Metabolically healthy and unhealthy obese – the 2013 Stock Conference report

Abstract

Summary Obesity is closely associated with cardiovascular diseases and type 2 diabetes, but some obese individuals, despite having excessive body fat, exhibit metabolic health that is comparable with that of lean individuals. The ‘healthy obese’ phenotype was described in the 1980s, but major advancements in its characterization were only made in the past five years. During this time, several new mechanisms that may be involved in health preservation in obesity were proposed through the use of transgenic animal models, use of sophisticated imaging techniques and in vivo measurements of insulin sensitivity. However, the main obstacle in advancing our understanding of the metabolically healthy obese phenotype and its related long-term health risks is the lack of a standardized definition. Here, we summarize the proceedings of the 13th Stock Conference of the International Association of the Study of Obesity. We describe the current research and highlight the unanswered questions and gaps in the field. Better understanding of metabolic health in obesity will assist in therapeutic decision-making and help identify therapeutic targets to improve metabolic health in obesity.

Epicardial fat thickness as a tool for predicting complicated obesity

“…Результаты многочисленных исследований пока-зали, что висцеральный жир представляет собой гормо-нально активную ткань, продуцирующую большое количество биологически активных веществ -адипо-кинов, участвующих в развитии метаболических нару-шений, процессах воспаления и фиброза, тромбообра-зования и атерогенеза [6,7], а выраженность ВЖТ и сте-пень ее дисфункции являются ключевым фактором, определяющим характер фенотипа ожирения: ослож-ненное ("метаболически нездоровое") или неослож-ненное ("метаболически здоровое") ожирение [8].…”

Obesity phenotypes: normal-weight individuals with metabolic disorders versus metabolically healthy obese

“…[1,6,7,36]. Moreover, Samocha-Bonet et al suggest that 30% of MHO people may be transitioned to the metabolically unhealthy obese group, while others propose as many as 50% [8]. Thus, longitudinal studies seem to be crucial to evaluate the possibility of developing metabolic complications typical of obesity [32].…”

“…The metabolically healthy obese subgroup was first featured in 1982 and represents 10-30% of the whole group of obese; however, until now there has been no standardised definition of this phenotype [6,8,35]. According to BMI classification, individuals belonging to this subgroup are obese, with BMI over 30 kg/m 2 , but they do not have metabolic abnormalities.…”

“…Furthermore, treatment of obesity and obesity-related complications generates high costs. Thus, the aim of medicine nowadays is to identify those who are at risk of developing obesity and metabolic disorders, and to try to prevent secondary clinical complications [6][7][8].…”

The color of fat and its central role in the development and progression of metabolic diseases

“…They studied the effect of 8 weeks of excess energy and lipid intake on adipocyte size and expansion in young healthy men: lean subjects with smaller adipocytes responded with a rapidly and not protective adipocyte remodelling, and despite expansion of subcutaneous fat they developed insulin resistance and released more inflammatory markers while subjects with larger subcutaneous adipocytes had less insulin resistance and visceral fat accumulation, maybe due to reduced expandability of these cells [31]. It is likely that other factors are involved, possibly a genetic predisposition to type 2 diabetes or in general to ectopic fat deposition [3], [35], [37], [38].…”