Visual Abstract

Metabolically healthy (MH) and unhealthy (MUH) obesity may have heterogeneous long-term health risks for diabetes and related adverse effects. We investigated trends in the prevalence of obesity phenotypes in US adults from 1988-2018.

Methods: We used data from adults ages 20-79 years assessed in the National Health and Nutrition Examination Survey 1988-2018. Participants were classified into six mutually exclusive groups based on the combination of weight status and presence of metabolic morbidity.

Results: The prevalence of MUH obesity increased from 23.6% in 1988-1994 to 36.7% in 2015-2018 (p<.05), while the prevalence of obesity without metabolic morbidity rose from 2.6% to 7.3% (p<.05) in the same period. The prevalence of other phenotypes declined in the same period. In particular, the prevalence of MUH normal-weight has declined from 21.5% in 1988-1994 to 10.7% in 2015-2018 (p<.05).

Discussion: In contrast to the perception that “healthy obesity” is rising, our findings suggest that indeed obesity accompanied by metabolic morbidity has risen dramatically in the past 30 years. This may signal future declines in population health and an increase in healthcare costs.

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Disclosure

S. A. Patel: None. D. Choi: None.

Funding

National Institutes of Health (P30DK111024, P30DK111024-04S2)

© 2021 by the American Diabetes Association
2021
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