title: Healthy obesity and objective physical activity.
abstract: BACKGROUND
  Disease risk is lower in metabolically healthy obese adults than in their unhealthy obese counterparts. Studies considering physical activity as a modifiable determinant of healthy obesity have relied on self-reported measures, which are prone to inaccuracies and do not capture all movements that contribute to health.
  
  
  OBJECTIVE
  We aimed to examine differences in total and moderate-to-vigorous physical activity between healthy and unhealthy obese groups by using both self-report and wrist-worn accelerometer assessments.
  
  
  METHODS
  Cross-sectional analyses were based on 3457 adults aged 60-82 y (77% male) participating in the British Whitehall II cohort study in 2012-2013. Normal-weight, overweight, and obese adults were considered "healthy" if they had <2 of the following risk factors: low HDL cholesterol, hypertension, high blood glucose, high triacylglycerol, and insulin resistance. Differences across groups in total physical activity, based on questionnaire and wrist-worn triaxial accelerometer assessments (GENEActiv), were examined by using linear regression. The likelihood of meeting 2010 World Health Organization recommendations for moderate-to-vigorous activity (≥2.5 h/wk) was compared by using prevalence ratios.
  
  
  RESULTS
  Of 3457 adults, 616 were obese [body mass index (in kg/m²) ≥30]; 161 (26%) of those were healthy obese. Obese adults were less physically active than were normal-weight adults, regardless of metabolic health status or method of physical activity assessment. Healthy obese adults had higher total physical activity than did unhealthy obese adults only when assessed by accelerometer (P = 0.002). Healthy obese adults were less likely to meet recommendations for moderate-to-vigorous physical activity than were healthy normal-weight adults based on accelerometer assessment (prevalence ratio: 0.59; 95% CI: 0.43, 0.79) but were not more likely to meet these recommendations than were unhealthy obese adults (prevalence ratio: 1.26; 95% CI: 0.89, 1.80).
  
  
  CONCLUSIONS
  Higher total physical activity in healthy than in unhealthy obese adults is evident only when measured objectively, which suggests that physical activity has a greater role in promoting health among obese populations than previously thought.
authors.affiliation: Department of Epidemiology & Public Health, University College London, London, United Kingdom; joshua.bell.11@ucl.ac.uk.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Bell
authors.affiliation: Department of Epidemiology & Public Health, University College London, London, United Kingdom; National Centre for Sport & Exercise Medicine, Loughborough University, Leicestershire, United Kingdom;
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.affiliation: MoveLab-Physical Activity and Exercise Research, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom;
authors.forename: Vincent T
authors.initials: VT
authors.lastname: van Hees
authors.affiliation: Department of Epidemiology & Public Health, University College London, London, United Kingdom; INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France; and University Versailles St-Quentin, Boulogne-Billancourt, France.
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.affiliation: Department of Epidemiology & Public Health, University College London, London, United Kingdom;
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: Department of Epidemiology & Public Health, University College London, London, United Kingdom; University Versailles St-Quentin, Boulogne-Billancourt, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Sabia
mesh_terms: D061725:Accelerometry; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D044882:Glucose Metabolism Disorders / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D006946:Hyperinsulinism / Q000453:epidemiology / Q000517:prevention & control*; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D018673:Nutrition Policy; D009765:Obesity / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism; D050177:Overweight / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism; D010349:Patient Compliance; D012307:Risk Factors; D057566:Self Report; D006113:United Kingdom / Q000453:epidemiology
keywords: epidemiology; metabolic health; metabolic risk factor clustering; obesity; physical activity