Abstract:
Introduction: Obesity is a heterogeneous chronic disease, and not all individuals with obesity exhibit the same cardiometabolic risk. A subset of patients, referred to as Metabolically Healthy Obesity (MHO), presents preserved metabolic health despite excess adiposity, whereas Metabolically Unhealthy Obesity (MUO) is characterized by multiple metabolic abnormalities and an increased cardiovascular risk. However, the prevalence and determinants of these phenotypes remain insufficiently investigated, particularly in North African populations.
Objective: To determine the prevalence of metabolically healthy obesity in a Moroccan cohort of adults with obesity and to compare the clinical and metabolic characteristics of MHO and MUO phenotypes, while identifying factors independently associated with metabolically unhealthy obesity.
Methods: We conducted a cross-sectional study including 120 adults with obesity (BMI ≥30 kg/m²) followed at the Department of Endocrinology, Diabetology, Metabolic Diseases and Nutrition, Cheikh Khalifa International University Hospital, Casablanca, Morocco.
Participants were classified as MHO or MUO according to predefined metabolic criteria. Demographic, anthropometric, clinical and biochemical data were collected, including waist circumference, blood pressure, glycemic status, lipid profile, hepatic steatosis and serum uric acid. Multivariable logistic regression analysis was performed to identify independent predictors of the MUO phenotype.
Results: A total of 120 patients were included. The mean age was 46.8 ± 12.4 years, with a female predominance (72.5%). Mean BMI was 36.9 ± 5.1 kg/m².
The MHO phenotype was identified in 31 patients (25.8%), whereas 89 patients (74.2%) were classified as MUO.
Compared with MHO subjects, MUO patients were significantly older (50.2 ± 11.6 vs. 37.1 ± 9.8 years; p<0.001) and had a larger waist circumference (116 ± 12 vs. 103 ± 9 cm; p<0.001).
Hypertension (62.9% vs. 9.7%), type 2 diabetes (49.4% vs. 0%), hepatic steatosis (71.9% vs. 29.0%) and hyperuricemia (38.2% vs. 12.9%) were significantly more prevalent among MUO patients (all p<0.001).
MUO patients also exhibited higher HbA1c levels (7.1 ± 1.4% vs. 5.3 ± 0.4%), higher triglyceride concentrations (2.05 ± 0.71 vs. 1.12 ± 0.32 g/L) and lower HDL cholesterol (0.42 ± 0.09 vs. 0.56 ± 0.11 g/L) (all p<0.001).
In multivariable logistic regression analysis, age >45 years (OR 3.4; 95% CI 1.5–7.8; p=0.004), increased waist circumference (OR 4.1; 95% CI 1.8–9.3; p=0.001), hepatic steatosis (OR 3.7; 95% CI 1.6–8.5; p=0.002) and hyperuricemia (OR 2.6; 95% CI 1.1–6.4; p=0.030) were independently associated with the MUO phenotype.
Conclusion: Approximately one-quarter of adults with obesity in our cohort exhibited a metabolically healthy phenotype, highlighting the marked heterogeneity of obesity beyond body mass index alone. Older age, central adiposity, hepatic steatosis and hyperuricemia were independently associated with metabolically unhealthy obesity. These findings emphasize that body mass index alone is insufficient to characterize obesity-related cardiometabolic risk and highlight the importance of comprehensive metabolic phenotyping to support personalized obesity management.
