Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants

Zhou, Z., Macpherson, J., Gray, S. R. , Gill, J. M.R. , Welsh, P. , Celis-Morales, C. , Sattar, N. , Pell, J. P. and Ho, F. K. (2021) Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants. Diabetologia, 64(9), pp. 1963-1972. (doi: 10.1007/s00125-021-05484-6) (PMID:34109441)

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Aims/hypothesis: People with obesity and a normal metabolic profile are sometimes referred to as having ‘metabolically healthy obesity’ (MHO). However, whether this group of individuals are actually ‘healthy’ is uncertain. This study aims to examine the associations of MHO with a wide range of obesity-related outcomes. Methods: This is a population-based prospective cohort study of 381,363 UK Biobank participants with a median follow-up of 11.2 years. MHO was defined as having a BMI ≥ 30 kg/m2 and at least four of the six metabolically healthy criteria. Outcomes included incident diabetes and incident and fatal atherosclerotic CVD (ASCVD), heart failure (HF) and respiratory diseases. Results: Compared with people who were not obese at baseline, those with MHO had higher incident HF (HR 1.60; 95% CI 1.45, 1.75) and respiratory disease (HR 1.20; 95% CI 1.16, 1.25) rates, but not higher ASCVD. The associations of MHO were generally weaker for fatal outcomes and only significant for all-cause (HR 1.12; 95% CI 1.04, 1.21) and HF mortality rates (HR 1.44; 95% CI 1.09, 1.89). However, when compared with people who were metabolically healthy without obesity, participants with MHO had higher rates of incident diabetes (HR 4.32; 95% CI 3.83, 4.89), ASCVD (HR 1.18; 95% CI 1.10, 1.27), HF (HR 1.76; 95% CI 1.61, 1.92), respiratory diseases (HR 1.28; 95% CI 1.24, 1.33) and all-cause mortality (HR 1.22; 95% CI 1.14, 1.31). The results with a 5 year landmark analysis were similar. Conclusions/interpretation: Weight management should be recommended to all people with obesity, irrespective of their metabolic status, to lower risk of diabetes, ASCVD, HF and respiratory diseases. The term ‘MHO’ should be avoided as it is misleading and different strategies for risk stratification should be explored.

Item Type:Articles
Additional Information:UK Biobank was established by the Wellcome Trust, the Medical Research Council, the Department of Health, the Scottish government and the Northwest Regional Development Agency. It has also had funding from the Welsh Assembly government and the British Heart Foundation.
Glasgow Author(s) Enlighten ID:Ho, Dr Frederick and Gill, Professor Jason and MACPHERSON, Mr JOHN and Zhou, Ziyi and Welsh, Dr Paul and Celis, Dr Carlos and Gray, Professor Stuart and Pell, Professor Jill and Sattar, Professor Naveed
Authors: Zhou, Z., Macpherson, J., Gray, S. R., Gill, J. M.R., Welsh, P., Celis-Morales, C., Sattar, N., Pell, J. P., and Ho, F. K.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:Diabetologia
ISSN (Online):1432-0428
Published Online:10 June 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Diabetologia 64(9): 1963-1972
Publisher Policy:Reproduced under a Creative Commons License

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