The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used

Obes Rev. 2014 Oct;15(10):781-90. doi: 10.1111/obr.12198. Epub 2014 Jul 16.


We performed a systematic review of the prevalence of metabolically healthy obesity (MHO). Medline, Web of Science and EMBASE were searched for original articles from inception to November 2013. Only prospective and cross-sectional studies were included. After screening 478 titles, we selected 55 publications, of which 27 were population-based studies and were used in the narrative synthesis. From the 27 studies, we identified 30 definitions of metabolic health, mainly based on four criteria: blood pressure, high-density lipoprotein cholesterol, triglycerides and plasma glucose. Body mass index ≥30 kg m(-2) was the main indicator used to define obesity (74% of the studies). Overall, MHO prevalence ranged between 6% and 75%. In the studies that stratified the analysis by sex, prevalence was higher in women (seven out of nine studies) and in younger ages (all four studies). One-third of the studies (n = 9) reported the response rate. Of these, four reported a response rate of ≥70% and they showed MHO prevalence estimates between 10% and 51%. The heterogeneity of MHO prevalence estimates described in this paper strengthens calls for the urgent need for a commonly established metabolic health definition.

Keywords: Epidemiology; obesity phenotype; prevalence.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Biomarkers / blood
  • Blood Glucose / physiology*
  • Blood Pressure / physiology*
  • Body Composition
  • Body Mass Index
  • Cholesterol, HDL / blood*
  • Cross-Sectional Studies
  • Health Behavior
  • Humans
  • Obesity / classification
  • Obesity / epidemiology*
  • Obesity / metabolism
  • Prevalence
  • Prospective Studies
  • Triglycerides / blood*


  • Biomarkers
  • Blood Glucose
  • Cholesterol, HDL
  • Triglycerides