Individualisation of care and the obesity paradox

The obesity 'paradox' has recently been discussed based upon the observation that although obesity may be a major causative factor in certain conditions, its presence appears to be protective once that condition occurs. There is a growing body of persuasive evidence to support the obesity paradox in diseases including renal failure and heart failure. Recent evidence is reliable, adjusting more effectively for confounders such as smoking and intercurrent illness, which make lower weight an unhealthy state. The existence of the paradox highlights the fact that approaches to weight management are not as simple as inducing the loss of a few kilograms in overweight and obese individuals, and emphasises the importance of individualisation of care in obesity management taking into account age, ethnicity and comorbid illness. This article explores the individualisation of care in obesity, drawing attention to the obesity paradox in particular.