Lifestyle and weight predictors of a healthy overweight profile over a 20-year follow-up

Abstract

Objective To examine whether changes in modifiable risk factors [physical activity, cardiorespiratory fitness (CRF), body weight, and diet composition] are associated with the transition to metabolically healthy overweight/obese (MHOW) versus metabolically abnormal overweight/obese. Methods Analysis included 1,358 adults [aged 25.0 (3.5) years] from the CARDIA study who were healthy at baseline and had overweight/obesity at follow-up. Participants with zero or one of the following six risk factors were classified as MHOW: elevated triglycerides, LDL, blood pressure, fasting glucose, and HOMA-insulin resistance and low HDL. Results Over the 20-year follow-up, the sample gained weight (BMI 24.5 to 31.1 kg/m2), and the prevalence of MHOW was 47% at follow-up. After adjusting for changes in CRF, diet, and weight change, physical activity and macronutrient intake were not independently associated with MHOW (P>0.05), while changes in CRF [fit-unfit: RR (95%)=0.58, 0.52-0.66; unfit-unfit: RR=0.67, 0.58-0.76, versus fit-fit] and weight [gain: RR (95%)=0.54, 0.43-0.67; cycle: RR=0.74, 0.57-0.94, versus stable] were independently associated with MHOW. Conclusions Focusing on high CRF and strategies to limit weight gain may be important for individuals with overweight and obesity in early to mid-adulthood to maintain a metabolically healthy profile.