Obesity increases the risk of several other chronic diseases and, because of its epidemic proportions, has become a major public health problem worldwide. Alarmingly, a lower proportion of adults have tried to lose weight during the past decade than during the mid-1980s to 1990s. The first-line treatment option for obesity is lifestyle intervention. Although this approach can decrease fat mass in the short term, these beneficial effects typically do not persist. If a large amount of weight loss is not an easily achievable goal, other goals that might motivate people with obesity to adopt a healthy lifestyle should be considered. In this setting, the concept of metabolically healthy obesity is useful. Accumulating evidence suggests that, although the risk of all-cause mortality and cardiovascular events might be higher in people with metabolically healthy obesity compared with metabolically healthy people of a normal weight, the risk is substantially lower than in individuals with metabolically unhealthy obesity. Therefore, every person with obesity should be motivated to achieve a normal weight in the long term, but more moderate weight loss sufficient for the transition from metabolically unhealthy obesity to metabolically healthy obesity might also lower the risk of adverse outcomes. However, how much weight needs to be lost for this transition to occur is under debate. This transition might be supported by lifestyle factors-such as the Mediterranean diet-that affect cardiovascular risk, independent of body fat. In this Series paper, we summarise available information about the concept of metabolically healthy obesity, highlight gaps in research, and discuss how this concept can be implemented in clinical care.

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代谢性健康肥胖：肥胖症治疗的低挂症？

肥胖症增加了其他几种慢性疾病的风险，并且由于其流行程度，已成为世界范围内的主要公共卫生问题。令人震惊的是，在过去十年中，尝试减肥的成年人比例低于1980年代中期至1990年代。肥胖的一线治疗选择是生活方式干预。尽管这种方法可以在短期内减少脂肪量，但是这些有益效果通常不会持续存在。如果大量减肥不是一个容易实现的目标，则应考虑其他可能促使肥胖者采取健康生活方式的目标。在这种情况下，代谢健康肥胖的概念很有用。越来越多的证据表明，尽管与正常体重的代谢健康人群相比，代谢健康的肥胖人群的全因死亡率和心血管事件的风险可能更高，但该风险远低于代谢不健康的肥胖人群。因此，每个肥胖者均应长期保持体重正常，但是较适度的体重减轻足以使新陈代谢异常的肥胖者转变为新陈代谢健康的肥胖者，也可能降低不良后果的风险。但是，要实现这种过渡需要减轻多少重量仍在讨论中。这种转变可能受到生活方式因素（例如地中海饮食）的支持，这些因素会影响心血管风险，而与体内脂肪无关。在本系列论文中，