Editing Obesity (section)

===Morbidity===
{{Main|Obesity-associated morbidity}}

Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in [[metabolic syndrome]],<ref name="HaslamJames" /> a combination of medical disorders which includes: [[diabetes mellitus type 2]], [[hypertension|high blood pressure]], [[hypercholesterolemia|high blood cholesterol]], and [[hypertriglyceridemia|high triglyceride levels]].<ref>{{cite journal | vauthors = Grundy SM | title = Obesity, metabolic syndrome, and cardiovascular disease | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 89 | issue = 6 | pages = 2595–600 | date = June 2004 | doi = 10.1210/jc.2004-0372 | pmid = 15181029 | s2cid = 7453798 | doi-access =  }}</ref> A study from the [[RAK Hospital]] found that obese people are at a greater risk of developing [[long COVID]].<ref>{{cite web |title=Obesity linked to long Covid-19, RAK hospital study finds |url=https://www.msn.com/en-ae/news/middleeast/obesity-linked-to-long-covid-19-rak-hospital-study-finds/ar-AANeVeI |publisher=Khaleej Times|date=12 August 2021 |access-date=12 August 2021}}</ref> The CDC has found that obesity is the single strongest risk factor for severe COVID-19 illness.<ref>{{cite journal | vauthors = Kompaniyets L, Pennington AF, Goodman AB, Rosenblum HG, Belay B, Ko JY, Chevinsky JR, Schieber LZ, Summers AD, Lavery AM, Preston LE, Danielson ML, Cui Z, Namulanda G, Yusuf H, Mac Kenzie WR, Wong KK, Baggs J, Boehmer TK, Gundlapalli AV | title = Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020 – March 2021 | journal = Preventing Chronic Disease | volume = 18 | pages = E66 | date = July 2021 | pmid = 34197283 | pmc = 8269743 | doi = 10.5888/pcd18.210123 | publisher = Centers for Disease Control and Prevention }}</ref>

Complications may be either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a [[sedentary lifestyle]]. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with [[type 2 diabetes]]. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.<ref name = "Seidell_2005">{{cite book | vauthors = Seidell JC | chapter = Epidemiology – definition and classification of obesity | veditors = Kopelman PG, Caterson ID, Stock MJ, Dietz WH |title=Clinical obesity in adults and children: In Adults and Children |publisher=Blackwell Publishing |year=2005 |pages=[https://archive.org/details/clinicalobesityi02edunse/page/3 3–11] |isbn=978-1-4051-1672-5 |chapter-url=https://archive.org/details/clinicalobesityi02edunse/page/3 }}</ref>{{rp|9}}

Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as [[osteoarthritis]], [[obstructive sleep apnea]], social stigmatization) and those due to the increased number of [[fat cells]] ([[diabetes mellitus|diabetes]], [[cancer]], [[cardiovascular disease]], [[non-alcoholic fatty liver disease]]).<ref name="HaslamJames" /><ref name="Bray2004">{{cite journal | vauthors = Bray GA | title = Medical consequences of obesity | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 89 | issue = 6 | pages = 2583–9 | date = June 2004 | pmid = 15181027 | doi = 10.1210/jc.2004-0535 | doi-access = free }}</ref> Increases in body fat alter the body's response to insulin, potentially leading to [[insulin resistance]]. Increased fat also creates a [[inflammation|proinflammatory state]],<ref>{{cite journal | vauthors = Shoelson SE, Herrero L, Naaz A | title = Obesity, inflammation, and insulin resistance | journal = Gastroenterology | volume = 132 | issue = 6 | pages = 2169–80 | date = May 2007 | pmid = 17498510 | doi = 10.1053/j.gastro.2007.03.059 }}</ref><ref>{{cite journal | vauthors = Shoelson SE, Lee J, Goldfine AB | title = Inflammation and insulin resistance | journal = The Journal of Clinical Investigation | volume = 116 | issue = 7 | pages = 1793–801 | date = July 2006 | pmid = 16823477 | pmc = 1483173 | doi = 10.1172/JCI29069 }}</ref> and a [[thrombosis|prothrombotic]] state.<ref name="Bray2004" /><ref>{{cite journal | vauthors = Dentali F, Squizzato A, Ageno W | title = The metabolic syndrome as a risk factor for venous and arterial thrombosis | journal = Seminars in Thrombosis and Hemostasis | volume = 35 | issue = 5 | pages = 451–7 | date = July 2009 | pmid = 19739035 | doi = 10.1055/s-0029-1234140 | s2cid = 260320617 }}</ref>

{| class="wikitable"
|-
! Medical field
! Condition
! Medical field
! Condition
|-
<!--Alphabetized-->| width="10%" | [[Cardiology]]
|
* [[Coronary heart disease]]:<ref>{{cite journal | vauthors = Lu Y, Hajifathalian K, Ezzati M, Woodward M, Rimm EB, Danaei G | title = Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants | journal = Lancet | volume = 383 | issue = 9921 | pages = 970–83 | date = March 2014 | pmid = 24269108 | pmc = 3959199 | doi = 10.1016/S0140-6736(13)61836-X }}</ref> [[angina pectoris|angina]] and [[myocardial infarction]]
* [[Congestive heart failure]]<ref name="HaslamJames" /><ref>{{cite journal | vauthors = Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, Vatten LJ | title = Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies | journal = Circulation | volume = 133 | issue = 7 | pages = 639–49 | date = February 2016 | pmid = 26746176 | doi = 10.1161/CIRCULATIONAHA.115.016801 | s2cid = 115876581 | doi-access = free }}</ref>
* [[High blood pressure]]<ref name="HaslamJames" />
* [[Dyslipidemia|Abnormal cholesterol levels]]<ref name="HaslamJames" />
* [[Deep vein thrombosis]] and [[pulmonary embolism]]<ref>{{cite journal | vauthors = Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ | title = Obesity and thrombosis | journal = European Journal of Vascular and Endovascular Surgery | volume = 33 | issue = 2 | pages = 223–33 | date = February 2007 | pmid = 17185009 | doi = 10.1016/j.ejvs.2006.10.006 | doi-access = free }}</ref>
| <!--Alphabetized-->[[Dermatology]]
|
* [[Acanthosis nigricans]]<ref name="derm2007">{{cite journal | vauthors = Yosipovitch G, DeVore A, Dawn A | title = Obesity and the skin: skin physiology and skin manifestations of obesity | journal = Journal of the American Academy of Dermatology | volume = 56 | issue = 6 | pages = 901–16; quiz 917–20 | date = June 2007 | pmid = 17504714 | doi = 10.1016/j.jaad.2006.12.004 }}</ref>
* [[Lymphedema]]<ref name="derm2007" />
* [[Cellulitis]]<ref name="derm2007" />
* [[Hirsutism]]<ref name="derm2007" />
* [[Intertrigo]]<ref>{{cite journal | vauthors = Hahler B | title = An overview of dermatological conditions commonly associated with the obese patient | journal = Ostomy/Wound Management | volume = 52 | issue = 6 | pages = 34–6, 38, 40 passim | date = June 2006 | pmid = 16799182 }}</ref>
|-
| <!--Alphabetized-->[[Endocrinology]] and [[reproductive medicine]]
|
* [[Diabetes mellitus]]<ref name="HaslamJames" />
* [[Polycystic ovarian syndrome]]<ref name="HaslamJames" />
* [[menstruation|Menstrual]] disorders<ref name="HaslamJames" />
* [[Infertility]]<ref name="HaslamJames" /><ref name="OBGYN2008">{{cite journal | vauthors = Arendas K, Qiu Q, Gruslin A | title = Obesity in pregnancy: pre-conceptional to postpartum consequences | journal = Journal of Obstetrics and Gynaecology Canada | volume = 30 | issue = 6 | pages = 477–488 | date = June 2008 | pmid = 18611299 | doi = 10.1016/s1701-2163(16)32863-8 }}</ref>
* [[Maternal obesity|Complications during pregnancy]]<ref name="HaslamJames" /><ref name="OBGYN2008" />
