Are there still healthy obese patients?
OBJECTIVE
Obesity is associated with an increased risk of premature death and represents a fast growing worldwide health problem that is reaching epidemic proportions. Obesity significantly increases the risk of developing metabolic disorders, hypertension, coronary heart disease, stroke, and several types of cancer. However, a subgroup of 'healthy' obese patients seems to be protected against metabolic and cardiovascular obesity comorbidities. This review focuses on potential mechanisms underlying the healthy obese subphenotype.


RESULTS
Individuals with obesity typically develop type 2 diabetes, dyslipidemia, fatty liver disease, gout, hypertension, and cardiovascular disease. In the past years it became clear that up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy lean individuals, lower liver fat content, and lower intima media thickness of the carotid artery than the majority of metabolically 'unhealthy' obese patients. Recent studies suggest that protection against development of hepatic steatosis, ectopic fat deposition, inflammation of visceral adipose tissue, and adipose tissue dysfunction contributes to healthy obesity.


CONCLUSIONS
For the stratification of obesity treatment, definition of metabolically healthy or high-risk phenotypes will facilitate the identification of the obese person who will benefit the most from early lifestyle, bariatric surgery, or pharmacological interventions.
Department of Medicine, University of Leipzig, Germany. bluma@medizin.uni-leipzig.de
Matthias
M
Blüher
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D001823:Body Composition; D015992:Body Mass Index; D059168:Carotid Intima-Media Thickness; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000378:metabolism*; D008099:Liver / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism*; D010641:Phenotype; D011379:Prognosis
D001786:Blood Glucose