Evidence map›Paper›PMID 34109441›Full record

ArticleDiabetologia2021

Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants.

Ziyi Zhou, John Macpherson, Stuart R Gray, Jason M R Gill, Paul Welsh, Carlos Celis-Morales, Naveed Sattar, Jill P Pell, Frederick K Ho

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetologia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
89citing papers in PubMed, 1 pooled it
18.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

89 citing papers in PubMed, 1 synthesis or guideline pooled it, 156 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Obesity, metabolic health status, and adverse outcomes in men and women.American journal of preventive cardiology · 2026
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  18. Precision Medicine for Obesity Treatment.Journal of the Endocrine Society · 2025
    Review
  19. Article
  20. Review

29 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 2 countries.

Ziyi ZhouInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
John MacphersonInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Stuart R GrayInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Jason M R GillInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Paul WelshInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Carlos Celis-MoralesInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Naveed SattarInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Jill P PellInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Frederick K HoInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK. Frederick.Ho@glasgow.ac.uk.
University of Glasgow · GBCatholic University of the Maule · CL

Funding

British Heart Foundation CH/1996001/9454Department of HealthMedical Research Council MC_PC_17228Medical Research Council MC_QA137853Wellcome Trust
6 · The paper itself

Abstract

aims/hypothesisPeople with obesity and a normal metabolic profile are sometimes referred to as having 'metabolically healthy obesity' (MHO). However, whether this group of individuals are actually 'healthy' is uncertain. This study aims to examine the associations of MHO with a wide range of obesity-related outcomes.

methodsThis is a population-based prospective cohort study of 381,363 UK Biobank participants with a median follow-up of 11.2 years. MHO was defined as having a BMI ≥ 30 kg/m

resultsCompared with people who were not obese at baseline, those with MHO had higher incident HF (HR 1.60; 95% CI 1.45, 1.75) and respiratory disease (HR 1.20; 95% CI 1.16, 1.25) rates, but not higher ASCVD. The associations of MHO were generally weaker for fatal outcomes and only significant for all-cause (HR 1.12; 95% CI 1.04, 1.21) and HF mortality rates (HR 1.44; 95% CI 1.09, 1.89). However, when compared with people who were metabolically healthy without obesity, participants with MHO had higher rates of incident diabetes (HR 4.32; 95% CI 3.83, 4.89), ASCVD (HR 1.18; 95% CI 1.10, 1.27), HF (HR 1.76; 95% CI 1.61, 1.92), respiratory diseases (HR 1.28; 95% CI 1.24, 1.33) and all-cause mortality (HR 1.22; 95% CI 1.14, 1.31). The results with a 5 year landmark analysis were similar. CONCLUSIONS/

interpretationWeight management should be recommended to all people with obesity, irrespective of their metabolic status, to lower risk of diabetes, ASCVD, HF and respiratory diseases. The term 'MHO' should be avoided as it is misleading and different strategies for risk stratification should be explored.

Indexed as

Obesity, Metabolically BenignBiological Specimen BanksBody Mass IndexCohort StudiesHumansProspective StudiesRisk FactorsUnited KingdomCardiovascular diseaseMetabolically healthy obesityObesity

Identifiers

PMID34109441
PMCPMC8382657
OpenAlexW3144156015

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.