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Diabetes Research
18.09.2017

Treatment of Overweight: Is Metabolically Healthy Obesity a Worthwhile Initial Goal?

Despite the well-known health risks, only some of those affected from obesity attempt to lose weight. Many people are most probably daunted by the prospect of losing the required large amount of weight. Researchers of the Helmholtz Zentrum München from Tübingen have shown in ‘The Lancet Diabetes & Endocrinology’ that metabolically healthy obesity could be a worthwhile initial goal in the therapy of obesity. The work was conducted with colleagues from the German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) and in the framework of the German Center for Diabetes Research (DZD).

metabolically healthy obesity

In comparison to people with metabolically abnormal obesity (approximately 70 % of people with obesity, who have more than one of the above mentioned risks factors, cardiometabolic risks + 150 %), people with metabolically healthy obesity (approximately 30% of people with obesity, at most one of the above-mentioned risk factors) have 25% increased cardiometabolic risk in comparison to people with normal weight.

Worldwide more and more individuals are obese. The consequence: Many of these people suffer from diseases associated with morbid overweight such as diabetes, high blood pressure, heart attack or stroke. Through a lifestyle intervention, the affected individuals often lose weight in the short term, but they usually fail in the long term. Furthermore, the question is whether the 5-8 per cent weight loss rate recommended by the medical associations is at all sufficient for every overweight or obese person to significantly reduce the risk of long-term severe health consequences. At an initial weight of e.g. 120 kg and a height of 180 cm (BMI, body mass index 37.0), the BMI of the patient would thus be 34.4 after the successful weight loss. He/she would not have yet achieved the desirable BMI of 25 or less, the level at which most people are clearly protected against obesity-related illnesses.

Wouldn’t it be more meaningful to define achievable intermediate goals to reach an individual healthy weight? What parameters could describe this intermediate goal? Can smaller steps more effectively help motivate those affected to lose weight? These were the key questions in a study conducted by scientists at the Medical Clinic IV of Tübingen University Hospital / the Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Zentrum München and the DIfE in Potsdam, both partners in the DZD.

In their current study, the professors Norbert Stefan and Hans-Ulrich Häring from Tübingen and Professor Matthias Schulze from Potsdam show how the concept of metabolically healthy obesity can be integrated into the risk management of obesity therapy. Based on their own data from the Tübingen Lifestyle Intervention Study, they show that a weight loss of more than 10 percent with an average baseline BMI of 35 is likely to be sufficient to get from "metabolically unhealthy obesity (MUHO)" to "metabolically healthy obesity (MHO)". However, they also stress the fact that that this percentage is not enough in the long term, since the disease risk for MHO individuals is still increased by 25 percent compared to metabolically healthy people with normal weight. In contrast: for MUHO people, who weigh just a bit more than MHO people, the risk of severe health consequences is 150 percent higher, compared to the same metabolically healthy people with normal weight.

As an important intermediate step, Stefan describes the achievement of MHO as a documented protection against obesity-related metabolic diseases: "Look at this protection as a low-hanging fruit. Although it is not easy to harvest, it is easier to achieve than to concentrate on the top fruits from the outset. "The doctor / patient communication is an important support to motivate the patient to reach and at least maintain this condition.


Further Information

Background:
People with metabolically healthy obesity have at most only one of the following risk factors: high blood pressure (hypertension), disturbed carbohydrate metabolism (insulin resistance), lipid metabolism (dyslipidemia), abdominal obesity, hyperglycemia or fatty liver .

Original Publication:
Stefan N, Häring H-U, Schulze MB. (2017): Metabolically healthy obesity: the low-hanging fruit in obesity treatment? The Lancet Diabetes & Endocrinology, DOI:  10.1016/S2213-8587(17)30292-9

As German Research Center for Environmental Health, Helmholtz Zentrum München pursues the goal of developing personalized medical approaches for the prevention and therapy of major common diseases such as diabetes mellitus, allergies and lung diseases. To achieve this, it investigates the interaction of genetics, environmental factors and lifestyle. The Helmholtz Zentrum München has about 2,500 staff members and is headquartered in Neuherberg in the north of Munich. Helmholtz Zentrum München is a member of the Helmholtz Association, a community of 19 scientific-technical and medical-biological research centers with a total of about 37,000 staff members. 

The primary research objective of the research groups working in the Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Zentrum München at the University of Tübingen is personalized prediction of diabetes risk and diabetes prevention as well as personalized therapy. Here special focus is placed on gene-environment interaction. 

The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Zentrum München – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of the Helmholtz Zentrum München at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Zentrum München at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich.

The German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) is a member of the Leibniz Association. It investigates the causes of diet-related diseases in order to develop new strategies for prevention and therapy and to provide dietary recommendations. Its research focus includes the causes and consequences of the metabolic syndrome, which is a combination of obesity, high blood pressure, insulin resistance and lipid metabolism disorder, as well as the role of diet in healthy aging and the biological basis of food choices and eating habits. In addition, DIfE is a partner of the German Center for Diabetes Research (DZD), which was founded in 2009 and has since been funded by the BMBF. 

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