Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants – published online 10/06/2021

Ziyi Zhou, John Macpherson, Stuart R. Gray, Jason M. R. Gill, Paul Welsh, Carlos Celis-Morales, Naveed Sattar, Jill P. Pell, Frederick K. Ho

People who are obese and with a normal metabolic profile are sometimes referred to as having ‘metabolically healthy obesity’ (MHO). In this issue, Zhou et al (https://doi.org/10.1007/s00125-021-05484-6) present findings from a prospective cohort study of 381,363 UK Biobank participants. They found that those with MHO had higher risk of incident diabetes, atherosclerotic cardiovascular disease, heart failure, respiratory disease and all-cause mortality, compared with those who were not obese and had a normal metabolic profile. The results were similar in an analysis excluding participants with incident outcomes in the first 5 years of follow-up, indicating minimal reverse causation. There were weak or non-significant interactions between obesity and metabolic health factors with health outcomes, suggesting MHO is not a distinctive phenotype. The authors conclude that the use of the label ‘metabolically healthy’ is misleading and should be avoided. Weight management could be beneficial for all people with obesity, irrespective of metabolic profile.

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