Predictors of Metabolically Healthy Obesity in Children

  1. Geoff D.C. Ball1,3
  1. 1Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta, Canada
  2. 2School of Kinesiology and Health Sciences, Faculty of Health, York University, Toronto, Ontario, Canada
  3. 3Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  1. Corresponding author: Geoff D.C. Ball, gdball{at}


OBJECTIVES To determine the prevalence of metabolically healthy obesity (MHO) in children and examine the demographic, adiposity, and lifestyle predictors of MHO status.

RESEARCH DESIGN AND METHODS This cross-sectional study included 8–17-year-olds with a BMI ≥85th percentile who were enrolled in a multidisciplinary pediatric weight management clinic from 2005–2010. Demographic, anthropometric, lifestyle, and cardiometabolic data were retrieved by retrospective medical record review. Participants were dichotomized as either MHO or metabolically unhealthy obese (MUO) according to two separate classification systems based on: 1) insulin resistance (IR); and 2) cardiometabolic risk (CR) factors (blood pressure, serum lipids, and glucose). Multivariable logistic regression was used to determine predictors of MHO using odds ratios (ORs) with 95% CIs.

RESULTS The prevalence of MHO-IR was 31.5% (n = 57 of 181) and MHO-CR was 21.5% (n = 39 of 181). Waist circumference (OR 0.33 [CI: 0.18–0.59]; P = 0.0002) and dietary fat intake (OR 0.56 [CI: 0.31–0.95]; P = 0.04) were independent predictors of MHO-IR; moderate-to-vigorous physical activity (OR 1.80 [95% CI 1.24–2.62]; P = 0.002) was the strongest independent predictor of MHO-CR.

CONCLUSIONS Up to one in three children with obesity can be classified as MHO. Depending on the definition, adiposity and lifestyle behaviors both play important roles in predicting MHO status. These findings can inform for whom health services for managing pediatric obesity should be prioritized, especially in circumstances when boys and girls present with CR factors.

  • Received July 18, 2013.
  • Accepted January 14, 2014.

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  1. Diabetes Care
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