A quick handgrip test could do more than measure muscle power; it might predict who’s most at risk of obesity-related diseases long before symptoms appear.
Study: Handgrip Strength and Trajectories of Preclinical Obesity Progression: A Multistate Model Analysis Using the UK Biobank. Image credit: Microgen/Shutterstock.com
The obesity epidemic is overtaking the world, driven mainly by unhealthy lifestyle choices. Its association with multiple long-term adverse health outcomes highlights the urgent need to identify predictors of obesity that could guide preventive strategies. A recent study published in The Journal of Clinical Endocrinology & Metabolism examines the value of handgrip strength in predicting the progression of preclinical obesity.
Introduction
Obesity was formally recognized as a disease in January 2025, in a consensus statement published in The Lancet Diabetes & Endocrinology. Preclinical obesity refers to elevated anthropometric (related to the body shape) obesity markers but without functional impairment due to obesity.
Preclinical obesity can progress to clinical obesity, characterized by metabolic dysfunction and a higher risk of death. It is unclear how this progression is affected by muscle strength.
The body mass index (BMI) is the most common measure used to diagnose obesity. However, it fails to distinguish between lean mass overall and muscle mass vs. fat mass, though these play very different roles in health. Athletes, for instance, may have a high BMI due to their muscle hypertrophy but are not obese.
The BMI also fails to specify the site of fat distribution, even though visceral fat deposition is associated with cardiovascular disease (CVD) and metabolic dysfunction, unlike other sites. Moreover, BMI-based obesity diagnoses do not capture many obese phenotypes. In many young and middle-aged adults, total body fat percentage more accurately describes obesity than BMI, even among those with normal BMI.
Visceral obesity is linked to muscle weakness, increased odds of physical disability, chronic disease (including CVD), and death. Muscle strength and function thus reflect obesity-related health consequences much better.
Again, low handgrip strength predicts a higher risk of death over the age of 50 years, independent of obesity (as defined by the BMI). Conversely, BMI-defined obesity or overweight has sometimes been found to show protective associations against mortality among people over 70 years. Thus, BMI alone is not a helpful marker of obesity risk.
About the study
The data came from the UK Biobank. Both BMI and any of 18 signs of obesity-related dysfunction were identified, such as signs of raised intracranial pressure, CVD, apnea, chronic fatigue, heart failure, hypertension, kidney disease, and chronic severe knee pain.
The current study attempted to capture the association of handgrip strength with the transition from preclinical to clinical obesity. This group was identified by the presence of a high body mass index along with one of the following measures in excess:
- Waist circumference
- Waist-to-hip ratio
- Waist-to-height ratio
- Percentage of body fat
Three models were used to track handgrip strength trajectories from the baseline to decline in function or death. The first model tracked three transitions, from the baseline to the first obesity-induced dysfunction, then to double dysfunction, and finally to all-cause death. The second tracked it to the first dysfunction and then to all-cause mortality. The third model progressed from baseline to death, without any obesity-related dysfunction in between.
The muscle-to-weight ratio (MWR) was defined as the ratio of total thigh fat-free muscle volume to body weight, while the lean-to-weight ratio (LWR) was defined as the ratio of total lean mass to body weight. These were based on magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA), respectively.
Finally, the researchers analyzed how grip strength was related to the risk of developing obesity-induced dysfunctions and of death.
Study results
There were 8,163 deaths over the mean follow-up period of 13.4 years. The risk of progression across the stages of preclinical obesity was reduced with each standard deviation (SD) of increase in handgrip strength.
The greatest reduction in risk was found in the first model, in the progression from baseline to first dysfunction, where the risk dropped by 14% per SD handgrip strength increase. For the second progression, the risk dropped by 8%, and by 13% across the third transition.
In the second model, similar decreases were seen in the two progressions. Even without any dysfunction, grip strength predicted a 9% lower risk of progressing from baseline to all-cause mortality (the third model).
When compared across tertiles, the highest grip strength tertile was protective in all models. The strongest effect was on the transition between double dysfunction to death from all causes, where the risk dropped by 23% per SD increase in handgrip strength.
These findings corroborate earlier research that indicates muscle strength is more accurately related to body composition than BMI. Muscle strength is lower with visceral obesity, while increased grip strength is associated with better glucose and lipid regulation.
Interestingly, MWR was more strongly associated with a reduced risk of preclinical obesity progression than DXA data, indicating that the latter may underestimate aging-associated muscle loss.
The underlying mechanisms of the association of better health with increased grip strength in people with high BMI could include the link between grip strength and reduced body fat percentage, since fat deposition is the driver of obesity-related dysfunctions. On average, individuals with higher grip strength also showed lower levels of the inflammatory marker C-reactive protein (CRP) at baseline.
Skeletal muscle secretes myokines, molecules that help regulate metabolism and insulin sensitivity. Reduced muscle strength might disrupt these protective pathways. However, these mechanisms were proposed as potential explanations rather than directly tested in this study. Additionally, the authors mention that low muscle strength may parallel reduced bone density, which has been associated in previous studies with cardiovascular risk.
Conclusions
For the first time, this study showed that
Increased grip strength was significantly associated with a decreased risk of obesity-induced dysfunctions progression and multiple-cause mortality.
However, as an observational study, it does not prove causation.
Future studies should validate these results and extend them to other models of obesity. These findings suggest that building up muscle strength may be an early intervention to prevent the progression of preclinical obesity. These results apply to individuals with preclinical obesity at baseline and may not generalize to other populations.
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