Abstract
BackgroundDespite the accepted health consequences of obesity, emerging research suggests that a significant segment of adults with obesity are metabolically healthy (MHO). To date, MHO individuals have been shown to have higher levels of physical activity (PA), but little is known about the importance of PA domains or the influence of weight history compared to their metabolically abnormal (MAO) counterpart.ObjectiveTo evaluate the relationship between PA domains, PA guideline adherence, and weight history on MHO.MethodsPooled cycles of the National Health and Nutritional Examination Survey (NHANES) 1999–2006 (≥20 y; BMI ≥ 30 kg/m2; N = 2,753) and harmonized criteria for metabolic syndrome (MetS) were used. Participants were categorized as “inactive” (no reported PA), “somewhat active” (>0 to < 500 metabolic equivalent (MET) min/week), and “active” (PA guideline adherence, ≥ 500 MET min/week) according to each domain of PA (total, recreational, transportation and household). Logistic and multinomial regressions were modelled for MHO and analyses were adjusted for age, sex, education, ethnicity, income, smoking and alcohol intake.ResultsCompared to MAO, MHO participants were younger, had lower BMI, and were more likely to be classified as active according to their total and recreational PA level. Based on total PA levels, individuals who were active had a 70 % greater likelihood of having the MHO phenotype (OR = 1.70, 95 % CI: 1.19–2.43); however, once stratified by age (20–44 y; 45–59 y; and; ≥60 y), the association remained significant only amongst those aged 45–59 y. Although moderate and vigorous PA were inconsistently related to MHO following adjustment for covariates, losing ≥30 kg in the last 10 y and not gaining ≥10 kg since age 25 y were significant predictors of MHO phenotype for all PA domains, even if adherence to the PA guidelines were not met.ConclusionAlthough PA is associated with MHO, the beneficial effects of PA may be moderated by longer-term changes in weight. Longitudinal analysis of physical activity and weight change trajectories are necessary to isolate the contribution of duration of obesity, PA behaviours, and longer-term outcomes amongst MHO individuals.
Highlights
Despite the accepted health consequences of obesity, emerging research suggests that a significant segment of adults with obesity are metabolically healthy (MHO)
metabolically healthy obese” (MHO) individuals were more likely to be younger, women, and non-Hispanic black or Mexican American compared to metabolically abnormal (MAO)
We found the prevalence of past smoking history was lower in MHO, whereas others have reported that smoking status was not related to MHO [6] unless inflammation was included as a component of MAO [8]; research on the relationship between smoking, inflammation, and cardiometabolic risks is inconsistent [23]
Summary
Despite the accepted health consequences of obesity, emerging research suggests that a significant segment of adults with obesity are metabolically healthy (MHO). The increased health risks due to obesity are well documented, for type II diabetes and cardiovascular disease [3, 4]. The metabolic syndrome (MetS), a cluster of cardiometabolic risk factors which includes central obesity, is associated with a five-fold increased risk of type II diabetes, and a twofold greater risk of cardiovascular disease [4, 5]. Using the Harmonized definition of MetS [7] in conjunction with inflammatory markers, Wildman et al [8] report that 29.2 % of obese men and 35.4 % of obese women in the U.S are “metabolically healthy obese” (MHO). Because the prevalence of MHO is dependent on the definition used, estimates of MHO have been reported to be as low as 3.3 %, or as high as 43.3 % [6]
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