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Obesity and Poor Metabolic Health Ups Risk of Premature Death

man pinching waist fatPeople who have high glucose levels, high blood pressure, a large waist and other factors that make them metabolic unhealthy are at increased risk for a premature death and cardiovascular disease, even if they are at a healthy weight, suggests a new systematic review of the research.

And among those who are metabolically healthy, people who are obese also face increased risk. The new analysis was published this week in the Annals of Internal Medicine.

The analysis did not look at cancer specifically, but many signs of poor metabolic health are factors for increased cancer risk, as well as type 2 diabetes and heart disease.

Overweight and obesity increases risk for seven cancers, including postmenopausal breast, colorectal, and pancreatic. And obesity brings metabolic issues.

The new analysis searched for studies on both metabolic health and weight, looking at the link to death and cardiovascular events, including heart surgery and stroke. The authors found a dozen relevant studies, eight that lasted over ten years and included approximately 61,000 people. The studies used a set of measures to evaluate whether participants were metabolically healthy or not. They used BMI to categorize whether people were at a normal weight, overweight or obese. BMI is a common – but imperfect – measure of body fat.

For studies that lasted only a few years, there was little difference among those at different weights who were metabolically healthy and mortality.

But when the authors focused on studies that lasted over ten years, they found obesity does make a difference. Those who were metabolically healthy and obese had an increased risk for dying earlier and heart disease compared to the metabolically healthy people at a normal weight.

And whatever people weighed – normal, overweight, or obese – the metabolic unhealthy were at increased risk. Compared to people at a normal weight and metabolically healthy, the metabolically unhealthy had from two to three times the risk of premature death or heart disease, even people who were at a “healthy” BMI.

The authors note that these findings may not apply to everyone, such as the elderly. And the studies did not take into account healthy behaviors, such as being active.


Caroline K. Kramer, Bernard Zinman, Ravi Retnakaran. "Are Metabolically Healthy Overweight and Obesity Benign Conditions? A Systematic Review and Meta-analysis." Annals of Internal Medicine. 2013 Dec;159(11):758-769.

Published on December 4, 2013

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