Obesity Phenotypes and Their Relationship with Visceral Adiposity and Adiponectin in an Indian Outpatient Cohort

Background: Obesity is a heterogeneous condition with diverse metabolic profiles and fat distribution patterns. Body mass index (BMI) alone may not adequately reflect adiposity and cardiometabolic risk. Different obesity phenotypes metabolically healthy obese (MHO), metabolically unhealthy obese (MUO), metabolically obese normal weight (MONW), normal weight obese (NWO), and lipodystrophy may have varying metabolic risks. This study aimed to characterize obesity phenotypes in a North Indian cohort and assess their anthropometric, metabolic, and biochemical profiles along with associated comorbidities. Methods: A cross-sectional study was conducted in the Department of Medicine at a tertiary care hospital between January and October 2024. A total of 100 adults aged 18–70 years with BMI ≥23 kg/m² were included. Anthropometric measurements and body composition parameters were assessed using bioimpedance analysis. Biochemical investigations included fasting glucose, insulin, lipid profile, liver and thyroid function tests, and serum adiponectin levels. Participants were classified into five phenotypes: MUO, MHO, MONW, NWO, and lipodystrophy. Statistical analysis was performed using SPSS version 25. Results: MUO was the most prevalent phenotype (46%), followed by MHO (29%), NWO (12%), MONW (8%), and lipodystrophy (5%). MUO individuals had significantly higher visceral fat, insulin resistance, adverse lipid profiles, and the lowest adiponectin levels (p <0.001). Metabolically unhealthy phenotypes showed higher prevalence of diabetes/prediabetes, hypertension, coronary artery disease, and sarcopenia (p <0.05). Conclusion: Obesity phenotypes show significant metabolic heterogeneity not captured by BMI alone. Phenotype-based assessment may improve cardiometabolic risk stratification and guide targeted management in South Asian populations.