Epidemiology of metabolic health: Lifestyle determinants and health-related quality of life

Overweight and obesity often leads to the development of a disturbed glucose metabolism, increased blood pressure and a disturbed fat profile (too low values of the "good" HDL-cholesterol and high triglycerides values). The combination of these metabolic complications, is called the metabolic syndrome. The metabolic syndrome is associated with an increased risk of type 2 diabetes and cardiovascular diseases. About one in four Europeans have the metabolic syndrome. Even though the metabolic syndrome is usually caused by obesity, a sub-group of obese people seem to be less susceptible to the metabolic health risks. They have an equally healthy metabolism as lean people. In the literature, this is referred to as metabolically healthy obese.
In ten large population studies from seven different European countries the occurrence of the metabolic syndrome and metabolically healthy obesity has been estimated. The metabolic syndrome is common in Europe and the Netherlands. However, in the Dutch LifeLines study still nearly 1 out of 4 obese women and 1 out of 10 obese men are metabolically healthy (depending on their age). From studies with LifeLines data only, it seems that the smoking-, drinking-, eating- and exercise behavior of people is important. The degree of tobacco use and drinking more than one alcoholic drink per day was already related to the development of the metabolic syndrome. However, a 'healthy' dietary pattern and intensive vigorous physical activity increased in obese people the chance of metabolically healthy obesity. Actively changing lifestyle factors will reduce the number of people that will develop the metabolic syndrome, and consequently will reduce the incidence of type 2 diabetes and cardiovascular diseases. However, even before these more serious chronic conditions occur, obese subjects (without metabolic complications) had an impaired quality of life. Therefore, in the treatment of obesity it is advisable to take into account aspects of quality of life.