Study Probes Healthy, Unhealthy Diet Differences to Explore Metabolically Healthy Obesity

Healthy, Unhealthy Diet

The phrase ‘healthy obese people’  may seem like an oxymoron, but there are certain obese people who are considered healthy. There is a category of obese individuals known as the metabolically healthy obese (MHO)—these are obese individuals that have a lack of ailments such as low glucose tolerance or metabolic syndrome. A study looks into the differences in dietary patterns between metabolically healthy obese people and non-MHO individuals to see whether measurements of healthy and unhealthy diets could identify any trends.

There is no hard-and-fast definition of metabolically healthy obesity. For this study, the researchers defined MHO as being obese but having fewer than two cardiometabolic risk factors. These risk factors included things like high blood pressure, being on medication for high cholesterol, and symptoms of metabolic syndrome. Twenty-four-hour dietary recall data was used to calculate Healthy Eating Index (HEI) scores. As the name implies, the HEI is a measure of how healthy a diet is and awards points on a 100-point scale, based on things like nutrient intake, low consumption of solid fats, or added sugars.

The results were interesting, but mixed. For instance, when comparing MHO to non-MHO individuals, the metabolically healthy obese adolescents had higher milk scores and did better on solid fats, alcohol, and added sugars. MHO women who were aged 19–44 scored better on whole fruit, whole grain, meat, and beans when compared to their non-MHO equivalents. Unfortunately, men aged 19–44 didn’t show significant differences in their HEI scores.

These differences vanished when the HEI scores were compared for obese individuals who were aged 45–85. In this category, the MHO group showed no significant difference in their scores compared to the non-MHO group. Interestingly, this was also the age category in which the highest HEI scores were seen. If you’re interested, their high score was an average of 56 out of 100—this should give you a sense of what the lower yet better-compared scores of the younger groups looked like.

What This Means

There are three main takeaways from these findings:

  • Among MHO adolescents and women aged 19–44, diets were healthier than their non-MHO counterparts.
  • HEI scores stopped showing meaningful differences after age 44 for women and did not show major differences at any age for men.
  • HEI scores were, overall, fairly low and suggest that even the metabolically healthy obese eat unhealthy diets, or at least diets with significant room for improvement.


Pett, K., “Overweight and Healthy,” Tufts Now web site, August 30, 2016;, last accessed September 2, 2016.

Camhi, S. et. al., “Healthy eating index and metabolically healthy obesity in U.S. adolescents and adults,” Preventive Medicine web site, 2015; 10.1016/j.ypmed.2015.04.023.