Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology and population health

Fate of the metabolically healthy obese—is this term a misnomer? A study from the Clinical Practice Research Datalink




The metabolically healthy obese (MHO) phenotype may express typical characteristics on long-term follow-up. Little is known about the initiation of this phenotypes and its future stability.


The Clinical Practice Research Datalink (CPRD) is a large-scale primary care database. The aim of this study was to assess the stability of, and evaluate the factors associated with a transition into an unhealthy outcome in, a MHO population in the UK.


The CPRD was interrogated for a diagnosis of ‘obesity’ and cross-referenced with a body mass index (BMI) ≥35 kg/m2; participants were further classified as MH using a clinical diagnostic code or a relative therapeutic code. A hazard cox regression univariate and multivariate analysis evaluated the time to transition for independent variables.


There were 231,399 patients with a recorded BMI of 35 kg/m2 or greater. Incomplete records were eliminated and follow-up limited to 300 months, the cohort was reduced to 180,560 patients. The prevalence of MHO within the obese population from the CPRD was 128,191/180,560 (71%). MHO individuals, who were of male gender (hazard ratio (HR) 1.23 (1.21–1.25), p = < 0.01), older age group (HR 3.93 (3.82–4.04), p = < 0.01), BMI of 50–60 kg/m2 at baseline (HR 1.32(1.26–1.38), p = 0.01), smokers (HR 1.07(1.05–1.09), p = < 0.01) and regionally from North West England (HR 1.15(1.09–1.21), p = < 0.01) were more prone to an unhealthy transition (to develop comorbidities). Overall, of those MH at baseline, 71,485/128,191(55.8%) remained healthy on follow-up, with a mean follow-up of 113.5 (standard deviations (SD) 78.6) months or 9.4 (SD 6.6) years.


From this unique large data set, there is a greater prevalence of MHO individuals in the UK population than in published literature elsewhere. Female gender, younger age group, and lower initial weight and BMI were found to be significant predictors of sustained metabolic health in this cohort. However, there remains a steady progressive transition from a healthy baseline over the years.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others


  1. World Health Organisation. Obesity and overweight. WHO factsheet 2018; Viewed 12 October 2017.

  2. Phillips CM. Metabolically healthy obesity across the life course: epidemiology, determinants, and implications. Ann N Y Acad Sci. 2016:85–100.

    Article  Google Scholar 

  3. Bluher M. Are there still healthy obese patients? Curr Opin Endocrinol Diabetes Obes. 2012;19:341–6.

    Article  Google Scholar 

  4. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 91 million participants. Lancet. 2011;377:557–67.

    Article  Google Scholar 

  5. Wildman RP, Muntner P, Reynolds K, Mcginn AP. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering. Arch Intern Med. 2013;168:1617–24.

    Article  Google Scholar 

  6. Phillips CM. Metabolically healthy obesity: definitions, determinants and clinical implications. Rev Endocr Metab Disord. 2013;14:219–27.

    Article  CAS  Google Scholar 

  7. Ogorodnikova A, Kim M, McGinn A, Muntner P, Khan U, Wildman R, et al. Incident cardiovascular disease events in metabolically benign obese individuals. Obesity. 2012;20:651–9.

    Article  Google Scholar 

  8. Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012;97:2482–8.

    Article  CAS  Google Scholar 

  9. Bell JA, Kivimaki M, Hamer M. Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies. Obes Rev. 2014;15:504–15.

    Article  CAS  Google Scholar 

  10. Dalzill C, Nigam A, Juneau M, Guilbeault V, Latour E, Mauriège P, et al. Intensive lifestyle intervention improves cardiometabolic and exercise parameters in metabolically healthy obese and metabolically unhealthy obese individuals. Can J Cardiol. 2014;30:434–40.

    Article  Google Scholar 

  11. Alam I, Ng TP, Larbi A. Does inflammation determine whether obesity is metabolically healthy or unhealthy? The aging perspective. Mediat Inflamm. 2012;2012:456456.

    Article  Google Scholar 

  12. Aguilar-Salinas CA, García E, Robles L, Riaño D, Ruiz-Gomez DG, García-Ulloa AC, et al. High adiponectin concentrations are associated with the metabolically healthy obese phenotype. J Clin Endocrinol Metab. 2008;93:4075–9.

    Article  CAS  Google Scholar 

  13. Meigs JB, Wilson PWF, Fox CS, Vasan RS, Nathan DM, Sullivan LM, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006;91:2906–12.

    Article  CAS  Google Scholar 

  14. Lynch L, O’Connell JM, Kwasnik AK, Cawood TJ, O’Farrelly C, O’Shea DB. Are natural killer cells protecting the metabolically healthy obese patient? Obesity. 2009;17:601–5.

