Understanding our body’s health, especially when dealing with concepts like obesity, can sometimes be a tricky landscape to navigate.
In a notable session at this year’s Annual Meeting of the European Association for the Study of Diabetes, Professor Matthias Blüher takes us through an intriguing journey exploring the nuances of what’s often termed “metabolically healthy obesity” (MHO) or popularly known as “fat but fit.”
Unveiling the Mask of Metabolic Health
MHO refers to a condition where an individual might have a body size that we typically associate with health risks but doesn’t show the expected metabolic disturbances like abnormal blood sugar, high blood pressure, or other signs pointing toward cardiovascular diseases.
Roughly 15-20% of individuals living with obesity seem to dodge these metabolic complications, giving rise to a variety of questions and the term “fat but fit.”
Interestingly, the phenomenon appears to be gender-biased, as women living with obesity are more likely (7-28%) to be categorized as having MHO compared to men (2-19%). But what lies beneath the surface of these numbers?
Digging Deeper: Where and How We Store Fat Matters
A central point of Professor Blüher’s discussion is the critical role of adipose tissue – essentially, our body’s fat storage cells – in determining whether an individual’s obesity can be dubbed as MHO.
In simple terms, if your adipocytes (fat cells) are of normal size, you’re less likely to showcase the usual complications linked with obesity.
In contrast, when these cells are enlarged and the surrounding tissue is inflamed, complications like insulin resistance, which pave the way for other metabolic issues, are more likely to crop up.
Moreover, where our bodies decide to store fat also holds significant implications for our metabolic health.
When fat is stored viscerally, meaning internally around organs like the liver, people are more prone to developing conditions like type 2 diabetes compared to when fat is distributed more uniformly around the body.
In scenarios where adipose tissue is not functioning optimally, it could lead to tissue damage and release molecules that promote inflammation and fat production, consequently contributing to damage in various organs.
For example, fat-released hormones (adipokines) might directly impact our vascular system, potentially leading to conditions like atherosclerosis.
The Healthiness of MHO: A Balance on a Tightrope
Addressing the million-dollar question – Can MHO genuinely be tagged as healthy? – Professor Blüher elaborates that even compared to their metabolically sound, normal-weight counterparts, individuals with obesity but no other metabolic complications still have a 50% heightened risk of coronary heart disease.
Therefore, while they may appear metabolically healthy at a glance, there is still an underlying, somewhat stealthy risk for those living with obesity, even in the seemingly benign form of MHO.
Consequently, the prior tendency to possibly sideline obesity treatment for those diagnosed with MHO, due to their seemingly lower risk profile, has come under scrutiny and critique.
The label of metabolically healthy obesity may, after all, be somewhat misleading.
In his conclusion, Professor Blüher asserts that, irrespective of the absence of other risk factors, an increase in fat mass and dysfunctional adipose tissue still places individuals at a higher risk for conditions like type 2 diabetes and cardiovascular diseases.
Hence, maintaining a focus on weight management and heeding weight loss recommendations remain paramount, even for those navigating through life with metabolically healthy obesity.
In this light, the exploration of the “fat but fit” concept becomes a fascinating, albeit complex, journey through our understanding of metabolic health, reminding us that the visual absence of health issues doesn’t necessarily equate to a risk-free existence.
It accentuates the importance of a nuanced, individualistic approach to understanding and managing our health in the enigmatic landscape of obesity and metabolic wellness.
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