Skip to content

Improving risk estimates for metabolically healthy obesity and mortality using a refined healthy reference group

Research output: Contribution to journalArticle

Original languageEnglish
JournalEuropean Journal of Endocrinology
Early online date31 May 2017
DateAccepted/In press - 30 May 2017
DateE-pub ahead of print (current) - 31 May 2017


Objective: We aimed to re-examine mortality risk estimates for metabolically healthy obesity by using a 'stable' healthy non-obese referent group.

Design: prospective cohort study

Methods: Participants were 5,427 men and women (aged 65.9 ± 9.4 years, 45.9% men) from the English Longitudinal Study of Ageing. Obesity was defined as body mass index ≥ 30 kg/m2 (vs. non-obese as below this threshold). Based on blood pressure, HDL-cholesterol, triglycerides, glycated haemoglobin, and C-reactive protein, participants were classified as 'healthy' (0 or 1 metabolic abnormality) or 'unhealthy' (≥ 2 metabolic abnormalities).

Results: 671 deaths were observed over an average follow up of 8 years. When defining the referent group based on 1 clinical assessment, the unhealthy non-obese (Hazard ratio = 1.22; 95% CI, 1.01, 1.45) and unhealthy obese (1.29; 1.05, 1.60) were at greater risk of all-cause mortality compared to the healthy non-obese, yet no excess risk was seen in the healthy obese (1.14; 0.83, 1.52). When we re-defined the referent group based on 2 clinical assessments, effect estimates were accentuated and healthy obesity was at increased risk of mortality (2.67; 1.64, 4.34).

Conclusion: An unstable healthy referent group may make 'healthy obesity' appear less harmful by obscuring the benefits of remaining never obese without metabolic dysfunction.

    Structured keywords

  • ICEP

Download statistics

No data available



  • Full-text PDF (accepted author manuscript)

    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via BioScientifica at Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 522 KB, PDF document


View research connections

Related faculties, schools or groups