Obesity Isn't Just a Matter of Weight

Researchers already know that obesity is often associated with elevated adipocytokine levels and systemic inflammation that creates endothelial dysfunction (ED) and atherosclerosis. However, some obese patients seem immune to metabolic syndrome (METS). Nevertheless, the current weight-based definitions of obesity don’t consider differences in metabolic health.

In order to identify differences in adipocytokine patterns across obese patients, a team of German researchers examined 20 healthy obese patients and 51 obese patients with METS and compared them to 21 post-bariatric surgery patients. The investigators assessed patients undergoing bariatric surgery at three, six, and 12 months after surgery and tracked systemic inflammatory markers, inflammatory adhesion molecules, and adipokines affecting endothelial function and endothelial dysfunction.

At the conclusion of the study, all of the post-bariatric surgery patients had improved ED, metabolism, adipokines, and anthropometric parameters. On the other hand, the metabolically healthy obese patients had less metabolic impairment and less vascular inflammation than post-bariatric surgery patients, though there were no differences in clinical endothelial dysfunction between those groups.

The post-bariatric surgery patients had superior metabolic improvements compared to the metabolically healthy obese individuals. Additionally, their anthropometric and metabolic parameters — including fasting glucose and insulin levels — had greater improvements compared to the same parameters in the metabolically healthy obese individuals. Post-bariatric surgery patients also had C-reactive protein levels that were 50 percent lower than those recorded in the metabolically healthy obese individuals.

Although the study was small, it contributed to a growing body of evidence that shows all obesity isn’t the same. The researchers concluded that “candidates undergoing bariatric surgery are likely to benefit more if, in addition to the full set of the metabolic syndrome, systemic inflammation and ED are present.”