The big picture on obesity and insulin resistance.

In this issue of the Journal, Abbasi et al. (1) use data from previous studies in 314 individuals to quantify the relationship between body mass index (BMI) and insulin resistance and the relationship between these two factors and other coronary heart disease (CHD) risk factors. The modified insulin suppression test, previously validated by this group, was used to define whole body insulin resistance. The main findings were that only about a quarter of the variability in insulin resistance was explicable by BMI. Second, at any BMI those individuals classified as insulin-resistant had higher insulin levels and were more glucose intolerant than insulin-sensitive individuals. Third, of the risk factors examined, low high-density lipoprotein (HDL)-cholesterol and hypertriglyceridemia were most strongly associated with insulin resistance.