed that approximately 10–25% of obese individuals may be metabolically healthy. Reported findings include:
* One study identifying 47.9% of obese individuals as having MHO
* Another reporting just 11%
MHO is more commonly observed in [[women]] than in [[men]] and tends to decline with increasing age.
== Clinical Significance ==
The clinical importance of MHO remains controversial. While MHO individuals appear to have a more favorable metabolic profile in the short term, long-term studies suggest they may still be at elevated risk for:
* [[Cardiovascular disease]]
* [[Type 2 diabetes mellitus]]
* Other obesity-related complications
Therefore, continued monitoring and lifestyle optimization are recommended.
== Management ==
Even in the absence of metabolic dysfunction, management for individuals with MHO typically includes:
* Balanced, nutrient-rich diet
* Regular [[physical activity]]
* Weight monitoring and regular check-ups to detect any metabolic changes early
Current guidelines emphasize the importance of preventive care and individualized risk assessment for patients with MHO.
{{obesity}}
[[Category:Obesity]]
[[Category:Obesity]]
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Latest revision as of 15:52, 27 March 2025
Metabolically healthy obesity
Synonyms
MHO, Metabolically-healthy obesity
Pronounce
N/A
Specialty
N/A
Symptoms
Obesity without metabolic abnormalities
Complications
Potential long-term cardiovascular risks
Onset
Variable, typically adulthood
Duration
Chronic, variable
Types
Causes
Genetic, environmental, lifestyle factors
Risks
Family history, diet, physical activity levels
Diagnosis
Clinical assessment, absence of metabolic syndrome components
Lifestyle modifications (diet and physical activity)
Medication
Generally not required, supportive if metabolic health deteriorates
Prognosis
Controversial; some studies suggest potential long-term risks
Frequency
Estimates vary widely, 6–75%
Deaths
Usually related to eventual metabolic complications
Metabolically healthy obesity (MHO), also known as metabolically-healthy obesity, is a disputed medical condition characterized by obesity that does not result in metabolic complications commonly associated with excess weight. These complications include dyslipidemia, impaired glucose tolerance, and metabolic syndrome.
A reduced inflammatory profile compared to metabolically unhealthy obese individuals
Due to these characteristics, it has been proposed that cardiometabolic risk might not significantly improve following weight loss interventions in MHO individuals.
Estimates of the prevalence of MHO vary widely, ranging from 6% to 75%. It is generally believed that approximately 10–25% of obese individuals may be metabolically healthy. Reported findings include:
One study identifying 47.9% of obese individuals as having MHO
Another reporting just 11%
MHO is more commonly observed in women than in men and tends to decline with increasing age.
The clinical importance of MHO remains controversial. While MHO individuals appear to have a more favorable metabolic profile in the short term, long-term studies suggest they may still be at elevated risk for:
