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Healthy obesity as an intermediate state of risk: A critical review

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journal contribution
posted on 2016-08-15, 08:53 authored by Joshua A. Bell, Mark Hamer
Introduction: Obesity is a top public health priority but interventions to reverse the condition have had limited success. About 1-in-3 obese adults are free of metabolic risk factor clustering and are considered ‘healthy', and much attention has focused on the implications of this state for obesity management. Areas covered: We searched for individual studies, systematic reviews, and meta-analyses which examined correlates and outcomes of metabolically healthy obesity. We discuss the key roles of fat distribution and physical activity in determining healthy vs. unhealthy obesity and report a greatly increased risk of incident type 2 diabetes associated with healthy obesity vs. healthy normal-weight, among other outcomes. We argue that despite inconsistencies in the definition, patterns across studies clearly show that healthy obesity is a state of intermediate disease risk. Expert commentary: Given the current state of population-level evidence, we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health. We recommend that weight loss through energy restriction be a stand-alone target in addition to increased physical activity for minimising risk of future disease.



  • Sport, Exercise and Health Sciences

Published in

Expert Review of Endocrinology and Metabolism


BELL, J.A. and HAMER, M., 2016. Healthy obesity as an intermediate state of risk: A critical review. Expert Review of Endocrinology and Metabolism, 11 (5), pp. 403-413.


© Expert Reviews. Published by Taylor and Francis


  • AM (Accepted Manuscript)

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This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/

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This is an Accepted Manuscript of an article published by Taylor & Francis in Expert Review of Endocrinology and Metabolism on 12 Aug 2016, available online: http://dx.doi.org/10.1080/17446651.2016.1220298




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