Obesity increases cardiometabolic risks, even with healthy metabolic markers
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People with obesity and a healthy metabolic profile have a higher risk for heart failure and respiratory disease compared with adults without obesity, according to a study published in Diabetologia.
Frederick Ho, PhD, a research associate in the Institute of Health and Wellbeing at the University of Glasgow, Scotland, said adults with obesity must engage in weight management, regardless of their cardiometabolic health markers.
“Obesity is a condition that could lead to multiple severe diseases, even among those who have normal metabolic profile,” Ho told Healio. “‘Metabolically healthy obesity’ is a misleading label and should be avoided.”
Ho and colleagues analyzed data from 381,363 participants in the UK Biobank. Participants were included in the study if they were not underweight and had complete height, weight, blood pressure and blood-based biomarker data. BP, C-reactive protein, triacylglycerols, LDL cholesterol, HDL cholesterol and HbA1c were the six metabolic markers used to define metabolic health. Participants were considered metabolically healthy if they met healthy criteria in at least four of six biomarkers. The study population was divided into a reference group of metabolically healthy adults without obesity (n = 208,625), a metabolically healthy group with obesity (n = 35,103), a metabolically unhealthy cohort without obesity (n = 78,259) and a cohort of metabolically unhealthy adults with obesity (n = 59,376).
Metabolically healthy obesity increases risks
After adjusting for sociodemographic and lifestyle factors, adults who were metabolically healthy with obesity had a higher risk for incident diabetes (HR = 4.32; 95% CI, 3.83-4.89), atherosclerotic cardiovascular disease (HR = 1.18; 95% CI, 1.1-1.27), myocardial infarction (HR = 1.23; 95% CI, 1.11-1.37), stroke (HR = 1.1; 95% CI, 1.01-1.21), heart failure (HR = 1.76; 95% CI, 1.61-1.92), respiratory disease (HR = 1.28; 95% CI, 1.24-1.33) and chronic obstructive pulmonary disease (HR = 1.19; 95% CI, 1.11-1.28) compared with metabolically healthy individuals without obesity. The metabolically healthy obesity group also had a higher all-cause mortality rate compared with the metabolically healthy cohort without obesity (HR = 1.22; 95% CI, 1.14-1.31).
Compared with participants without obesity, regardless of metabolic health, adults with metabolically health obesity had a higher risk for diabetes (HR = 2.06; 95% CI, 1.77-2.4), heart failure (HR = 1.6; 95% CI, 1.45-1.75) and respiratory diseases (HR = 1.2; 95% CI, 1.16-1.25). The metabolically healthy obesity group also had a slightly increased risk for all-cause mortality (HR = 1.12; 95% CI, 1.04-1.21) and heart failure mortality (HR = 1.44; 95% CI, 1.09-1.89).
“Different from other clinical outcomes, people with metabolically healthy obesity had even higher risk [for heart failure and respiratory disease] compared with people who had normal weight but an unhealthy metabolic profile,” Ho said. “This reinforces the adverse consequences of obesity to be multidimensional and go beyond the usual metabolic health markers.”
Risks with metabolic profile transition
Researchers also analyzed data from a subgroup of 8,521 participants who completed a reassessment of their metabolic status after a median follow-up of 4.4 years. Half of the subgroup participants who had metabolically healthy obesity at baseline remained in that group at follow-up, 20% did not have obesity and more than 25% moved to the metabolically unhealthy obesity group. Compared with people without obesity who were metabolically unhealthy at baseline and follow-up, participants who transitioned from metabolically healthy obesity to metabolically unhealthy obesity had a higher risk for atherosclerotic CVD (HR = 2.46; 95% CI, 1.12-5.41) and all-cause mortality (HR = 3.07; 95% CI, 1.44-6.56). No associations were observed for those who remained in the metabolically healthy obesity group at follow-up.
“People with obesity have a diverse clinical profile,” Ho said. “Even though the metabolically healthy obesity label is not useful, future studies can explore how we can make use of metabolic and other health markers to assist clinical management.”
For more information:
Frederick Ho, PhD, can be reached at frederick.ho@glasgow.ac.uk.
Perspective
Back to TopJamy D. Ard, MD, FTOS; Morgana Mongraw-Chaffin, PhD, MPH, FAHA
Obesity is a complex chronic disease that is defined rather simply using body mass index. Ho and colleagues’ work is now part of a growing literature confirming that this simple definition obscures the heterogeneity of risks from obesity and that the designation “metabolically healthy obesity” is also often misleading.
Obesity risk appears cumulative in nature, and many with obesity will experience complications given time. Furthermore, the risk of obesity may work predominantly through metabolic syndrome for some outcomes, eg, atherosclerotic CVD, or through pathways independent of metabolic syndrome for other outcomes, eg, type 2 diabetes and heart failure. Therefore, if we focus clinically on simply preventing metabolic syndrome rather than treating obesity, these data suggest we are missing the boat on the dangers of obesity.
This study underscores the need to address obesity at the population level. Obesity prevention focused on individual behaviors has been largely ineffective, but systemic solutions that alter the obesogenic environment are urgently needed for public health impact. Obesity treatment needs to be more broadly available, and this work suggests that it should be indicated regardless of metabolic syndrome status, highlighting the need for new clinical biomarkers that are more representative of the true risks of excess adiposity.
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