Inflammation as a Marker for Unhealthy Obesity

Since AMA declared this summer that obesity is a disease, much discussion has focused the difference between unhealthy obesity and good metabolic health at a high BMI. Inflammation might be essential for understanding this distinction.

About one in five people with a BMI in the range of obesity have normal metabolic health. They will live a normal life to a normal age. That’s why experts in obesity medicine go beyond BMI to diagnose obesity, using something like the Edmonton Obesity Staging System.

A group of distinguished experts from the U.S. and Germany have just published a thorough review of the phenomenon of high BMI and good metabolic health in The Lancet Diabetes and Endocrinology. They propose criteria for distinguishing these people and labeling their condition as “metabolically healthy obesity.” The authors call attention to the need for intervention strategies tailored toward the metabolic profile of an individual to conserve scarce resources for dealing with the magnitude of obesity’s public health impact.

A new publication in the Journal of Clinical Endocrinology and Metabolism points to inflammation as a key indicator of unhealthy obesity. Catherine Phillips and Ivan Perry analyzed the metabolic health and indicators of systemic inflammation in a sample of 2047 men and women ranging in age from 25 to 74. In people with good metabolic health and BMI in the range of obesity, they found significantly lower indicators of inflammation. Commenting on their findings, Phillips said:

Regardless of their body mass index [BMI], people with favorable inflammatory profiles also tended to have healthy metabolic profiles.

From a public health standpoint, we need better methods for identifying which obese people face the greatest risk of diabetes and heart disease. Inflammatory markers offer a potential strategy for pinpointing people who could benefit most from medical interventions.

Here we have another reminder that appearance, weight, and BMI are not reliable ways to diagnose obesity.

Click here and here to read more in MedPage Today, click here to read the analysis of high BMI and metabolic health, and click here to read the study by Phillips and Perry.

Macrophage, photograph © ZEISS Microscopy / flickr

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