Metabolically healthy obese individuals are still at high risk for diabetes: Application of the marginal structural model

Hye Ah Lee, Hyesook Park

Research output: Contribution to journalArticlepeer-review


Aim: To assess the effect of obesity phenotype on the incidence of diabetes, considering phenotype as a time-varying exposure. Methods: We used community-based cohort data from the Korean Genome and Epidemiology Study, with a 16-year follow-up period. Obesity phenotype was determined using body mass index and metabolic syndrome criteria. The influence of obesity phenotype on the occurrence of diabetes was evaluated using a Cox proportional hazard model and a marginal structural model (MSM). Results: Obesity phenotypes were defined in 6265 individuals, with diabetes identified in 903 (14.4%) during the follow-up period. Individuals with metabolically healthy obesity (MHO) exhibited a higher risk of diabetes compared to those with metabolically healthy normal weight (MHNW), with a hazard ratio (HR) of 1.48 (95% confidence interval [CI] 1.15-1.90). This association remained significant after applying the MSM (HR 1.49, 95% CI 1.01-2.20). Moreover, various sensitivity analyses consistently demonstrated a higher risk of diabetes in individuals with MHO compared to those with MHNW. Conclusions: Even when obesity phenotype was treated as a time-varying exposure, individuals with MHO were still at higher risk for developing diabetes than those with MHNW. Consequently, such individuals should aim to avoid transitioning to a metabolically unfavourable state and strive to reduce their body weight to a normal range.

Original languageEnglish
Pages (from-to)431-440
Number of pages10
JournalDiabetes, Obesity and Metabolism
Issue number2
StatePublished - Feb 2024

Bibliographical note

Publisher Copyright:
© 2023 John Wiley & Sons Ltd.


  • diabetes
  • metabolic syndrome
  • obesity
  • risk factor


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