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Metabolically normal obesity: a misnomer?

International Journal of Obesity volume 36, page 164 (2012)Cite this article

In two recent articles in the International Journal of Obesity, Pataky et al.1, 2 have considered the question of how to effectively define those persons who are obese, but who do not have the metabolic disturbances commonly associated with obesity: the ‘metabolically normal obese’. Although there is no doubt interest in investigating which persons are more or less susceptible to the development of the various components of the metabolic syndrome, the concept of a ‘metabolically normal’ obese person implicitly assumes that there exists a form of obesity for which there is no additional metabolic risk … ever. It is true that there will be some individuals who are obese but who never develop the metabolic syndrome, or its serious consequences of diabetes, cardiovascular disease and premature mortality. Yet, this group is in the extreme minority, and the most recent compelling research from Sweden shows that among those men who were obese but did not meet the criteria for the metabolic syndrome, the risk for cardiovascular disease over the next 30 years was in fact doubled.3 Among those who were only overweight and did not meet the metabolic syndrome criteria, cardiovascular disease risk was 50% greater. This finding effectively suggests that although there are some obese people who do not have a phenotype that meets the criteria for diagnosis of the metabolic syndrome, it would be foolish to describe them as metabolically normal. The natural history of the metabolic syndrome is typified by obesity that precedes rather than coincides with the development of the associated abnormalities.4 Most obese people do go on to develop the hallmarks of the metabolic syndrome—it is simply a question of when. Although it may be true that obese or overweight individuals without additional risk factors for metabolic disease should be treated slightly differently in a clinical setting, actually defining metabolic normality among those who are obese appears to have little merit. From a public health perspective, popularizing and validating terms such as ‘metabolically normal obesity’ not only brings with it the danger of misrepresenting the scientific evidence, but also introduces a term that can be very easily misinterpreted. The risks of obesity are serious, often under-estimated and not restricted to metabolic disturbances. Obesity without the metabolic syndrome is a major risk factor in its own right and needs to be recognized as such.5

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References

  1. Pataky Z, Bobbioni-Harsch E, Golay A . Open questions about metabolically normal obesity. Int J Obes (Lond) 2010; 34 (Suppl 2): S18–S23.

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  1. Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia

    A J Cameron

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  1. A J Cameron
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Correspondence to A J Cameron.

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Cameron, A. Metabolically normal obesity: a misnomer?. Int J Obes 36, 164 (2012). https://doi.org/10.1038/ijo.2011.57

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