title: Healthy obese persons: how can they be identified and do metabolic profiles stratify risk?
abstract: OBJECTIVE
  New research supports the intuitive observation that many persons classified as obese are healthy, and should not be treated and categorized medically as diseased. There is increasing agreement that major blood biomarkers are often not discriminatory, as for example, the return to normal blood glucose levels in bariatric patients who do not have long-term benefits. Although weight loss is appreciated to improve metabolic and inflammatory parameters, the cellular and immune factors that couple obesity to cardiometabolic risk are only partially understood.
  
  
  RESULTS
  Reduced BMI upon successful bariatric surgery does not always result in reduced pericardial fat; certain patients gain ectopic fat, which should be considered an adverse response. There is emerging evidence that pericardial fat volume and brown fat stores may provide individualized patient assessments.
  
  
  CONCLUSIONS
  Some obese persons can be relieved of the additional stigma of classification in a major disease category, and unnecessary medical interventions and costs can be reduced. Other patients should be monitored more closely for unexpected adverse outcomes.
authors: Cancer Research Center and Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
authors: Gerald V
authors: GV
authors: Denis
authors: James A
authors: JA
authors: Hamilton
mesh_terms: D000818:Animals; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D003937:Diagnosis, Differential; D006262:Health; D006801:Humans; D008659:Metabolic Diseases / Q000175:diagnosis / Q000209:etiology*; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology; D009765:Obesity / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism*; D012306:Risk
references: Circ Res. 2005 May 13;96(9):939-49
references: 15890981
references: Am J Cardiol. 1989 Aug 1;64(5):369-73
references: 2756882
references: Arch Intern Med. 2008 Aug 11;168(15):1617-24
references: 18695075
references: Endocrinology. 2003 Dec;144(12):5159-65
references: 12960011
references: Jpn J Med. 1988 May;27(2):142-9
references: 3047469
references: Obes Surg. 2008 Jun;18(6):648-51
references: 18392907
references: Diabetes Care. 2010 Sep;33(9):1957-9
references: 20573755
references: Clin Endocrinol (Oxf). 2013 Sep;79(3):314-5
references: 23445212
references: Curr Opin Lipidol. 2010 Feb;21(1):38-43
references: 19915462
references: Proc Natl Acad Sci U S A. 2013 Mar 26;110(13):5133-8
references: 23479618
references: Int J Obes Relat Metab Disord. 2004 Feb;28(2):320-3
references: 14647180
references: Circulation. 2009 Mar 31;119(12):1586-91
references: 19289634
references: Cytokine. 2005 Mar 21;29(6):251-5
references: 15749025
references: Vitam Horm. 2013;91:49-75
references: 23374712
references: Lancet. 2011 Feb 12;377(9765):557-67
references: 21295846
references: Sci Transl Med. 2012 Mar 28;4(127):127rv4
references: 22461645
references: Int J Obes Relat Metab Disord. 2002 Feb;26(2):176-83
references: 11850748
references: Comp Biochem Physiol B. 1989;94(2):225-32
references: 2591189
references: Am J Physiol Endocrinol Metab. 2010 Sep;299(3):E506-15
references: 20570822
references: Am J Cardiol. 2008 May 1;101(9):1281-4
references: 18435958
references: Discov Med. 2010 Dec;10(55):489-99
references: 21189220
references: Eur Cytokine Netw. 2006 Mar;17(1):4-12
references: 16613757
references: J Clin Invest. 2003 Dec;112(12):1821-30
references: 14679177
references: Nat Rev Cancer. 2004 Aug;4(8):579-91
references: 15286738
references: Diabetes Metab Rev. 1997 Mar;13(1):3-13
references: 9134345
references: Obesity (Silver Spring). 2009 Apr;17(4):625; author reply 626-7
references: 19322142
references: JAMA. 2005 Oct 19;294(15):1909-17
references: 16234497
references: Diabetologia. 2008 Sep;51(9):1752-4
references: 18504546
references: Hepatology. 1990 Nov;12(5):1106-10
references: 2227807
references: Int J Obes (Lond). 2010 Sep;34(9):1404-14
references: 20404828
references: Nat Clin Pract Cardiovasc Med. 2005 Oct;2(10):536-43
references: 16186852
references: Oncogene. 2004 Aug 23;23(38):6365-78
references: 15322511
references: Diabetes. 1998 May;47(5):699-713
references: 9588440
references: Obesity (Silver Spring). 2010 Jun;18(6):1116-21
references: 19875992
references: Circulation. 2008 Feb 5;117(5):605-13
references: 18212276
references: Int J Cardiol. 2007 Feb 7;115(2):272-3
references: 16759715
references: Int J Obes Relat Metab Disord. 1998 Mar;22(3):222-6
references: 9539189
references: Am J Cardiol. 2004 Oct 15;94(8):1084-7
references: 15476634
references: Obesity (Silver Spring). 2013 Jan;21(1):203-9
references: 23505187
references: J Am Coll Cardiol. 1995 Mar 15;25(4):879-84
references: 7884091
references: Obes Res. 2002 Nov;10 Suppl 1:14S-21S
references: 12446853
references: Int J Obes. 1990 Dec;14(12):1013-22
references: 2086494
references: Cardiovasc Diabetol. 2006 Jan 13;5:1
references: 16412224
references: Atherosclerosis. 2001 Jul;157(1):203-9
references: 11427222
references: Circulation. 2005 Oct 25;112(17):2735-52
references: 16157765
references: Int J Obes (Lond). 2012 Feb;36(2):286-94
references: 21587201
references: PLoS One. 2012;7(5):e37887
references: 22666405
references: N Engl J Med. 2003 Apr 24;348(17):1625-38
references: 12711737
references: Ann Intern Med. 2000 Jan 18;132(2):112-7
references: 10644271
references: Circulation. 2003 Nov 18;108(20):2460-6
references: 14581396
references: Am J Gastroenterol. 1990 Oct;85(10):1349-55
references: 2220728
references: Ann Surg. 2006 Nov;244(5):734-40
references: 17060766
references: Diabetologia. 1985 Jul;28(7):412-9
references: 3899825
references: Immunol Rev. 2012 Sep;249(1):253-75
references: 22889227
references: Am J Clin Nutr. 1981 Aug;34(8):1617-21
references: 7270486
references: Metabolism. 2001 Dec;50(12):1499-504
references: 11735101
references: N Engl J Med. 2012 Apr 26;366(17):1577-85
references: 22449317