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

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.