ArticleEuropean heart journal2013
The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness.
Article in European heart journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 199 papers, 6 of them syntheses that pooled it.
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Who cites it
199 citing papers in PubMed, 6 syntheses or guidelines pooled it, 458 citations in OpenAlex.
- Knowledge mapping and bibliometric analysis of metabolic phenotypes in childhood and adolescent obesity: research hotspots and emerging trends from 2000 to 2026.Frontiers in public health · 2026Pooled it
- The Benefits of Physical Activity for People with Obesity, Independent of Weight Loss: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- Pooled it
- Association of metabolically healthy obesity with depressive symptoms: pooled analysis of eight studies.Molecular psychiatry · 2014Pooled it
- Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2014Pooled it
- Beyond BMI: The "Metabolically healthy obese" phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality -- a systematic review.BMC public health · 2014Pooled it
- Cardiorespiratory fitness and submaximal exercise dynamics in normal-weight obesity and metabolically healthy obesity.European journal of applied physiology · 2024Trial
- Trial
- Trial
- Associations between the GNB3 C825T polymorphism and obesity-related metabolic risk factors in Korean obese women.Journal of endocrinological investigation · 2014Trial
- Population-Level Heterogeneity in People with Obesity: A Cross-Sectional Cluster Analysis of a Population-Based Registry.Journal of clinical medicine · 2026Article
- Physical activity for weight loss maintenance in people with and without physical disability: The international weight control registry.Disability and health journal · 2026Article
- Cross-Sectional Associations of Metabolically Healthy Obesity, Lifestyle Factors, and Steatotic Liver Disease in Adults from the Fels Longitudinal Study.Metabolites · 2026Article
- Association Between Obesity Status and Hypertension Phenotypes: Are Inflammatory Indicators the Missing Link? Evidence From a Large Population Study.Journal of clinical hypertension (Greenwich, Conn.) · 2026Article
- Peak oxygen consumption as a modifier of the obesity paradox in patients with obesity with heart failure with reduced ejection fraction.International journal of obesity (2005) · 2026Article
- Chemerin Normal Function and Roles in Metabolic and Nonmetabolic Disorders: An Up-To-Date Comprehensive Review.Biochemistry research international · 2026Review
- Circadian Syndrome Mediates the Association Between Body Roundness Index and Incident Stroke Risk in Middle-Aged and Older Chinese Adults: A Nationwide Prospective Cohort Study.Behavioural neurology · 2026Article
- Disentangling consequences of self-perceived weight from excess adiposity in metabolically healthy overweight/obesity.BMC public health · 2025Observational
- Association of obesity phenotypes with risk of cardiovascular disease mortality: a prospective cohort study.BMC public health · 2025Article
- The prevalence of metabolically healthy obesity and healthy status and related risk factors among Iranian adults: a cohort-based cross-sectional study.Journal of diabetes and metabolic disorders · 2025Article
139 more citing papers are in PubMed but not listed here.
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Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
Abstract
aimsCurrent knowledge on the prognosis of metabolically healthy but obese phenotype is limited due to the exclusive use of the body mass index to define obesity and the lack of information on cardiorespiratory fitness. We aimed to test the following hypotheses: (i) metabolically healthy but obese individuals have a higher fitness level than their metabolically abnormal and obese peers; (ii) after accounting for fitness, metabolically healthy but obese phenotype is a benign condition, in terms of cardiovascular disease and mortality. METHODS AND
resultsFitness was assessed by a maximal exercise test on a treadmill and body fat per cent (BF%) by hydrostatic weighing or skinfolds (obesity = BF% ≥ 25 or ≥ 30%, men or women, respectively) in 43 265 adults (24.3% women). Metabolically healthy was considered if meeting 0 or 1 of the criteria for metabolic syndrome. Metabolically healthy but obese participants (46% of the obese subsample) had a better fitness than metabolically abnormal obese participants (P < 0.001). When adjusting for fitness and other confounders, metabolically healthy but obese individuals had lower risk (30-50%, estimated by hazard ratios) of all-cause mortality, non-fatal and fatal cardiovascular disease, and cancer mortality than their metabolically unhealthy obese peers; while no significant differences were observed between metabolically healthy but obese and metabolically healthy normal-fat participants.
conclusions(i) Higher fitness should be considered a characteristic of metabolically healthy but obese phenotype. (ii) Once fitness is accounted for, the metabolically healthy but obese phenotype is a benign condition, with a better prognosis for mortality and morbidity than metabolically abnormal obese individuals.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.