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Although it is well recognized that obesity is a health hazard, its heterogeneity has remained a challenge in clinical practice (1). For instance, whereas there is a clear link between obesity and complications such as dyslipidemia, hypertension, and type 2 diabetes, not every obese patient is characterized by these risk factors. Obesity is defined by an excess of body fat associated with increased health risk, and its diagnosis is generally made on the basis of a body mass index (BMI) greater than 30 kg/m2. The study by Hamer and Stamatakis (2) provides additional evidence that one can find individuals with a diagnosis of clinical obesity defined on the basis of their BMI but without the expected cardiovascular disease (CVD) risk factors. In their study, this subgroup of participants represented 5.2% of the overall cohort of 22,203 individuals who were followed for an average of 7 yr. Over this period, there were 604 CVD deaths and 1868 all-cause deaths. Results of this well-conducted prospective study are pretty straightforward: obese individuals not characterized by risk factors were not found to be at increased CVD, and their total mortality risk was comparable to that of metabolically healthy nonobese participants. Thus, in the absence of CVD risk factors, obesity by itself does not appear to be a major risk factor for CVD and related mortality. On the other hand, metabolically unhealthy nonobese subjects were at increased risk for CVD and all-cause deaths.

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Editorials > Editorials - Editorial
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