Metabolically healthy obesity does not guarantee clean bill of health

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The Endocrine Society
Metabolically healthy obesity does not guarantee clean bill of health High BMI linked to increased risk of diabetes, cardiovascular disease Chevy Chase, MD—Obese people who are currently metabolically healthy face a higher risk of developing diabetes and cardiovascular disease, according to new research accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Research has found conflicting evidence about whether it is possible for some obese people to avoid health complications that increase the risk of metabolic diseases. These complications can include high blood pressure, high blood sugar, insulin resistance and low levels of high-density lipoproteins, the "good" form of cholesterol that reduces heart disease risk. Past studies have found as many as 30 percent of obese people may be metabolically healthy.

"Unfortunately, our findings suggest metabolically healthy obesity is not a benign condition," said the study's corresponding author, Carlos Lorenzo, MD, of the University of Texas Health Science Center at San Antonio, Texas. "Regardless of their current metabolic health, people who are obese face an increased risk of developing cardiovascular disease and diabetes in the future."

Researchers analyzed prospective data from the San Antonio Heart Study, a population-based study of Mexican Americans and Caucasians, to assess incidence of diabetes in 2,814 participants and cardiovascular disease incidence in 3,700 participants. The SAHS study followed up with participants for a period lasting between six and 10 years. The analysis examined whether the risk of developing diabetes or heart disease was different for normal weight people who had at least two metabolic conditions or metabolically healthy obese people.

To determine metabolic health, researchers examined whether subjects had elevated blood pressure, elevated triglyceride and blood sugar levels, insulin resistance and decreased HDL cholesterol. People who had none or only one of the characteristics were classified as metabolically healthy.

The analysis found that increased body mass index was linked to an elevated risk of developing diabetes. Normal weight people who had multiple metabolic abnormalities also faced an increased risk of developing diabetes. Both groups faced an elevated risk of cardiovascular disease after taking into account demographics and smoking behavior.

"Our data demonstrate the importance of continuing to monitor for diabetes and cardiovascular disease in both people with metabolically healthy obesity and those who have metabolically abnormalities despite being a normal weight," Lorenzo said. "If physicians and patients are too complacent about assessing risk, we can miss important opportunities to prevent the development of chronic and even deadly conditions."

### Other authors of the study include: K. Aung, M.A. Hinojosa and S.M. Haffner of the University of Texas Health Science Center.

The study was supported by the National Institutes of Health's National Heart, Lung and Blood Institute.

The study, "Risk of Developing Diabetes and Cardiovascular Disease in Metabolically Unhealthy Normal Weight and Metabolically Healthy Obese Individuals," was published online, ahead of print.

Founded in 1916, The Endocrine Society is the world's oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 16,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at https://twitter.com/#!/EndoMedia.