Healthy Obese Adults Tend To Become Unhealthy Over Time Interview with:
Dr. Joshua Bell PhD Candidate
Epidemiology & Public Health
University College London, UK

Medical Research: What is the background for this study? What are the main findings?

Dr. Bell: When viewed at single points in time, about one-third of obese adults show normal metabolic profiles, that is, they have normal blood pressure, cholesterol and blood sugar levels. These adults have been labeled as ‘healthy’, but until now we have lacked evidence on the long-term stability of this state over time. By viewing theDr. Joshua Bell PhD Candidate Epidemiology & Public Health University College London, UK natural course of healthy obesity over two decades we found that about half of healthy obese adults become unhealthy obese after 20 years, with a clear trend for increasing progression to ill-health over time. Healthy obese adults are also much more likely to become unhealthy obese than healthy or unhealthy non-obese adults, indicating that healthy obesity is often just a phase.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bell: We know that healthy obese adults have a greater risk for developing type 2 diabetes and cardiovascular disease than healthy normal-weight adults, although this risk appears lower than for the unhealthy obese. As we now see, healthy obese adults tend to become unhealthy obese over time, further supporting healthy obesity as a high risk state with serious implications for disease risk.

When applying this to clinical practice, however, it is important to recognize individual-level variation and that weight loss is not equally feasible for all obese patients. The focus can initially be placed on improving fat distribution by reducing visceral fat and building muscle through engaging in regular physical activity and avoiding prolonged sedentary time, which together with a diet free of processed foods may reduce inflammation even if weight is not lost. However these improvements may be difficult to sustain in the long-term, and so reducing obesity in all its forms should remain the ultimate goal.    

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bell: A long-term view of healthy obesity is needed in order to avoid inappropriate public health messages. Healthy obese adults tend to become unhealthy obese over time, however there may be exceptions, and future research can investigate whether long-term stability in metabolic health among obese adults is protective against disease, and whether stability is a feasible and worthwhile alternative for those who have difficulty losing weight.  Ultimately, more effective and sustainable weight loss solutions need to be developed.


The Natural Course of Healthy Obesity Over 20 Years




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