title: Diet composition and activity level of at risk and metabolically healthy obese American adults.
abstract: OBJECTIVE
  Obesity often clusters with other major cardiovascular disease risk factors, yet a subset of the obese appears to be protected from these risks. Two obesity phenotypes are described, (i) "metabolically healthy" obese, broadly defined as body mass index (BMI) ≥ 30 kg/m(2) and favorable levels of blood pressure, lipids, and glucose; and (ii) "at risk" obese, BMI ≥ 30 with unfavorable levels of these risk factors. More than 30% of obese American adults are metabolically healthy. Diet and activity determinants of obesity phenotypes are unclear. We hypothesized that metabolically healthy obese have more favorable behavioral factors, including less adverse diet composition and higher activity levels than at risk obese in the multi-ethnic group of 775 obese American adults ages 40-59 years from the International Population Study on Macro/Micronutrients and Blood Pressure (INTERMAP) cohort.
  
  
  METHODS
  In gender-stratified analyses, mean values for diet composition and activity behavior variables, adjusted for age, race, and education, were compared between metabolically healthy and at risk obese.
  
  
  RESULTS
  Nearly one in five (149/775 or 19%) of obese American INTERMAP participants were classified as metabolically healthy obese. Diet composition and most activity behaviors were similar between obesity phenotypes, although metabolically healthy obese women reported higher sleep duration than at risk obese women.
  
  
  CONCLUSIONS
  These results do not support hypotheses that diet composition and/or physical activity account for the absence of cardiometabolic abnormalities in metabolically healthy obese.
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. alhankinson@northwestern.edu
authors.forename: Arlene L
authors.initials: AL
authors.lastname: Hankinson
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.forename: Linda
authors.initials: L
authors.lastname: Van Horn
authors.forename: Queenie
authors.initials: Q
authors.lastname: Chan
authors.forename: Ian
authors.initials: I
authors.lastname: Brown
authors.forename: Elaine
authors.initials: E
authors.lastname: Holmes
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Stamler
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology* / Q000378:metabolism; D015995:Prevalence; D012307:Risk Factors; D057185:Sedentary Behavior; D013690:Television; D014481:United States
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D018977:Micronutrients