Moving to a personalized medicine approach to promote health across the weight spectrum.

Abstract

We disagree with the assertion by Bell et al.1 that '[s]ufficient evidence has amassed to dismiss healthy obesity as a harmless condition, and to instead adopt a default view of healthy obesity as a high risk state for future decline.' A more comprehensive assessment of the literature reveals many unanswered questions regarding the stability of metabolic health among higher body mass index (BMI) individuals.2 Although some metabolically healthy obese (MHO) individuals see metabolic decline, existing data are insufficient to claim this as inevitable. Indeed, the evidence offered by Bell et al.1 underscores this point. For example, a meta-analysis they reference actually shows considerable variability in the association between MHO and Type II diabetes risk. This is unsurprising given the underpowered nature of this meta-analysis, which documented only 98 incident cases of diabetes in MHO individuals across all studies.3 Likewise, the development of metabolic risk among MHO individuals is either no different from healthy 'normal' weight individuals (in the case of cholesterol and triglycerides) or is inconsistent across time points (in the case of glucose and hypertension).4 Contending 'sufficient evidence' is unwarranted.