* [[Birth defects]]<ref name="HaslamJames" />
* [[Stillbirth|Intrauterine fetal death]]<ref name="OBGYN2008" />
| <!--Alphabetized-->[[Gastroenterology]]
|
* [[Gastroesophageal reflux disease]]<ref name="Dibaise2013">{{Cite journal |vauthors=Dibaise JK, Foxx-Orenstein AE |date=July 2013 |title=Role of the gastroenterologist in managing obesity |journal=[[Expert Review of Gastroenterology & Hepatology]] |type=Review |volume=7 |issue=5 |pages=439–51 |doi=10.1586/17474124.2013.811061 |pmid=23899283|s2cid=26275773 }}</ref>
* [[Non-alcoholic fatty liver disease|Fatty liver disease]]<ref name="Dibaise2013" />
* [[Cholelithiasis]] (gallstones)<ref name="Dibaise2013" />
|-
| <!--Alphabetized-->[[Neurology]]
| style="width:40%;" |
* [[Stroke]]<ref name="HaslamJames" />
* [[Meralgia paresthetica]]<ref>{{cite journal | vauthors = Harney D, Patijn J | title = Meralgia paresthetica: diagnosis and management strategies | journal = Pain Medicine | volume = 8 | issue = 8 | pages = 669–77 | year = 2007 | pmid = 18028045 | doi = 10.1111/j.1526-4637.2006.00227.x | type = Review | doi-access = free }}</ref>
* [[Migraines]]<ref>{{cite journal | vauthors = Bigal ME, Lipton RB | title = Obesity and chronic daily headache | journal = Current Pain and Headache Reports | volume = 12 | issue = 1 | pages = 56–61 | date = January 2008 | pmid = 18417025 | doi = 10.1007/s11916-008-0011-8 | s2cid = 23729708 | type = Review }}</ref>
* [[Carpal tunnel syndrome]]<ref>{{cite journal | vauthors = Sharifi-Mollayousefi A, Yazdchi-Marandi M, Ayramlou H, Heidari P, Salavati A, Zarrintan S, Sharifi-Mollayousefi A | title = Assessment of body mass index and hand anthropometric measurements as independent risk factors for carpal tunnel syndrome | journal = Folia Morphologica | volume = 67 | issue = 1 | pages = 36–42 | date = February 2008 | pmid = 18335412 }}</ref>
* [[Dementia]]<ref>{{cite journal | vauthors = Beydoun MA, Beydoun HA, Wang Y | title = Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis | journal = Obesity Reviews | volume = 9 | issue = 3 | pages = 204–18 | date = May 2008 | pmid = 18331422 | pmc = 4887143 | doi = 10.1111/j.1467-789X.2008.00473.x | type = Meta-analysis }}</ref>
* [[Idiopathic intracranial hypertension]]<ref>{{cite journal | vauthors = Wall M | title = Idiopathic intracranial hypertension (pseudotumor cerebri) | journal = Current Neurology and Neuroscience Reports | volume = 8 | issue = 2 | pages = 87–93 | date = March 2008 | pmid = 18460275 | doi = 10.1007/s11910-008-0015-0 | s2cid = 17285706 | type = Review }}</ref>
* [[Multiple sclerosis]]<ref>{{cite journal | vauthors = Munger KL, Chitnis T, Ascherio A | title = Body size and risk of MS in two cohorts of US women | journal = Neurology | volume = 73 | issue = 19 | pages = 1543–50 | date = November 2009 | pmid = 19901245 | pmc = 2777074 | doi = 10.1212/WNL.0b013e3181c0d6e0 | type = Comparative Study }}</ref>
| <!--Alphabetized-->[[Oncology]]<ref>{{cite journal | vauthors = Basen-Engquist K, Chang M | title = Obesity and cancer risk: recent review and evidence | journal = Current Oncology Reports | volume = 13 | issue = 1 | pages = 71–6 | date = February 2011 | pmid = 21080117 | pmc = 3786180 | doi = 10.1007/s11912-010-0139-7 }}</ref>
|
* [[esophageal cancer|Esophageal]]
* [[colorectal cancer|Colorectal]]
* [[pancreatic cancer|Pancreatic]]
* [[Gallbladder cancer|Gallbladder]]
* [[Endometrial cancer|Endometrial]]
* [[Renal cell carcinoma|Kidney]]
* [[Leukemia]]
* [[Hepatocellular carcinoma]]<ref name="Dibaise2013" />
* [[Malignant melanoma]]
|-
| style="width:10%;" | <!--Alphabetized-->[[Psychiatry]]
| style="width:40%;" |
