Does metabolically healthy obesity really exist: going toward new definitions.

Such discordance has led to the concept of "metabolically healthy obesity," describing individuals with excess adiposity but without overt metabolic abnormalities.

这种不一致性导致了“代谢健康型肥胖”概念的提出，描述的是那些脂肪过多但没有明显代谢异常的个体。

However, the validity and clinical relevance of metabolically healthy obesity remain controversial.

然而，代谢健康型肥胖的有效性和临床相关性仍然存在争议。

evidence_acquisition

We conducted a narrative review of PubMed-indexed studies examining obesity phenotypes considering the recent preclinical/clinical obesity framework proposed by the Lancet Commission on Diabetes and Endocrinology.

我们对PubMed索引的研究进行了叙述性回顾，这些研究检查了考虑了《柳叶刀》糖尿病和内分泌学委员会最近提出的临床前/临床肥胖框架的肥胖表型。

Preference was given for large epidemiological cohorts and mechanistic studies with detailed phenotyping.

优先考虑大型流行病学队列和具有详细表型的机制研究。

evidence_synthesis

The metabolically healthy obesity concept is limited by inconsistent definitions, reliance on cardiometabolic risk factors, and poor long-term stability.

代谢健康型肥胖的概念受到定义不一致、依赖心血管代谢风险因素以及长期稳定性差的限制。

Emerging evidence supports a shift toward a disease-based framework distinguishing preclinical obesity (excess adiposity with preserved organ and tissue function) from clinical obesity which is associated with organ dysfunction.

新兴的证据支持向基于疾病的框架转变，将临床前肥胖（脂肪过多但器官和组织功能保持完好）与临床肥胖（与器官功能障碍相关的肥胖）区分开来。

Conclusions

Replacing binary metabolic phenotypes with the preclinical and clinical obesity framework proposed by the Lancet Commission provides a biologically grounded, clinically actionable model that aligns obesity classification with organ dysfunction and disease progression.

将二元代谢表型替换为《柳叶刀》委员会提出的临床前和临床肥胖框架，提供了一个生物学基础的、临床可行的模型，该模型将肥胖分类与器官功能障碍和疾病进展对齐。

Adopting a continuum-based, function-oriented approach may improve risk stratification, guide therapeutic prioritization, and reduce misconceptions surrounding "benign" obesity.

采用基于连续体的、以功能为导向的方法可能会改善风险分层，指导治疗优先级，并减少围绕“良性”肥胖的误解。