German researchers investigated the possibility of establishing a healthy metabolism as an achievable step in the treatment of obesity.
Obesity has risen to be a serious health concern worldwide. As a disease, obesity is defined as having a body mass index (BMI) of 30kg/m2 or higher. It increases the risk of many other diseases and is a leading cause of death in the USA. Ironically, fewer adults have been trying to lose weight in the last 10 years compared to the years 1980 to 1990.
Researchers in Germany recently published a series paper in The Lancet Diabetes & Endocrinology exploring small achievable steps for treating obesity. In particular, they investigated the weight loss needed to reduce cardiometabolic disease risks, and thus transition from metabolically unhealthy to metabolically healthy obesity. Using this data, potential clinical applications were discussed.
The safest and most highly recommended method of treatment for obesity is lifestyle intervention. But previous studies such as the Look AHEAD trial and Diabetes Prevention Program Outcomes Study have shown that it is difficult to maintain the reduced body weights post-intervention.
Metabolically Healthy Obesity
Metabolically healthy obesity is a term that has not yet been firmly established or utilized in the healthcare field. However, it is being used in clinical studies to quantify the successfulness of weight-loss programs. Studies on metabolically healthy obesity look at factors such as blood pressure, blood sugar, and triglyceride, and HDL cholesterol levels. In most cases, metabolic health was described as having fewer than two signs of metabolic syndrome, as defined by the American Heart Association. Having this term established in a clinical setting may be helpful for patients to gauge their progress, rather than the clinician having to explain each metabolic syndrome separately without a benchmark.
Metabolically healthy obese individuals still have a higher risk of having cardiovascular events than those of normal weight, but their risk is considerably less than those with metabolically unhealthy obesity. Unfortunately, it is common for obese individuals to re-develop unhealthy metabolism even after a successful weight loss program. This shows that although a healthy metabolism is present in the obese individual, they should continuously strive to adopt a healthy lifestyle.
Transitioning from Metabolically Unhealthy to Healthy Obesity
Most lifestyle intervention programs aim for 5% weight loss for the patient. However, 5% weight loss does not guarantee a conversion from metabolically unhealthy to healthy in all of the patients, although it may have reduced some cardiometabolic risks. It was seen that those with a higher baseline BMI would need to lose more weight to see a metabolic benefit. Importantly, a healthy diet can reduce cardiometabolic risk, independent of weight reduction. The Mediterranean diet was used in these studies and was repeatedly proven to be successful.
Regardless of the outcome, having the patients informed of metabolic health could be a source of motivation for healthier lifestyle changes in the long run. Weight loss alone should not be the focus of a lifestyle intervention program. The weight loss achieved should be discussed between clinicians and patients, in context of metabolic parameters. Having the term metabolically healthy established can make this process much easier. This will turn the journey to health into a much more meaningful one for the patients. Instead of focusing on the scales, the patients will be able to see the treatment more holistically and personally.
Written by Alena Kim, BSc
Reference: Stefan, Norbert, Hans-Ulrich Häring, and Matthias B. Schulze. “Metabolically healthy obesity: the low-hanging fruit in obesity treatment?.” The Lancet Diabetes & Endocrinology (2017).