New research supports the intuitive observation that many persons classified as obese are healthy, and should not be treated and categorized medically as diseased. There is increasing agreement that major blood biomarkers are often not discriminatory, as for example, the return to normal blood glucose levels in bariatric patients who do not have long-term benefits. Although weight loss is appreciated to improve metabolic and inflammatory parameters, the cellular and immune factors that couple obesity to cardiometabolic risk are only partially understood.
Reduced BMI upon successful bariatric surgery does not always result in reduced pericardial fat; certain patients gain ectopic fat, which should be considered an adverse response. There is emerging evidence that pericardial fat volume and brown fat stores may provide individualized patient assessments.
Some obese persons can be relieved of the additional stigma of classification in a major disease category, and unnecessary medical interventions and costs can be reduced. Other patients should be monitored more closely for unexpected adverse outcomes.
aCancer Research Center and Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
bObesity and Cancer Section, The Obesity Society Silver Spring, Maryland
cDepartment of Physiology and Biophysics, Department of Radiology, Boston University School of Medicine
dDepartment of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
Correspondence to James A. Hamilton, PhD, Department of Physiology and Biophysics, Boston University School of Medicine, 700 Albany Street, Boston, MA 02118, USA. Tel: +1 617 638 5048; fax: +1 617 638 4041; e-mail: firstname.lastname@example.org