Sarah S Farabi, Gordon I Smith, Jun Yoshino, Samuel Klein,  Metabolically Healthy Obesity is not a Myth, JCEM Case Reports, Volume 1, Issue 2, March 2

Metabolically Healthy Obesity is not a Myth

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2023-09-14 18:00:21

Sarah S Farabi, Gordon I Smith, Jun Yoshino, Samuel Klein, Metabolically Healthy Obesity is not a Myth, JCEM Case Reports, Volume 1, Issue 2, March 2023, luad015,

People with obesity who do not have the metabolic syndrome or components of the metabolic syndrome have been characterized as having metabolically healthy obesity (MHO). However, the existence of MHO has been questioned because people with MHO are at greater risk of developing diabetes and fatal cardiovascular disease than people who are lean and healthy. Here we report findings from a 25-year-old woman with rigorously defined MHO (normal oral glucose tolerance, insulin sensitivity [assessed using the hyperinsulinemic-euglycemic clamp procedure], plasma triglyceride, and intrahepatic triglyceride content) evaluated at baseline (body mass index, 37.7 kg/m2) and 5 years later, after a 32% (30.8 kg) increase in body mass (BMI, 49.6 kg/m2). Weight gain did not have adverse effects on fasting plasma glucose, oral glucose tolerance, β-cell function, insulin sensitivity, plasma triglyceride, intrahepatic triglyceride content, or carotid intima-media thickness. Adipose tissue expression of genes involved in extracellular matrix formation remained unchanged. Adipose tissue expression of several inflammation-related genes increased by more than 30%, but was not associated with a corresponding increase in plasma cytokine concentrations, with the exception of IL-6 and C-reactive protein. The present case study demonstrates that some people with obesity are resistant to the adverse cardiometabolic effects of excess adiposity and marked weight gain.

Obesity is typically associated with a variety of cardiometabolic comorbidities, including insulin resistance, atherogenic dyslipidemia, nonalcoholic fatty liver disease, prediabetes, and the metabolic syndrome [ 1]. However, some people with obesity do not have these complications and are considered “metabolically healthy” [ 2]. Even though the risk of all-cause mortality, type 2 diabetes, and coronary heart disease in people classified as having metabolically healthy obesity (MHO) is lower than those with metabolically unhealthy obesity (MUO), the risk of developing cardiometabolic comorbidities is still greater in people with MHO compared with people who are healthy and normal weight. In addition, many people with MHO convert to MUO over time [ 3]. As a result, it has been proposed that MHO does not really exist and all people with obesity are at increased risk for cardiometabolic diseases. A major limitation of these studies is the absence of a single, rigorous definition of MHO. More than 30 different definitions of MHO have been used in previous studies [ 4], and most criteria allow people to be classified as MHO even if they have evidence of metabolic abnormalities (eg, people with 1-2 metabolic syndrome components are still considered to have MHO in most previous studies) [ 5].

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