The World Health Organisation defines obesity as ‘abnormal fat accumulation that presents a health risk’. But many people can have obesity and yet, be healthy, without any metabolic health issues. The condition is called metabolically healthy obesity or MHO. However, that does not mean they’re safe. Experts say they are at higher risk of developing further health complications if there is no proper and timely intervention.
What is metabolically healthy obesity?
In an email interaction with Happiest Health, Dr Ivania Rizo, director of obesity medicine, Boston Medical Center, points out that ‘metabolically healthy’, in the context of MHO, refers to the absence of metabolic abnormalities, like insulin resistance, high blood pressure and dyslipidemia (unhealthy levels of lipids), associated with obesity.
Dr Nitin Kapoor, professor and head, department of endocrinology, diabetes and metabolism, Christian Medical College, Vellore, adds that MHO is used to describe individuals who may have a high body mass index (in the range of obesity – BMI>/= 25 Kg/m2 in the Indian setting) but at that point, don’t have any metabolic complications associated with obesity. However, he adds, most recent literature suggests that this phenotype is just a stage in transition. “MHO is considered as just the preceding stage of metabolically unhealthy obesity, possibly a window of opportunity to intervene and prevent the development of further complications.”
Can you be metabolically healthy and obese?
Dr Rizo says body mass index (BMI), calculated by dividing a person’s weight in kilograms by the square of their height in meters, is frequently used as a screening tool to classify obesity. “However, BMI does not provide a complete picture of an individual’s health status. Some individuals with obesity may have normal metabolic profiles and a lower risk of developing obesity-related complications compared to others with the same BMI,” she says.
MHO is quite opposite to the common phenotype that we see in the Indian setting called normal weight obesity (NWO), says Dr Kapoor. In a cohort study in Kerala, co-authored by him, the prevalence of NWO was found to be close to 30 per cent. These are individuals who have a normal BMI (don’t have obesity by BMI but have high body fat percentage) but often have metabolic complications like diabetes, hypertension and dyslipidaemia.
Causes of metabolically healthy obesity
Dr Rizo says the exact cause of MHO is not fully understood and there is ongoing research on it. But Dr Kapoor says the same factors that cause obesity, like underlying genetic play, poor dietary practices and limited physical activity, are responsible for MHO as well.
However, Dr Rizo says there appears to be some biological mechanisms underlying MHO including the importance of fat distribution. “MHO individuals have lower amounts of ectopic fat (visceral fat and fat in the liver), high leg fat deposition and an increased ability of the subcutaneous fat tissue to expand. MHO individuals have preserved insulin sensitivity and beta-cell function,” she says.
Obesity is a chronic relapsing and progressive disease. Dr Rizo, also a member of the Obesity Society, adds that according to a multi-ethnic study of atherosclerosis (MESA), almost 50 per cent of participants who were defined as MHO at baseline, developed metabolic abnormalities during the approximately 12-year follow-up. “Another meta-analysis of 12 studies noted that over a 10-year period, over half of the people identified as MHO developed at least one metabolic abnormality,” she says. She points out that timely treatment is important because people with MHO have an increased risk of developing cardio-metabolic diseases in comparison to metabolically healthy lean people.
What are the metabolic complications of obesity?
People with MHO have a higher risk of developing the following conditions over time:
- Type 2 diabetes
- Cardiovascular diseases
- High blood pressure
- Cholesterol
- Non-alcoholic fatty liver disease
- Osteoarthritis of the knee
- Plantar fasciitis (inflammation of the fibrous tissue in the foot)
- Obstructive sleep apnea
In Dr Kapoor’s opinion, metabolically healthy obesity is not healthy. He says that metabolic problems are just one of the components of obesity-related complications. Obesity is also associated with mobility issues and has psychological consequences. “The mechanical impact of weight can significantly affect the quality of life of a person living with obesity and need not occur along with metabolic disorders. Similarly, the stigma and psychological impact of obesity is independent of metabolic problems and is associated with more propensity for weight gain,” he says.
Management and prevention
Experts say the golden mantra for preventing further complications is to follow healthy lifestyle practices. These are mentioned in the recently published Endocrine Society of India guidelines too, says Dr Kapoor.
- Restrict calorie intake and ensure portion control.
- Take the recommended amount of protein.
- Eat on time.
- Avoid fat-rich foods.
- Regular exercises, at least 150 minutes of moderate-intensity aerobic activity and strength training
- Stress management
- Getting sufficient sleep
- Avoiding smoking and limiting alcohol consumption
- Consult your physicians/endocrinologist for their advice on how to manage it further.
“Obesity is a chronic relapsing and progressive disease, and it is important to discuss all available evidence-based interventions to decrease health risks,” says Dr Rizo.
Takeaways
- Metabolically healthy obesity or MHO refers to the absence of metabolic abnormalities, like insulin resistance, high blood pressure and dyslipidemia, associated with obesity.
- People with MHO are at higher risk of developing further obesity-related health complications like diabetes, cardiac issues and cholesterol if they don’t address the issue in time.
- Underlying genetic play, poor dietary practices and limited physical activity may be responsible for MHO.
- The only measure to prevent further complications of obesity is to follow healthy lifestyle practices.
One Response
Very informative