Factors Associated with Metabolically Unhealthy Obesity and Its Relation to Food Insecurity in Korean Adults with Obesity.

Objectives: The association between food insecurity and metabolically unhealthy obesity (MUO) in the population with obesity is unclear. We evaluated factors associated with MUO and the relationship between food insecurity and MUO in individuals with obesity.

Methods: We analyzed data from 5191 adults with obesity (body mass index ≥ 25 kg/m) from the 8th Korea National Health and Nutrition Examination Survey 2019-2021. MUO was defined when participants with obesity had any of the following: (1) triglycerides ≥ 150 mg/dL, (2) High-density lipoprotein-cholesterol < 40 mg/dL (men), <50 mg/dL (women), (3) systolic blood pressure ≥ 135 mmHg, diastolic blood pressure ≥85 mmHg or on treatment for hypertension, (4) fasting glucose ≥ 100 mg/dL, or on treatment for diabetes. The odds ratios (ORs) and 95% confidence intervals (CIs) for MUO according to food security status, sociodemographic characteristics, and lifestyle factors were calculated using multivariate logistic regression analysis.

Results: The prevalence of MUO and metabolically healthy obesity (MHO) among the participants was 85.4% and 14.6%, respectively. In the multivariate model, the OR (95% CIs) for MUO in the food insecurity group was 1.87 (1.03-3.43). The odds for MUO were higher among participants with older age, higher BMI, <12 years of education, lower fat intake, non-manual work, and moderated and low physical activity than among their counterparts.

Conclusions: Food insecurity, older age, higher BMI, lower educational level, lower fat intake, non-manual workers, and lower physical activity were associated with MUO. Therefore, targeted interventions and policies are needed for vulnerable groups.