title: [Healthy obesity? Why the adiposity paradox is only seemingly paradox].
abstract: The health consequences of being overweight have been discussed controversially. Indeed, from a metabolic point of view, overweight and obese people are quite heterogenous. The body mass index (BMI) is not suitable to predict health oriented outcomes on an individual level without taking into account further parameters such as waist circumference, blood pressure, serum glucose, serum lipids, and physical fitness. The BMI does not distinguish between metabolically healthy and metabolically unhealthy. Of upmost importance for health consequences of obesity is body fat distribution. Two types of principally different fat distribution can be identified: abdominal and gluteofemoral fat. Waist circumference and hip circumference can be utilized to distinguish between those two types. People with accumulation of body fat in the abdominal region have a markedly higher risk of developing type-2-diabetes and cardiovascular disease. Moreover, their total mortality is increased. On the other hand, waist circumference is not sufficiently capable of indicating individual risk. Instead, the amount of visceral fat is believed to be a primary risk factor because of its metabolic characteristics (i. e. increased lipolysis, diabetogenic and atherogenic adipokine profile). Recent findings point to visceral fat being more an indicator of the parallel accumulation of fat deposits in organs placed in the abdomen. The accumulation of lipids in tissues not primary intended for fat storage is called,,ectopic fat". It can be found in muscle, liver, pancreas, and kidney. The fattening of those organs is now considered to have the key role in the pathogenesis of type-2-diabetes. The pathophysiological effects of ectopic fat and the associated metabolic derangements can solve the conflicting findings concerning health consequences of BMI--at least in part. Moreover, these findings may have therapeutic consequences. The reduction of ectopic fat as well as the modification of its metabolic effects - via dietetic, bariatric or pharmaceutic means - opens up the pathway to counteract impaired glucose tolerance early and in a causal way.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ströhle
authors.forename: Nicolai
authors.initials: N
authors.lastname: Worm
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D050154:Adiposity / Q000502:physiology*; D001823:Body Composition; D015992:Body Mass Index; D006801:Humans; D009765:Obesity / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D010809:Physical Fitness