The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering: Prevalence and Correlates of 2 Phenotypes Among the US Population (NHANES 1999-2004)
Abstract
BACKGROUND: The prevalence and correlates of obese individuals who are resistant to the development of the adiposity-associated cardiometabolic abnormalities and normal-weight individuals who display cardiometabolic risk factor clustering are not well known. METHODS: The prevalence and correlates of combined body mass index (normal weight, < 25.0; overweight, 25.0-29.9; and obese, > or = 30.0 [calculated as weight in kilograms divided by height in meters squared]) and cardiometabolic groups (metabolically healthy, 0 or 1 cardiometabolic abnormalities; and metabolically abnormal, > or = 2 cardiometabolic abnormalities) were assessed in a cross-sectional sample of 5440 participants of the National Health and Nutrition Examination Surveys 1999-2004. Cardiometabolic abnormalities included elevated blood pressure; elevated levels of triglycerides, fasting plasma glucose, and C-reactive protein; elevated homeostasis model assessment of insulin resistance value; and low high-density lipoprotein cholesterol level. RESULTS: Among US adults 20 years and older, 23.5% (approximately 16.3 million adults) of normal-weight adults were metabolically abnormal, whereas 51.3% (approximately 35.9 million adults) of overweight adults and 31.7% (approximately 19.5 million adults) of obese adults were metabolically healthy. The independent correlates of clustering of cardiometabolic abnormalities among normal-weight individuals were older age, lower physical activity levels, and larger waist circumference. The independent correlates of 0 or 1 cardiometabolic abnormalities among overweight and obese individuals were younger age, non-Hispanic black race/ethnicity, higher physical activity levels, and smaller waist circumference. CONCLUSIONS: Among US adults, there is a high prevalence of clustering of cardiometabolic abnormalities among normal-weight individuals and a high prevalence of overweight and obese individuals who are metabolically healthy. Further study into the physiologic mechanisms underlying these different phenotypes and their impact on health is needed.
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Alternative measures such as waist circumference or body fat percentage might be more accurate for detecting excess adiposity and therefore as measures of obesity-related health risks.
“Alternative measures, such as waist circumference or body fat percentage, might be more accurate for the detection of excess adiposity and, therefore, as measures of obesity-related health risks.47”
From Definition and diagnostic criteria of clinical obesity (2025) · cites this paper as [47]
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- Authors
- Wildman, R. P.
- Affiliations
- Albert Einstein College of Medicine (US)
- Corresponding author
- Wildman, Rachel P.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2008-08-11
- Volume
- 168
- Issue
- 15
- Pages
- 1617
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2098059712
- Cited by
- 1,618
- References
- 6
- Citations by year
- 2026: 64 · 2025: 48 · 2024: 59 · 2023: 74 · 2022: 85 · 2021: 88 · 2020: 99 · 2019: 86 · 2018: 120 · 2017: 109 · 2016: 131 · 2015: 125 · 2014: 121 · 2013: 122 · 2012: 90
- FWCI
- 47.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- metabolically healthy obesity, normal-weight individuals, overweight adults, obesity, body mass index, insulin resistance, waist circumference, physical activity, blood pressure, dyslipidemia, C-reactive protein, fasting blood glucose, HDL cholesterol, prevalence, racial and ethnic differences
- MeSH terms
- Adult, Age Factors, Blood Glucose, Blood Pressure, C-Reactive Protein, Cross-Sectional Studies, Female, Health Surveys, Humans, Insulin Resistance, Cholesterol, HDL, Male, Middle Aged, Motor Activity, Obesity, Phenotype, Risk Factors, Triglycerides, United States, Body Mass Index, Cluster Analysis, Racial Groups, Waist-Hip Ratio, Overweight
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