Abstract
Obesity is a global epidemic affecting over a third of the adult population. Within the obese, subgroups have been identified, including the metabolically healthy obese (MHO) and the fit/fat phenotypes. The MHO phenotype was traditionally thought to have lower cardiovascular risk than the ‘typically obese’, a notion that is being challenged by recent data. Similarly, the emerging fit/fat phenotype is raising questions about the impact of obesity on mortality and cardiovascular risk. The present narrative review provides an overview of these phenotypes and summarizes current evidence and viewpoints regarding the same. The review then incorporates this data into a format that can be utilized by clinicians and researchers to aid clinical decision-making.
Highlights
Since 1980, worldwide obesity has more than doubled and continues to increase in prevalence
Having established that the metabolically healthy obese (MHO) was associated with increased allcause mortality and/or CVD risk, Kramer et al [24] further studied the effect of metabolic status across obesity groups by comparing the metabolically unhealthy obese (MUO) and MU-overweight groups with the metabolically unhealthy normal weight (MUNW) group
Regardless of the relative importance of metabolic status or obesity, the Kramer analysis and other data [20,29] demonstrate that the MHO phenotype is far from benign and does confer considerable increased risk for CVD and mortality, albeit possibly less than the risk conferred by the presence of both obesity and metabolic dysfunction
Summary
Since 1980, worldwide obesity has more than doubled and continues to increase in prevalence. According to the Centers for Disease Control and Prevention, in the United States between 2011 and 2012, approximately 3 out of every 5 adults were overweight and more than one-third were obese, which equates to 78.6 million adults [1,2]. In the 1940s, Dr Jean Vague was the first to observe a constellation of risk factors for diabetes mellitus, dyslipidemia and atherosclerosis in obese patients [4]. His “vague” observations led to recognition of metabolic syndrome as a cluster of related conditions conferring increased cardiovascular risk and have since led to many debates regarding its diagnosis, with a consensus definition being achieved only recently (Table 1) [5]
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