A The quick handgrip test could do more than measure muscle strength. can predict who is 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 sweeping the world, driven primarily 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.
Import
Obesity was officially 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 body shape) indices of obesity 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 not clear how this development is affected by muscle strength.
Body mass index (BMI) is the most common measure used to diagnose obesity. However, it fails to distinguish between total lean mass and muscle mass versus fat mass, although they play very different roles in health. Athletes, for example, may have a high BMI because of their muscle hypertrophy, but they are not obese.
BMI also fails to identify the location of fat distribution, even though visceral fat deposition is associated with cardiovascular disease (CVD) and metabolic dysfunction, unlike other locations. Furthermore, obesity diagnoses based on BMI do not capture many obese phenotypes. In many young and middle-aged adults, total body fat percentage more accurately describes obesity than BMI, even in those with a normal BMI.
Visceral obesity is associated with muscle weakness, increased odds of physical disability, chronic disease (including cardiovascular disease), and death. Thus, muscle strength and function much better reflect obesity-related health consequences.
Again, low grip strength predicts a higher risk of death over age 50, independent of obesity (as defined by BMI). In contrast, obesity or overweight as defined by BMI has sometimes been found to show protective associations against mortality among people over 70 years of age. Therefore, BMI alone is not a useful indicator of obesity risk.
About the study
Data were obtained from UK Biobank. Both BMI and any of 18 signs of obesity-related dysfunction were identified, including signs of increased intracranial pressure, cardiovascular disease, apnea, chronic fatigue, heart failure, hypertension, kidney disease, and chronic severe knee pain.
The current study sought 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 together with one of the following measurements in excess:
- Waist circumference
- Waist-hip ratio
- Waist-height ratio
- Body fat percentage
Three models were used to track handgrip strength trajectories from baseline to decline in function or death. The first model tracked three transitions, from baseline to obesity-induced first impairment, then to dual impairment, and finally to all-cause death. The second he traced it to first dysfunction and then to all-cause mortality. The third model progressed from baseline to death, with no obesity-related dysfunction in between.
Muscle-to-weight ratio (MWR) was defined as the ratio of total thigh fat-free muscle volume to body weight, while 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 is related to the risk of obesity-related disorders and death.
Study results
There were 8,163 deaths during a mean follow-up period of 13.4 years. The risk of progression to preclinical obesity stages decreased with each standard deviation (SD) increase in grip strength.
The greatest reduction in risk was found in the first model, in progression from baseline to first dysfunction, where the risk decreased by 14% per increase in SD handgrip strength. For the second progression, the risk was reduced by 8% and by 13% during the third transition.
In the second model, similar reductions were observed in the two progressions. Even without any dysfunction, grip strength predicted a 9% lower risk of progression from baseline to all-cause mortality (the third model).
Compared among third parties, higher grip strength was protective across all models. The strongest effect was on transition from dual impairment to all-cause death, where the risk decreased by 23% per SD increase in handgrip strength.
These findings confirm previous research indicating that 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 developing preclinical obesity than DXA data, indicating that the latter may underestimate aging-related muscle loss.
Mechanisms underlying the association of better health with increased grip strength in high BMI individuals could include the relationship between grip strength and reduced body fat percentage, as fat deposition is the driver of obesity-related dysfunctions. On average, people with higher grip strength also had 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 can disrupt these protective pathways. However, these mechanisms were suggested as possible explanations rather than directly tested in this study. In addition, the authors report that low muscle strength may parallel reduced bone mineral 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 reduced risk of developing obesity-related disorders and all-cause mortality.
However, as an observational study, it does not prove causation.
Future studies should validate these results and extend them to other obesity models. These findings suggest that increasing 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.
