As global obesity rates continue to rise, it is important to understand the origin, role and range of human variation of body mass index (BMI) in assessing health and healthcare. A growing body of evidence suggests that BMI is a poor indicator of health across populations, and that there may be a metabolically healthy obese phenotype. Here, we review the reasons why BMI is an inadequate tool for assessing cardiometabolic health. We then suggest that cold climate adaptations may also render BMI an uninformative metric. Underlying evolutionary and environmental drivers may allow for heat conserving larger body sizes without necessarily increasing metabolic health risks. However, there may also be a potential mismatch between modern obesogenic environments and adaptations to cold climates, highlighting the need to further investigate the potential for metabolically healthy obese phenotypes among circumpolar and other populations as well as the broader meaning for metabolic health. Lay Summary Global obesity rates are on the rise; however, body mass index (BMI) is a poor indicator of metabolic health. Here, we propose that cold climate populations may exhibit high BMIs, but relatively healthy metabolic profiles (metabolically healthy obesity) due to environmental and evolutionary pressures associated with inhabiting a cold climate.
Ocobock, C; Niclou, A
Commentary-fat but fit horizontal ellipsis and cold? Potential evolutionary and environmental drivers of metabolically healthy obesity
Evolution Medicine And Public Health