Metabolically Healthy Obesity?

Every so often we hear a story in the news about ‘healthy obesity,’ but what does that mean? On one hand, it is well-established that obesity is a primary risk factor in developing type 2 diabetes. However, there are some obese people who show none of the typical diabetes danger signs and seem to be healthy, despite being obese. In fact, research has shown as much as 25% of obese individuals are “metabolically healthy”. A new study provides clues to why obesity leads to metabolic issues in some people, but not others.

Researchers from the Medical University of Vienna found that high levels of a molecule called heme oxygenase-1 (HO-1) are linked to poor metabolic health and an increased risk of type 2 diabetes in obese individuals. In contrast to past findings, they found higher levels of HO-1 in liver and fat biopsies from obese, insulin-resistant people compared with obese, metabolically healthy individuals. When the researchers deleted the HO-1 gene in immune cells called macrophages, molecular signs of inflammation decreased in mice, suggesting that HO-1 actually promotes inflammation, contrary to widespread belief. Thus, the researchers believe HO-1 blockers could potentially be used in the treatment of metabolic disease.

While this research doesn’t point to health problems for people with metabolically healthy obesity, other research has found that obesity is not without risks– excess weight could have negative implications for these individuals down the road. A 2013 study showed that obese people who are metabolically healthy still face a higher risk of developing diabetes, as well as cardiovascular disease. Using data from a large study, researchers looked at whether patients had elevated triglycerides, blood pressure and blood sugar levels, insulin resistance and decreased HDL cholesterol. People who had none or only one of the characteristics were classified as metabolically healthy.

The analysis found that increased BMI was linked to an elevated risk of developing diabetes—despite being otherwise healthy. Normal weight people who had multiple metabolic abnormalities also faced an increased risk of developing diabetes. Both groups faced an elevated risk of cardiovascular disease. The findings highlight the importance of continuing to monitor for diabetes and cardiovascular disease in people with metabolically healthy obesity.

Related Reading: Obese Teens Feel Healthy, But Blood Tests Show Otherwise

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