Epidemiology and Population Health

Long-term metabolic risk for the metabolically healthy overweight/obese phenotype



The clinical relevance of the metabolically healthy overweight/obese (MHO) phenotype is controversial and the relationships between weight change and the development of cardiometabolic risk factors is unknown. Therefore, we aim to: (1) Assess the long-term risk of developing one or more components of the metabolic syndrome in MHO adults compared with metabolically healthy normal weight (MHNW); (2) Evaluate risk of a composite of death, cardiovascular disease (CVD), and risk of developing type 2 diabetes between adults defined according to baseline body mass index and metabolic health.


Retrospective cohort study of adults 18–65 years of age seen at our institution between 1998 and 2000 who lived in Olmsted County. Metabolically healthy was defined as the absence of all components of the metabolic syndrome (except for waist circumference). Main outcome was the development of metabolic risk factors. The secondary outcome was a composite of mortality, CVD and heart failure.


Of the 18 070 individuals with complete data at baseline, 1805 (10%) were MHO (mean age 38±11 years) and 3047 were MHNW (mean age 35±11 years). After a median follow-up of 15 years, interquartile range 10–17, 80% of MHO vs 68% of MHNW developed at least one cardiometabolic risk factor (P<0.001). In multivariate analysis, MHO individuals who gained 10% of their body weight were more likely to have developed metabolic complications compared to MHO individuals that did not gain weight (P=0.001 for 10–15%, P<0.001 for >15% weight gain). The risk for the secondary composite end point was similar between MHO and MHNW, number of events 218/1805 vs 217/3048 for MHO and MHNW, respectively, (hazard ratio: 1.16, 95% confidence interval: 0.96–1.40).


MHO are more likely to develop metabolic complications than MHNW, especially if they gain weight.

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We would like to thank Dr Arlene Calvo and Morgan Hess-Holtz from the University of South Florida Health Panama for their help with cumulative incidence analysis. This manuscript was supported by CTSA Grant Number TL1 TR000137 from the National Center for Advancing Translational Science (NCATS), grant DK050456 from the US Public Health Service and the Mayo Foundation.


Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Correspondence to M D Jensen.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Espinosa De Ycaza, A., Donegan, D. & Jensen, M. Long-term metabolic risk for the metabolically healthy overweight/obese phenotype. Int J Obes 42, 302–309 (2018). https://doi.org/10.1038/ijo.2017.233

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