The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used

Abstract

Summary: We performed a systematic review of the prevalence of metabolically healthy obesity (MHO). Medline, W eb of S cience and EMBASE were searched for original articles from inception to N ovember 2013. Only prospective and cross‐sectional studies were included. After screening 478 titles, we selected 55 publications, of which 27 were population‐based studies and were used in the narrative synthesis. From the 27 studies, we identified 30 definitions of metabolic health, mainly based on four criteria: blood pressure, high‐density lipoprotein cholesterol, triglycerides and plasma glucose. Body mass index ≥30 kg m−2 was the main indicator used to define obesity (74% of the studies). Overall, MHO prevalence ranged between 6% and 75%. In the studies that stratified the analysis by sex, prevalence was higher in women (seven out of nine studies) and in younger ages (all four studies). One‐third of the studies (n = 9) reported the response rate. Of these, four reported a response rate of ≥70% and they showed MHO prevalence estimates between 10% and 51%. The heterogeneity of MHO prevalence estimates described in this paper strengthens calls for the urgent need for a commonly established metabolic health definition.