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Healthy obese persons: how can they be identified and do metabolic profiles stratify risk?

Denis, Gerald V.a,b; Hamilton, James A.c,d

Current Opinion in Endocrinology, Diabetes and Obesity: October 2013 - Volume 20 - Issue 5 - p 369–376
doi: 10.1097/
OBESITY AND NUTRITION: Edited by Caroline M. Apovian and Jeffrey I. Mechanick

Purpose of review 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.

Recent findings 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.

Summary 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:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins