The first time I read what metabolically healthy meant, I believed it was a very spurious terminology. It meant the patient was obese without any parameters for metabolic syndrome, such as, hypertension, diabetes or dyslipidemia. Physiologically, this is not possible via a systemic inflammatory standpoint. This is again the issue with the 70 kg white military men metrics from World War 1 and World War 2. These numbers don’t truly represent what’s going on in the population today with genetically modified food, and high fructose sugar in food, not to mention the particulate environmental pollution that the current population is exposed to.
Ultimately, bench and clinical research have to be undertaken to determine present day inflammatory markers, such as, interleukins and inflammatory mediator markers that reveal what is going on in the body once one reaches a BMI of 27.0. This is already a heightened inflammatory state. Most clinicians don’t even assess prehypertension or recommend the DASH and MIND diet for dietary weight loss methods. The patients are just told to lose weight. There is no obesity medicine consult, dietitian or nutritionist consult. Most patients need support to be disciplined to consistently, and sustainably lose weight.
Luckily with the new drugs, such as, Semaglutide and Mounjora, most adults and adolescents will no longer need Bariatric Surgery to maintain weight loss. The only issue is you have to stay on these drugs indefinitely to keep the weight off, so far in the current literature.