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Introduction Population-based studies have identified an obese phenotype that is not accompanied by adiposity-associated cardio-metabolic risk factors. This instability may explain the inconsistency in findings between studies with shorter and longer follow-up periods in relation to healthy obesity and the risk of incident type 2 diabetes and cardiovascular disease 2 , 3. In particular, the characteristics of healthy obese participants that remain stable or develop metabolic abnormalities are poorly understood. In the Whitehall II study of British men and women, more than half of healthy obese adults progressed to an unhealthy obese state after 20 years 5.

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