Karelis commented on the concept of metabolically healthy but obese individuals in a recent issue of The Lancet. Despite being obese diagnosed on the basis of their body mass index, a large proportion (up to 30%) of obese subjects is not characterized by an atherogenic and diabetogenic metabolic risk profile. These individuals have a low accumulation of intra-abdominal (visceral) fat, which would explain their healthy metabolic profile, whereas high-risk obese patients have ectopic fat deposition. Karelis had also suggested previously that these metabolically healthy but obese individuals responded differently to a weight loss program than obese individuals with metabolic disturbances. The article suggests, therefore, that treating all obese individuals with the same approach may not be appropriate.
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