At the Annual Meeting of the European Association for the Study of Diabetes (EASD), Professor Matthias Blüher discussed the concept of “metabolically healthy obesity” (MHO), often referred to as “fat but fit.”
Approximately 15-20% of individuals with obesity do not exhibit metabolic complications commonly associated with the condition, such as abnormal blood sugar control, high blood pressure, type 2 diabetes, and cardiovascular disease markers.
Estimates suggest that MHO is more prevalent in women with obesity (7-28%) than in men (2-19%). MHO is characterized by lower liver fat mass compared to what might be expected based on body mass index (BMI) and total fat mass.
Professor Blüher emphasized that it is not solely BMI but rather how adipose tissue behaves in individuals with obesity that determines whether their condition is MHO.
People with normal-sized fat-storing cells (adipocytes) are less likely to develop obesity-related complications, while those with enlarged adipocytes and inflamed adipose tissue are more prone to conditions like insulin resistance.
The distribution of fat in the body also plays a crucial role in defining MHO. Visceral fat, which accumulates around internal organs like the liver, increases the risk of type 2 diabetes compared to more evenly distributed body fat.
Professor Blüher pointed out that in people with dysfunctional adipose tissue, damage can occur, leading to tissue fibrosis, the secretion of proinflammatory and adipogenic molecules, and end-organ damage.
Adipokines, hormones released by fat cells, can affect the vascular system and contribute to conditions like atherosclerosis. Additionally, metabolites such as fatty acids may impair the liver’s function or the insulin-producing cells in the pancreas.
Regarding whether MHO can genuinely be described as “healthy,” Professor Blüher cited studies showing that individuals with obesity and no metabolic comorbidities still have a 50% increased risk of coronary heart disease compared to people with normal weight and no metabolic issues.
In conclusion, although some individuals with obesity do not exhibit immediate cardio-metabolic complications, recent research challenges the idea of MHO being genuinely “healthy.”
Even in the absence of other metabolic risk factors, increased fat mass and adipose tissue dysfunction contribute to a higher risk of type 2 diabetes and cardiovascular diseases.
Therefore, weight management and recommendations for weight loss remain important for people with MHO.
If you care about weight loss, please read studies about the keto diet for weight loss: Pros and cons, and how to drink water to lose weight.
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