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‘Healthy obesity’ not a harmless condition, study suggests

By Staff Writer
Obese women in good metabolic health may still face a higher chance of developing CVD in the future, compared with women who are in a normal weight range, according to a recent German study.

The study showed that obesity was a risk factor for CVD regardless of whether women developed metabolic diseases such as hypertension or type 2 diabetes.

Using data from the US Nurses’ Health Study, researchers looked at the association between obesity and CVD incidence in more than 90,000 women aged 30 to 55 years, followed up between 1980 and 2010.

The women were free from CVD at the start of the study period and metabolic health was defined as the absence of diabetes, hypertension and hypercholesterolaemia.

Metabolically unhealthy women of a normal weight had 2.4 times the risk of CVD compared with normal weight women with no metabolic issues, whereas those with ‘healthy obesity’ faced a 39% higher risk.

However, most healthy women were likely to become metabolically unhealthy over time, no matter what their BMI, according to the study, published in The Lancet Diabetes & Endocrinology.

Endocrinologist Professor Lesley Campbell of the Garvan Institute of Medical Research, Sydney, told Endocrinology Today that although the researchers reached sound conclusions, their methodology was flawed.

In particular, she said using hypercholesterolaemia as one of the markers of being metabolically unhealthy was less accurate, as this was a separate genetic disorder and not a sign of metabolic health.

Self-reported information such as BMI was also not very reliable and the findings showed that many of the outcomes appeared to be the result of ageing.

‘Their conclusion is not off, but they’re just not testing it in the most scientific way. However, they have the benefit of very big numbers and long follow up,’ Professor Campbell said.

‘Weight is highly heritable and metabolic syndrome is too, so people should not attack those afflicted about it, but rather encourage them to follow a healthy lifestyle long term, getting more physical activity and eating reasonably.’

The authors of an accompanying editorial said while the study did provide interesting insights into weight and CVD prognosis, it did not take activity levels or cardiorespiratory fitness into account, yet this was one of the strongest predictors of CVD.
Lancet Diabetes Endocrinol 2018; http://dx.doi.org/10.1016/S2213-8587(18)30137-2.
Lancet Diabetes Endocrinol 2018; http://dx.doi.org/10.1016/S2213-8587(18)30143-8.