Healthy obese persons: how can they be identified and do metabolic profiles stratify risk?

PURPOSE OF REVIEW New research supports the intuitive observation that many persons classified as obese are healthy, and should not be treated and categorized medically as diseased. There is increasing agreement that major blood biomarkers are often not discriminatory, as for example, the return to normal blood glucose levels in bariatric patients who do not have long-term benefits. Although weight loss is appreciated to improve metabolic and inflammatory parameters, the cellular and immune factors that couple obesity to cardiometabolic risk are only partially understood. RECENT FINDINGS Reduced BMI upon successful bariatric surgery does not always result in reduced pericardial fat; certain patients gain ectopic fat, which should be considered an adverse response. There is emerging evidence that pericardial fat volume and brown fat stores may provide individualized patient assessments. SUMMARY Some obese persons can be relieved of the additional stigma of classification in a major disease category, and unnecessary medical interventions and costs can be reduced. Other patients should be monitored more closely for unexpected adverse outcomes.