We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk .
Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .
INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success .
About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .
Associations of Cardiorespiratory Fitness and Obesity With Risks of Impaired Fasting Glucose and Type 2 Diabetes in Men
OBJECTIVE —The purpose of this study was to examine the associations of cardiorespiratory fitness ( hereafter fitness ) and various obesity measures with risks of incident impaired fasting glucose ( IFG ) and type 2 diabetes .  RESEARCH DESIGN AND METHODS —This was a prospect i ve cohort study of 14,006 men ( 7,795 for the analyses of IFG ) , who did not have an abnormal electrocardiogram or a history of heart attack , stroke , cancer , or diabetes . RESULTS —Of the men , 3,612 ( 39,610 person-years ) and 477 ( 101,419 person-years ) developed IFG and type 2 diabetes  , respectively . Compared with the least fit 20 % in multivariate analyses , IFG and type 2 diabetes risks in the most fit 20 % were 14 and 52 % lower , respectively ( both P < 0.001 ) . Men with BMI ≥30.0 kg/m2 , waist girth > 102.0 cm , or percent body fat ≥25 had 2.7- , 1.9- , and 1.3-fold higher risks for type 2 diabetes , respectively , compared with those for nonobese men ( all P < 0.01 ) , and the results for IFG were similar . In the combined analyses , obese unfit ( least fit 20 % ) men had a 5.7-fold higher risk for type 2 diabetes compared with normal-weight fit ( most fit 80 % ) men . We observed similar trends for the joint associations of BMI and fitness with IFG and those of waist girth or percent body fat and fitness with both IFG and type 2 diabetes . CONCLUSIONS —Low fitness and obesity increased the risks of IFG and type 2 diabetes by approximately similar magnitudes . When considered simultaneously , fitness attenuated but did not eliminate the increased risks of IFG and type 2 diabetes associated with obesity , and the highest risk was found in obese and unfit men
We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk .
Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .
INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success .
About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .