Metabolic Features of Individuals with Obesity Referred for Bariatric and Metabolic Surgery: a Cohort Study.
Level 4 - case-series / case-control
Cross-sectional analysis of baseline metabolic parameters in a single surgical cohort
PubMed 31468305 · doi:10.1007/s11695-019-04067-0
What was done
Researchers evaluated baseline metabolic profiles of 600 patients referred for bariatric and metabolic surgery. Metabolic obesity phenotypes were defined using blood pressure, glucose, lipids, uric acid, and lipoprotein levels. Independent t-tests and general linear models with repeated measures were used to compare metabolically healthy and unhealthy phenotypes, oral glucose tolerance test (OGTT) curve shapes, and associated risk factors.
What was found
Of the 600 participants, 108 (18.0%) were classified as metabolically healthy obese (MHO) and 492 (82.0%) as metabolically unhealthy obese (MUO). Baseline body weight was significantly higher in the MUO group (P < 0.001). Non-phasic OGTT curves were observed in 100% of glucose, 100% of C-peptide, and 95.8% of insulin curves in the MUO group. Men had higher odds of elevated lipid levels than women (OR = 1.83, 95% CI 1.21–2.77). Compared with class I obesity, class II/III obesity was associated with elevated blood pressure (OR = 2.22, 95% CI 1.43–3.44), glucose (OR = 1.73, 95% CI 1.11–2.68), and uric acid levels (OR = 3.61, 95% CI 2.29–5.69).
Why it matters
This study demonstrates that nearly one in five patients seeking bariatric surgery retains a metabolically healthy profile despite severe obesity. Identifying specific physiological markers like non-phasic OGTT curves can aid preoperative metabolic risk stratification.
Limits
The study is cross-sectional, precluding causal inferences about progression between phenotypes. Findings are restricted to a tertiary bariatric surgery referral cohort and may not generalize to the broader population with obesity. Post-surgical longitudinal outcomes and long-term metabolic stability were not reported in the abstract.
Cited by
- supports Some individuals with a BMI over 40 have normal insulin, blood sugar, lipids, low hs-CRP, and no apparent chronic disease.