Meeting physical activity guidelines is associated with metabolic healthy obesity among patients pursuing metabolic bariatric surgery
*Amir Ebadinejad 1, Pavlos Papasavas 1, *Yin Wu 1, *Juan P. Cobar 1, *Raymond McKay 3, *Connie Santana 1, *Lucas Carr 2, *Anna Schwartz 1, Darren Tishler 1, *Dale Bond 1
1Surgery, Hartford Hospital, Hartford, CT; 2Department of Health and Human Physiology, University of Iowa, Iowa City, IA; 3Cardiology, Hartford Hospital, Hartford, CT
Background
Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) phenotypes are largely underexplored in the context of metabolic bariatric surgery (MBS). Moreover, it is not known if physical activity (PA), which plays a critical role in improving and maintaining cardiometabolic health, differentiates MBS patients with the MHO versus the MUO phenotype. Therefore, our study aimed to assess whether MBS patients who meet the national aerobic PA guideline are more likely to be categorized as MHO versus MUO.
Study Design
After obtaining IRB approval, we conducted a cross-sectional, single-center, observational study of 490 patients with obesity who were pursuing MBS between August 2022 and November 2023. Participants were classified as having MHO or MUO based on the revised National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria. Participants who met ?2 abnormal findings out of 4 (i.e., high blood pressure (?130/ 85 mmHg or Rx); high triglycerides (?150 mg/dL or Rx); low HDL-C (? 40 and 50 mg/dL in men and women, respectively or Rx); high glucose (fasting plasma glucose ? 100 mg/dL or HbA1C ? 5.7 or Rx) were classified as having MUO. The Physical Activity Vital Sign (PAVS) screening tool identified whether patients were meeting the national PA guideline (i.e., ?150 weekly minutes of moderate-to-vigorous intensity PA). The comparisons between MHO and MUO groups were tested with Independent-Samples Mann-Whitney U tests or Person Chi-square/Fisher’s Exact tests. A multivariate logistic regression was performed to evaluate whether being physically active was associated with higher likelihood of being in the MHO group.
Results
Of the 490 participants (82.2% female, mean age=41.9±11.3 years; mean BMI=43.9±7.0 kg/m2) 389 (79.4%) had MUO and 101 (20.6%) had MHO. The population comprised 45.1% white and 16.7% black, with the majority being non-Hispanic/Latino (60.6%), showing no significant difference between the groups. A higher proportion of MHO were active compared to MUO (37.6% vs. 27.4%, p=.045). Additionally, participants who were active had 75% greater odds of being in the MHO group compared to those who were inactive, adjusting for age, sex, smoking status, and BMI (OR = 1.7, 95% CI: 1.05, 2.91, p=.03).
Conclusion
One-fifth of patients pursuing MBS were classified as having the MHO phenotype. Patients who were active were more likely to have the MHO phenotype compared to those patients who were inactive. These findings support additional research to test whether phenotypic switching (MUO to MHO) in the context of severe obesity is possible through PA intervention.
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