    Article  CAS  Google Scholar 

  15. Williams T, van Staa T, Puri S, Eaton S. Recent advances in the utility and use of the General Practice Research Database as an example of a UK Primary Care Data resource. Ther Adv Drug Saf. 2012;3:89–99.

    Article  Google Scholar 

  16. Herrett E, Thomas SL, Schoonen WM, Smeeth L, Hall AJ. Validation and validity of diagnoses in the General Practice Research Database: A systematic review. Br J Clin Pharmacol. 2010;69:4–14.

    Article  CAS  Google Scholar 

  17. Howell J. The General Practice Research Database: quality of morbidity data. Popul Trends. 1997;87:36–40.

  18. Donegan K, Fox N, Black N, Livingston G, Banerjee S, Burns A. Trends in diagnosis and treatment for people with dementia in the UK from 2005 to 2015: a longitudinal retrospective cohort study. Lancet. 2017;2:e149–56.

    PubMed  Google Scholar 

  19. Pascoe SW, Neal RD, Heywood PL, Allgar VL, Miles JN, Stefoski-Mikeljevic J. Identifying patients with a cancer diagnosis using general practice medical records and Cancer Registry data. Fam Pract. 2008;25:215–20.

    Article  Google Scholar 

  20. Bhaskaran K, Douglas I, Forbes H, Dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: A population-based cohort study of 5·24 million UK adults. Lancet. 2014;384:755–65.

    Article  Google Scholar 

  21. Nazareth I, King M, Haines A, Rangel L, Myers S. Accuracy of diagnosis of psychosis on general practice computer system. BMJ . 1993;307:32–4.

    Article  CAS  Google Scholar 

  22. Khan NF, Harrison SE, Rose PW. Validity of diagnostic coding within the General Practice Research Database: a systematic review. Br J Gen Pract. 2010;60:199–206.

    Article  Google Scholar 

  23. Mathur R, Bhaskaran K, Chaturvedi N, Leon DA, Van Staa T, Grundy E, et al. Completeness and usability of ethnicity data in UK-based primary care and hospital databases. J Public Health. 2014;36:684–92.

    Article  Google Scholar 

  24. Ogorodnikova AD, Kim M, McGinn AP, Muntner P, Khan U, Wildman RP. Incident cardiovascular disease events in metabolically benign obese individuals. Obesity. 2012;20:651–9.

    Article  Google Scholar 

  25. Achilike I, Hazuda HP, Fowler SP, Lorenzo C, Antonio S. HHS public access. Int J Obes. 2015;39:228–34.

    Article  CAS  Google Scholar 

  26. Hwang Y-C, Hayashi T, Fujimoto WY, Kahn SE, Leonetti DL, McNeely MJ, Boyko EJ. Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype. Int J Obes. 2016;19:69–77.

    Google Scholar 

  27. Soriguer F, Gutiérrez-Repiso C, Rubio-Martín E, García-Fuentes E, Almaraz MC, Colomo N, et al. Metabolically healthy but obese, a matter of time? Findings from the prospective pizarra study. J Clin Endocrinol Metab. 2013;98:2318–25.

    Article  CAS  Google Scholar 

  28. Justicia J, Rosales A, Bañuel E, Oller-López JL, Valdivia M, Haïdour A, et al. Natural course of metabolically healthy overweight/obese subjects and the impact of weight change. J Clin Nurs. 2016;8:1–12.

    Google Scholar 

  29. Lassale C, Tzoulaki I, Moons KGM, Sweeting M, Boer J, Johnson L, et al. Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. Eur Heart J. 2018;39:397–406.

    Article  Google Scholar 

  30. Campbell J, Dedman DJ, Eaton SC, Gallagher AMWT. Is the CPRD GOLD population comparable to the UK population? Pharmacoepidemiol Drug Saf. 2013;22:280–1.

    Google Scholar 

  31. Herrett EL, Thomas SL, Smeeth L. Validity of diagnoses in the general practice research database. Br J Gen Pr. 2011;61:438–9.

    Google Scholar 

  32. Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, Staa Tvan, et al. Data resource profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol. 2015;44:827–36.

    Article  Google Scholar 

Download references


The authors have read the journal’s guidelines on finances and have no conflicts of interest to disclose. Word count: 3,172

Author information

Authors and Affiliations


Corresponding author

Correspondence to Osama Moussa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moussa, O., Arhi, C., Ziprin, P. et al. Fate of the metabolically healthy obese—is this term a misnomer? A study from the Clinical Practice Research Datalink. Int J Obes 43, 1093–1101 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links