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One prominent issue in the obesity field is to gain a greater understanding of the heterogeneity obesity subtypes. Despite the well-known associations of obesity with features of the 'metabolic syndrome' (insulin resistance, dyslipidaemia and hypertension), several investigators have noted that not all obese individuals develop metabolic complications [1,2]. These individuals have been termed metabolically healthy but obese (MHO) [3]. MHO individuals are insulin sensitive, normotensive and have normal lipid profiles, despite having excessive levels of body fat [4]. In fact, MHO metabolic profiles are similar to those of younger lean women [5]. It is presently unclear as to why MHO individuals appear to be 'protected or at least more resistant' to the development of metabolic disturbances associated with obesity. Furthermore, there exist no current criteria in an attempt to identify MHO individuals.Recognition of MHO patients is important because the absence of metabolic complications could modulate prognosis and treatment indications. One criterion to identify MHO persons that has been proposed in the literature has relied exclusively on a measure of insulin sensitivity using the hyperinsulinaemic euglycaemic clamp (glucose disposal greater than 8 mg/kg/fat-free mass) [3]. However, as the 'clamp' technique is time intensive and a method reserved for research purposes, it is important to develop simple clinical tools in order to identify MHO patients. The early identification of MHO individuals would permit epidemiological and pathophysiological studies of this subtype of obesity. Based on our experience, we propose a preliminary set of simple markers to identify the MHO individual based on our clinical studies. These markers should be viewed as preliminary and thus the need for validation in larger data sets will be warranted.We propose metabolic cutpoints based on plasma insulin, triglycerides and homeostasis model assessment (HOMA) (table 1). The proposed choice of these metabolic markers are partially based on the National Cholesterol Education Program's Adult Treatment Panel III report [6] for the metabolic syndrome, for lipid profiles and from the study of Brochu et al.[4] for HOMA. Although arbitrary, we would suggest that when four out of five of the listed metabolic markers are met, a diagnosis of the MHO individual can be made.Preliminary results from an on going study in our laboratory in obese, postmenopausal women have identified four MHO individuals out of a possible 41 patients (10%) that meet the criteria for these metabolic markers. These four MHO women had an average age of 60 AE 6.7, BMI of 34.1 AE 5.0 and percentage body fat of 48.6 AE 6.3. Insulin sensitivity, as determined by HOMA, was the first criterion listed and reflects a high priority for the identification of MHO individuals given the central importance of insulin sensitivity in the metabolic syndrome. We would also suggest that favourable lipid profiles, such as low levels of triglycerides, total and low-density lipoprotein cholestero...

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Aim: The aim of this study was to assess differences in cardiovascular risk and performance of self-care activities in people who rated their diabetes control as good or poor. Methods: A sub-sample of 77 participants who took part in the Evaluation of Diabetes Treatment telephone interview were invited into a clinic to complete a series of laboratory examinations. Self-rated diabetes control was validated using the following laboratory markers: HbA1c, total cholesterol/HDL cholesterol ratio and LDL cholesterol. Differences in blood pressure and BMI were also assessed. Finally, all participants also completed the Summary of Self-Care activities questionnaire. Results: Those people who rated their diabetes control as fair or poor had a significantly higher BMI, HbA1c levels, total cholesterol/HDL-cholesterol ratio and systolic blood pressure. When asked about self-care activities in the past week, those people who reported their diabetes control was fair/poor had spent significantly fewer days following a general diet and exercising. Conclusions: People with poor self-rated diabetes control have unfavourable cardiovascular risk and decreased performance of self-care activities.

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