* [[Major depressive disorder|Depression]] in women<ref name="HaslamJames" />
* Social [[Social stigma|stigmatization]]<ref name="HaslamJames" />
| <!--Alphabetized-->[[Respirology]]
|
* [[Sleep apnea|Obstructive sleep apnea]]<ref name="HaslamJames" /><ref name="Poulain">{{cite journal | vauthors = Poulain M, Doucet M, Major GC, Drapeau V, Sériès F, Boulet LP, Tremblay A, Maltais F | title = The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies | journal = CMAJ | volume = 174 | issue = 9 | pages = 1293–9 | date = April 2006 | pmid = 16636330 | pmc = 1435949 | doi = 10.1503/cmaj.051299 }}</ref>
* [[Obesity hypoventilation syndrome]]<ref name="HaslamJames" /><ref name="Poulain" />
* [[Asthma]]<ref name="HaslamJames" /><ref name="Poulain" />
* Increased complications during [[general anaesthesia]]<ref name="HaslamJames" />
* increased risk of severe COVID-19<ref name="Poly 620044">{{cite journal | vauthors = Poly TN, Islam MM, Yang HC, Lin MC, Jian WS, Hsu MH, Jack Li YC | title = Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis | journal = Frontiers in Medicine | volume = 8 | pages = 620044 | date = 5 February 2021 | pmid = 33634150 | pmc = 7901910 | doi = 10.3389/fmed.2021.620044 | doi-access = free }}</ref>
|-
| <!--Alphabetized-->[[Rheumatology]] and [[orthopedics]]
|
* [[Gout]]<ref>{{cite journal | vauthors = Aune D, Norat T, Vatten LJ | title = Body mass index and the risk of gout: a systematic review and dose-response meta-analysis of prospective studies | journal = European Journal of Nutrition | volume = 53 | issue = 8 | pages = 1591–601 | date = December 2014 | pmid = 25209031 | doi = 10.1007/s00394-014-0766-0 | s2cid = 38095938 }}</ref>
* Poor mobility<ref>{{cite journal | vauthors = Tukker A, Visscher TL, Picavet HS | title = Overweight and health problems of the lower extremities: osteoarthritis, pain and disability | journal = Public Health Nutrition | volume = 12 | issue = 3 | pages = 359–68 | date = March 2009 | pmid = 18426630 | doi = 10.1017/S1368980008002103 | doi-broken-date = 1 November 2024 | type = Research Support | doi-access = free }}</ref>
* [[Osteoarthritis]]<ref name="HaslamJames" />
* [[Low back pain]]<ref>{{cite journal | vauthors = Molenaar EA, Numans ME, van Ameijden EJ, Grobbee DE | title = [Considerable comorbidity in overweight adults: results from the Utrecht Health Project] | language = nl | journal = Nederlands Tijdschrift voor Geneeskunde | volume = 152 | issue = 45 | pages = 2457–63 | date = November 2008 | pmid = 19051798 | type = English abstract }}</ref>
| <!--Alphabetized-->[[Urology]] and [[Nephrology]]
|
* [[Erectile dysfunction]]<ref>{{cite journal | vauthors = Corona G, Rastrelli G, Filippi S, Vignozzi L, Mannucci E, Maggi M | title = Erectile dysfunction and central obesity: an Italian perspective | journal = Asian Journal of Andrology | volume = 16 | issue = 4 | pages = 581–91 | date = 2014 | pmid = 24713832 | pmc = 4104087 | doi = 10.4103/1008-682X.126386 | doi-access = free }}</ref>
* [[Urinary incontinence]]<ref>{{cite journal | vauthors = Hunskaar S | title = A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women | journal = Neurourology and Urodynamics | volume = 27 | issue = 8 | pages = 749–57 | year = 2008 | pmid = 18951445 | doi = 10.1002/nau.20635 | s2cid = 20378183 | type = Review | doi-access = free }}</ref>
* [[Chronic renal failure]]<ref>{{cite journal | vauthors = Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O | title = Obesity and risk for chronic renal failure | journal = Journal of the American Society of Nephrology | volume = 17 | issue = 6 | pages = 1695–702 | date = June 2006 | pmid = 16641153 | doi = 10.1681/ASN.2005060638 | type = Research Support | doi-access = free }}</ref>
