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  • Letter to the Editor
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Response to ‘Metabolically normal obesity’ a misnomer?

International Journal of Obesity volume 36, page 165 (2012)Cite this article

In his letter to the editor, Dr Cameron claims that metabolic normality in obese subjects implicitly means a permanent state.1 Like any definition of normality, ‘metabolic normality’ in obese subjects does not represent a persistent condition. As an example, a normal glucose tolerance in an obese (or even normal-body-weight) subject does not mean that this person will remain normal forever. In addition, as clearly indicated by our2 and other studies,3 metabolically normal obese represent an intermediate condition between healthy normal-body-weight and at-risk obese individuals. In fact, although remaining within a normal range, metabolically normal obese subjects show increased values of blood pressure, heart rate, intima–media thickness, lipid profile, as well as insulin resistance compared with normal-body-weight controls.

Data from the literature clearly indicate that, for the majority of the obese subjects, the metabolic normality is just a matter of time. We think, however, that this is a further reason to define the limits of normality, in order to decide when it is necessary to apply more aggressive preventive and/or therapeutic strategies. In fact, the management of uncomplicated obesity should definitely be different from the one of subjects who are already at risk. For instance, the normality of the cardio-metabolic profile of these subjects does not justify any pharmacological treatment. Furthermore, the beneficial effect of weight reduction, reported in a single study,4 should be confirmed by larger investigations. On the other hand, data from the literature5 and from our own experience6 indicate that further increase in body weight and some lifestyle parameters influence the appearance of risk factors in metabolically normal obese subjects. We may, therefore, expect that prevention of weight increase and lifestyle interventions could delay or even prevent the evolution from uncomplicated obesity to its co-morbidities. Dr Cameron suggests that ‘obesity without metabolic syndrome is a major risk in its own right’. In our opinion, this is an excellent reason to closely investigate the subpopulation of ‘metabolically normal’ obese, in order to elucidate the potential contribution of other risk factors that could underlie the increased incidence of morbidity, in spite of the absence of metabolic syndrome.

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References

  1. Cameron AJ . ‘Metabolically normal obesity’ a misnomer? Int J Obes (Lond) 2011 (in issue).

  2. Pataky Z, Makoundou V, Nilsson P, Gabriel RS, Lalic K, Muscelli E et al. Metabolic normality in overweight and obese subjects. Which parameters? Which risks? Int J Obes (Lond) 2011; doi:10.1038/ijo.2010.264.

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  6. Pataky Z, Bobbioni-Harsch E, Makoundou V, Golay A . How long metabolically normal obese remain normal? Obes Rev 2010; 11 (Suppl 1): 53.

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Authors and Affiliations

  1. Department of Community Medicine, Service of Therapeutic Education for Chronic Diseases, WHO Collaborating Centre, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland

    Z Pataky, E Bobbioni-Harsch & A Golay

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  1. Z Pataky
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  2. E Bobbioni-Harsch
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  3. A Golay
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Correspondence to Z Pataky.

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Pataky, Z., Bobbioni-Harsch, E. & Golay, A. Response to ‘Metabolically normal obesity’ a misnomer?. Int J Obes 36, 165 (2012). https://doi.org/10.1038/ijo.2011.63

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