Wildman 2008: Normal Weight with Cardiometabolic Risk
Wildman et al. • Archives of Internal Medicine
Key Finding
23.5% of normal-weight adults have metabolic dysfunction; BMI alone misses risk
Original title: “The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering”
Plain English Summary
NHANES analysis finding 23.5% of normal-weight adults have cardiometabolic abnormalities while 51% of overweight adults are metabolically healthy.
In-Depth Analysis
Background
Wildman RP, Muntner P, Reynolds K, et al. Arch Intern Med. 2008;168(15):1617-1624. PMID: 18695075
This cross-sectional analysis of NHANES data from Albert Einstein College of Medicine challenged the assumption that normal BMI indicates metabolic health, identifying a substantial population of "metabolically obese normal weight" individuals.
Study Design
| Parameter | Details |
|---|---|
| Design | Cross-sectional analysis of NHANES 1999-2004 |
| Population | 5,440 US adults aged ≥20 years |
| Classification | BMI categories × cardiometabolic risk clustering |
| Definition | ≥2 of: elevated BP, TG, glucose, hsCRP, low HDL, insulin resistance |
Key Findings
| BMI Category | Metabolically Unhealthy |
|---|---|
| Normal weight (BMI <25) | 23.5% |
| Overweight (BMI 25-29.9) | 48.5% |
| Obese (BMI ≥30) | 68.2% |
Conversely, 31.7% of obese individuals were metabolically healthy.
Mechanistic Insights
The disconnect between BMI and metabolic health relates to body composition and fat distribution. Normal-weight individuals with visceral adiposity, low muscle mass, or hepatic fat accumulation ("TOFI" - thin outside, fat inside) can have significant cardiometabolic risk.
Clinical Implications
BMI alone is insufficient for cardiovascular risk assessment. Nearly 1 in 4 normal-weight adults have cardiometabolic abnormalities. Metabolic biomarkers should be assessed regardless of weight status.
Metabolic Health Perspective
This study validates the importance of metabolic markers (TG/HDL ratio, HOMA-IR, hsCRP) over simple anthropometrics. The WHtR calculator captures some of this risk that BMI misses by assessing visceral adiposity.
Paradigm Relevance
How this study applies to different clinical perspectives:
Standard Medical
Conventional clinical guidelines used by most doctors
Not directly relevant to this paradigm
Research Consensus
RelevantCurrent scientific understanding, often ahead of guidelines
Metabolic Optimization
RelevantProactive targets for optimal health, not just disease absence
Study Details
- Type
- Cohort Study
Related Biomarkers
Original Source
DOI (Digital Object Identifier) is a permanent link to this publication. Unlike website URLs that can change, a DOI always resolves to the correct source.
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