* [[Hypogonadism]]<ref>{{cite journal | vauthors = Makhsida N, Shah J, Yan G, Fisch H, Shabsigh R | title = Hypogonadism and metabolic syndrome: implications for testosterone therapy | journal = The Journal of Urology | volume = 174 | issue = 3 | pages = 827–34 | date = September 2005 | pmid = 16093964 | doi = 10.1097/01.ju.0000169490.78443.59 | type = Review | citeseerx = 10.1.1.612.1060 }}</ref>
* [[Buried penis]]<ref name="pmid19935302">{{cite journal | vauthors = Pestana IA, Greenfield JM, Walsh M, Donatucci CF, Erdmann D | title = Management of "buried" penis in adulthood: an overview | journal = Plastic and Reconstructive Surgery | volume = 124 | issue = 4 | pages = 1186–95 | date = October 2009 | pmid = 19935302 | doi = 10.1097/PRS.0b013e3181b5a37f | s2cid = 36775257 | type = Review }}</ref>
|}

==== Metrics of health ====
{{Main|Metabolically healthy obesity}}

Newer research has focused on methods of identifying healthier obese people by clinicians, and not treating obese people as a monolithic group.<ref>{{cite journal | vauthors = Denis GV, Hamilton JA | title = Healthy obese persons: how can they be identified and do metabolic profiles stratify risk? | journal = Current Opinion in Endocrinology, Diabetes, and Obesity | volume = 20 | issue = 5 | pages = 369–376 | date = October 2013 | pmid = 23974763 | pmc = 3934493 | doi = 10.1097/01.med.0000433058.78485.b3 }}</ref> Obese people who do not experience medical complications from their obesity are sometimes called ''[[metabolically healthy obese|(metabolically) healthy obese]]'', but the extent to which this group exists (especially among older people) is in dispute.<ref name=":3">{{cite journal | vauthors = Blüher M | title = Metabolically Healthy Obesity | journal = Endocrine Reviews | volume = 41 | issue = 3 | pages = bnaa004 | date = May 2020 | pmid = 32128581 | pmc = 7098708 | doi = 10.1210/endrev/bnaa004 }}</ref> The number of people considered ''metabolically healthy'' depends on the definition used, and there is no universally accepted definition.<ref name=":4"/> There are numerous obese people who have relatively few metabolic abnormalities, and a minority of obese people have no medical complications.<ref name=":4">{{cite journal | vauthors = Smith GI, Mittendorfer B, Klein S | title = Metabolically healthy obesity: facts and fantasies | journal = The Journal of Clinical Investigation | volume = 129 | issue = 10 | pages = 3978–3989 | date = October 2019 | pmid = 31524630 | pmc = 6763224 | doi = 10.1172/JCI129186 }}</ref> The guidelines of the [[American Association of Clinical Endocrinologists]] call for physicians to use [[risk stratification]] with obese patients when considering how to assess their risk of developing type 2 diabetes.<ref>{{cite journal | vauthors = Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, Nadolsky K, Pessah-Pollack R, Plodkowski R | title = American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity | journal = Endocrine Practice | volume = 22 | issue = Suppl 3 | pages = 1–203 | date = July 2016 | pmid = 27219496 | doi = 10.4158/EP161365.GL | s2cid = 3996442 | doi-access = free }}</ref>{{Rp|pages=59–60}}

