Editing Obesity (section)

==== 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}}