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Clinical Research

Do lifestyle factors and quality of life differ in people with metabolically healthy and unhealthy obesity?

Abstract

Background and objectives

Although obesity is typically associated with metabolic co-morbidities, some people with obesity do not develop metabolic abnormalities. We evaluated whether modifiable lifestyle factors (i.e., physical activity, dietary composition, and sleep characteristics) can help explain why some people with obesity are metabolically healthy (MHO) and whether metabolically unhealthy obesity (MUO) affects quality of life (QOL).

Subjects/methods

Physical activity and sleep characteristics were assessed by using tri-axial accelerometers and dietary intake, sleep quality, and QOL were evaluated by using validated questionnaires in people stratified into three groups: (1) lean with normal glucose tolerance, plasma triglyceride (TG) concentration and intrahepatic TG (IHTG) content (metabolically healthy lean [MHL]; n = 20); (2) obesity and normal glucose tolerance, plasma TG concentration and IHTG content (MHO; n = 36); and (3) obesity with abnormal glucose metabolism and hepatic steatosis (MUO; n = 43).

Results

People with MHO performed ~45-min more light-intensity physical activity/day than the MHL and MUO groups (P < 0.05). QOL, particularly the physical function domain, was higher in the MHO than the MUO group (P < 0.05). Although self-reported intake of starch, dairy, and cured meats were higher in the MUO than the MHO group (P < 0.02), the absolute differences were small and unlikely to have metabolic effects. No differences were found in sleep duration or quality between groups.

Conclusions

These data suggest physical activity, but not sleep or dietary intake, contribute to better metabolic health in people with MHO than those with MUO, and that QOL is lower in people with MUO than those with MHO.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the staff of the Center for Human Nutrition at Washington University School of Medicine and the Clinical and Translational Research Unit for assistance in conducting the metabolic studies and their technical assistance in processing the study samples, and the study participants for their participation.

Funding

This study was supported by NIH grants P30 DK056341 (Washington University Nutrition and Obesity Research Center), P30 DK020579 (Washington University Diabetes Research Center), UL1 TR000448 (Washington University Institute of Clinical and Translational Sciences), including sub-award KL2 TR002346, and the Barnes-Jewish Hospital Foundation.

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Contributions

GIS and SK designed the study. SSF, GIS, and GGS conducted the clinical studies. SSF, GIS, GGS, RIS, and SK analyzed the data and SSF, GIS, and SK wrote the paper. All authors critically reviewed and edited the paper.

Corresponding author

Correspondence to Samuel Klein.

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Competing interests

SK serves as a scientific consultant for Janssen and Altimmune, and has a sponsored research agreement with Janssen.

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Farabi, S.S., Smith, G.I., Schweitzer, G.G. et al. Do lifestyle factors and quality of life differ in people with metabolically healthy and unhealthy obesity?. Int J Obes 46, 1778–1785 (2022). https://doi.org/10.1038/s41366-022-01180-6

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