Abstract
Obesity represents an important independent risk factor for cardiovascular and metabolic diseases and is thus associated with increased cardiovascular and overall mortality. However, not all obesities are associated with cardio-metabolic health complications.
A subgroup of obese patients who are protected from cardiovascular and metabolic risks and exhibit favorable cardiometabolic profile in spite of excessive body fatness is denoted as metabolically healthy obesity (MHO). It is defined by absence of components of the metabolic syndrome or by preservation of appropriate insulin sensitivity usually measured by the homeostasis model of insulin resistance (HOMA-IR).
Conflicting results have been reported with regard to the long-term stability of this phenotype and the development of cardiometabolic complications as type 2 diabetes and hypertension. The observed discrepancies may partly be due to too moderate criteria used as well as to inability of the most MHO definitions to reveal hidden metabolic risks.
It is expected that application of more strict criteria in the current MHO definitions and addition of new criteria reflecting insulin resistance, fatty liver and chronic inflammation may characterize individuals with a more stable phenotype of MHO. However, it should be kept in mind that the metabolic health across BMI categories is frequently a transient phenotype influenced by interaction of genotype, ethnicity, gender and ageing with environmental and lifestyle changes.