The metabolically obese, normal-weight individual revisited.
Abstract
Nearly 20 years ago, it was suggested that individuals exist who are not obese on the basis of height and weight, but who, like people with overt obesity, are hyperinsulinemic, insulin-resistant, and predisposed to type 2 diabetes, hypertriglyceridemia, and premature coronary heart disease. Since then it has become increasingly clear that such metabolically obese, normal-weight (MONW) individuals are very common in the general population and that they probably represent one end of the spectrum of people with the insulin resistance syndrome. Available evidence also suggests that MONW individuals could account for the higher prevalence of type 2 diabetes, cardiovascular disease, and other disorders in people with a BMI in the 20-27 kg/m2 range who have gained modest amounts of weight (2-10 kg of adipose mass) in adult life. Specific factors that appear to predispose MONW, as well as more obese individuals, to insulin resistance include central fat distribution, inactivity, and a low VO2max. Because these factors are potentially reversible and because insulin resistance may contribute to the pathogenesis of many diseases, it is our premise that a compelling argument can be made for identifying MONW individuals and treating them with diet, exercise, and possibly pharmacological agents before these diseases become overt, or at least early after their onset. One reason for doing so is that disorders such as type 2 diabetes may be accompanied by irreversible consequences, e.g., ischemic heart disease and nephropathy, at the time of diagnosis or shortly thereafter. Another is that MONW individuals in general should be younger and more amenable and responsive to diet and exercise therapy than are obese patients with established disease. That long-term diet and exercise can work is suggested by two large studies in which, over 5-6 years, the incidence of diabetes was diminished in nonobese and minimally obese patients with impaired glucose tolerance. Based on these considerations and the emerging worldwide epidemic of type 2 diabetes, we believe that studies to assess whether therapies aimed at young MONW individuals can prevent the development of type 2 diabetes and other diseases, including perhaps obesity itself, are urgently needed.
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Some individuals have the metabolic syndrome with only a moderate degree of total body obesity.
“Indeed, as mentioned before, some individuals exhibit the metabolic syndrome with only a moderate degree of total body obesity.43,44”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [43]
The US population varies considerably in degree of insulin resistance; those with more inherent insulin resistance can develop the metabolic syndrome with only moderate excess abdominal fat, while even people with little or no inherent insulin resistance can develop it if they accumulate marked abdominal obesity.
“Moreover, the population of the United States varies considerably in degree of insulin resistance 46 ; those having more inherent insulin resistance can develop the metabolic syndrome with only moderate excess in abdominal fat, 43,44 but even people with little or no inherent insulin resistance can develop the metabolic syndrome if they accumulate marked abdominal obesity.3,8”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [43]
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- Authors
- Ruderman, N., Chisholm, D., Pi-Sunyer, X., & Schneider, S.
- Affiliations
- Boston University (US)
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 1998-05-01
- Volume
- 47
- Issue
- 5
- Pages
- 699-713
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2141917949
- Cited by
- 893
- References
- 25
- Citations by year
- 2026: 21 · 2025: 16 · 2024: 14 · 2023: 31 · 2022: 19 · 2021: 23 · 2020: 36 · 2019: 23 · 2018: 44 · 2017: 49 · 2016: 58 · 2015: 49 · 2014: 37 · 2013: 46 · 2012: 42
- FWCI
- 8.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk019514-35)
- National Heart, Lung, and Blood Institute (P01HL055854, P01 HL 55854)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-49147, DK-19514, R01DK049147)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- metabolic syndrome, type 2 diabetes prevention, hyperinsulinemia, central fat distribution, physical inactivity, VO2max, impaired glucose tolerance, cardiovascular disease, hypertriglyceridemia, coronary artery disease, obesity, diet and exercise therapy, prediabetes
- MeSH terms
- Adult, Body Weight, Diabetes Mellitus, Diabetes Mellitus, Type 2, Disease Susceptibility, Female, Humans, Hyperinsulinism, Hypertension, Insulin Resistance, Male, Middle Aged, Obesity, Hypertriglyceridemia
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