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Obesity cannot be “metabolically healthy”

Tuesday September 12th, 2017

The term “metabolically healthy obesity” should no longer be used because it misleads individuals into believing that obesity can be healthy, British researchers say today.

In the largest study to date comparing weight and metabolic status to cardiovascular disease risks, scientists at the University of Birmingham found that individuals who are ‘metabolically healthy obese’ have an increased risk of cardiovascular disease events compared to those who are normal weight without metabolic abnormalities.

The research team at the university’s Institute of Applied Health Research used electronic health records of 3.5 million British adults who were all initially free of cardiovascular disease.

They followed up each patient’s record, at an average of 5 years and four months later, to establish if they had developed any of four CVD events of coronary heart disease, cerebrovascular disease, heart failure, or peripheral vascular disease.

Patients were divided into four ‘body size phenotypes’ using Body Mass Index: underweight; normal weight; overweight; obese and researchers focused on three metabolic abnormalities: diabetes, hypertension and hyperlipidaemia.

The study team found that metabolically healthy obese individuals had a 96% increased risk of heart failure, 49% higher risk of coronary heart disease, and 7% higher risk of cerebrovascular disease compared to those who were normal weight and metabolically healthy.

The study, published in today’s edition of the Journal of the American College of Cardiology, also showed that individuals in the ‘normal’ weight category who had one or more metabolic abnormalities had an increased risk of coronary heart disease, cerebrovascular disease, heart failure and peripheral vascular disease compared to normal weight individuals without metabolic abnormalities.

Lead author and epidemiologist Dr Rishi Caleyachetty said: “In our study, we had unprecedented statistical power to examine body size phenotypes by the number of metabolic abnormalities, potentially reflecting several definitions of the ‘metabolically healthy’ phenotype in relation to a range of CVD events.

“Obese individuals with no metabolic risk factors are still at a higher risk of coronary heart disease, cerebrovascular disease and heart failure than normal weight metabolically healthy individuals.

“So-called ‘metabolically healthy’ obesity is clearly not a harmless condition and the term should no longer be used in order to prevent misleading individuals that obesity can be healthy.”

Senior author Professor Neil Thomas, of the University of Birmingham, added: “The finding that normal weight individuals with metabolic abnormalities also had similar risk of cardiovascular disease events than normal weight metabolically healthy individuals has important implications.

“In many countries it is currently recommended that clinicians in primary care settings use overweight and obesity as the main criteria to screen adults for cardiovascular risk factors as part of cardiovascular risk assessment. Our research suggests that this could result in the failure to identify metabolic abnormalities, such as diabetes, high blood pressure and high cholesterol, in many normal weight patients.”

Caleyachetty R et al. Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women. Journal of The American College of Cardiology September 2017; doi: 10.1016/j.jacc.2017.07.763.

Tags: Diet & Food | Fitness | Heart Health | UK News

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