Obesity contributes to reduced life expectancy, impaired quality of life and disabilities mainly in those individuals who develop cardiovascular diseases, type 2 diabetes, osteoarthritis and cancer. However, there is large variation in the individual risk to develop obesity-associated comorbid diseases which cannot simply be explained by the extent of adiposity. Observations that a proportion of individuals with obesity have a significantly lower risk for cardiometabolic abnormalities led to the concept of metabolically healthy obesity (MHO). Although there is no clear definition, normal glucose and lipid metabolism parameters in addition to the absence of hypertension usually serve as criteria to diagnose MHO. Biological mechanisms underlying MHO include lower ectopic (visceral and liver) and higher leg fat deposition, expandability of subcutaneous adipose tissue, preserved insulin sensitivity and beta-cell function as well as better cardiorespiratory fitness compared to unhealthy obesity. Whereas the absence of metabolic abnormalities may reduce the risk of type 2 diabetes and cardiovascular diseases in metabolically healthy compared to unhealthy individuals with obesity, it is still higher in comparison with healthy lean people. In addition, MHO seems to be a transient phenotype further justifying therapeutic weight loss attempts even in this subgroup which might not benefit from reducing body weight to the same extent as patients with unhealthy obesity. MHO represents a model to study mechanisms linking obesity to cardiometabolic complications. MHO should not be considered a safe condition, which does not require obesity treatment, but may guide decision making for a personalized and risk-stratified obesity treatment.

中文翻译：

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代谢健康肥胖症。

肥胖症主要是在那些患有心血管疾病，2型糖尿病，骨关节炎和癌症的人群中，导致预期寿命缩短，生活质量和残疾受损。但是，发生肥胖相关合并症的个体风险差异很大，这不能简单地通过肥胖程度来解释。观察到一部分肥胖者的心脏代谢异常风险显着降低，这导致了新陈代谢型肥胖（MHO）的概念。尽管没有明确的定义，但除了不存在高血压外，正常的葡萄糖和脂质代谢参数通常可作为诊断MHO的标准。MHO的生物学机制包括较低的异位（内脏和肝脏）和较高的腿部脂肪沉积，与不健康的肥胖症相比，皮下脂肪组织的可扩张性，保留的胰岛素敏感性和β细胞功能以及更好的心肺功能。与不健康的肥胖者相比，缺乏代谢异常可以降低代谢健康的2型糖尿病和心血管疾病的风险，但与健康的瘦人相比仍然更高。此外，MHO似乎是一种短暂的表型，即使在这个亚组中，也进一步证明了治疗性减肥尝试的合理性，这可能无法从减轻体重到与不健康肥胖患者相同的程度上受益。MHO代表了一个模型，用于研究将肥胖与心脏代谢并发症联系起来的机制。MHO不应视为不需要肥胖治疗的安全状况，