In 2014, the BioSHaRE–[[European Union|EU]] Healthy Obese Project (sponsored by Maelstrom Research, a team under the [[Research Institute of the McGill University Health Centre]]) came up with two definitions for ''healthy obesity'', one more strict and one less so:<ref name=":3" /><ref>{{Cite journal |vauthors=van Vliet-Ostaptchouk JV, Nuotio M, Slagter SN, Doiron D, Fischer K, Foco L, Gaye A, Gögele M, Heier M, Hiekkalinna T, Joensuu A |date=February 2014 |title=The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies |journal=[[BMC Endocrine Disorders]] |publisher=[[BioMed Central]] ([[Springer Nature]]) |volume=14 |pages=9 |doi=10.1186/1472-6823-14-9 |issn=1472-6823 |pmc=3923238 |pmid=24484869 |doi-access=free }}</ref>
{| class="wikitable" style="background-color:rgba(0,0,0,0);border:none"
|+BioSHaRE Healthy Obese (HOP) Project Criteria (2014)<br />{{Nobold|A patient must have a [[body mass index]] ≥ 30, and all of the following:}}
|style="border:0px"|
!Less strict
!More strict
|-
! colspan="3" |[[Blood pressure]] measured as follows, with no pharmaceutical help
|-
!Overall ([[mmHg]])
|≤ 140
|≤ 130
|-
![[Systole|Systolic]] (mmHg)
|<small>N/A</small>
|≤ 85{{Clarify|date=September 2023}}
|-
![[Diastolic]] (mmHg)
|≤ 90
|<small>N/A</small>
|-
! colspan="3" |[[Blood sugar level]] measured as follows, with no pharmaceutical help
|-
!Blood glucose ([[mmol]]/[[Litre|L]])
|≤ 7.0
|≤ 6.1
|-
! colspan="3" |[[Triglycerides]] measured as follows, with no pharmaceutical help
|-
!Fasting (mmol/L)
| colspan="2" |≤ 1.7
|-
!Non-fasting (mmol/L)
| colspan="2" |≤ 2.1
|-
! colspan="3" |[[High-density lipoprotein]] measured as follows, with no pharmaceutical help
|-
!Men (mmol/L)
| colspan="2" |> 1.03
|-
!Women (mmol/L)
| colspan="2" |> 1.3
|-
! colspan="3" |No diagnosis of any [[cardiovascular disease]]
|}

To come up with these criteria, BioSHaRE controlled for age and tobacco use, researching how both may effect the metabolic syndrome associated with obesity, but not found to exist in the metabolically healthy obese.<ref>{{Cite journal |vauthors=Stolk R |date=26 November 2013 |title=The Healthy Obese Project (HOP) |url=https://www.bioshare.eu/sites/default/files/BioSHaRE%20Newsletter%20Issue%204%2026%2011%2013.pdf |url-status=dead |journal=BioSHaRE Newsletter |issue=4 |page=2 |archive-url=https://web.archive.org/web/20151023131837/https://www.bioshare.eu/sites/default/files/BioSHaRE%20Newsletter%20Issue%204%2026%2011%2013.pdf |archive-date=23 October 2015 |access-date=11 April 2022}}</ref> Other definitions of metabolically healthy obesity exist, including ones based on waist circumference rather than BMI, which is unreliable in certain individuals.<ref name=":4" />

Another identification metric for health in obese people is [[Triceps surae muscle|calf]] [[Muscle strength|strength]], which is positively correlated with [[physical fitness]] in obese people.<ref>{{Cite journal |vauthors=Scott D, Shore-Lorenti C, McMillan LB, Mesinovic J, Clark RA, Hayes A, Sanders KM, Duque G, Ebeling PR |date=March 2018 |title=Calf muscle density is independently associated with physical function in overweight and obese older adults |journal=Journal of Musculoskeletal and Neuronal Interactions |location=Likovrisi |publisher=Hylonome Publications |volume=18 |issue=1 |pages=9–17 |issn=1108-7161 |pmc=5881124 |pmid=29504574}}</ref> [[Body composition]] in general is hypothesized to help explain the existence of metabolically healthy obesity—the metabolically healthy obese are often found to have low amounts of [[Ectopia (medicine)|ectopic]] fat (fat stored in tissues other than adipose tissue) despite having overall fat mass equivalent in weight to obese people with [[metabolic syndrome]].<ref>{{Cite journal |vauthors=Karelis AD |date=October 2008 |title=Metabolically healthy but obese individuals |journal=[[The Lancet]] |language=en |volume=372 |issue=9646 |pages=1281–1283 |doi=10.1016/S0140-6736(08)61531-7|pmid=18929889 |s2cid=29584669 }}</ref>{{Rp|page=1282}}