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[The obesity paradox]

Rémi C Martin Du Pan, Alain Golay

    Revue Medicale Suisse
    |July 25, 2014
    PubMed

    Insights

    The obesity paradox reveals that moderate obesity may lower mortality in older adults with heart conditions, unlike in the general population. This suggests healthier lifestyle choices in some obese individuals may influence outcomes.

    Area of Science:

    • Cardiology
    • Obesity Research
    • Public Health

    Context:

    • Cardiovascular (CV) mortality generally rises with obesity severity, measured by body mass index (BMI).
    • A contrasting trend, the "obesity paradox," is observed in patients with existing coronary diseases or heart failure.
    • This paradox shows reduced global mortality in older adults (over 65) with moderate obesity (BMI 30-35) compared to normal weight (BMI 20-25) and morbidly obese (BMI > 35) individuals.

    Purpose:

    • To investigate the "obesity paradox" in cardiovascular patient cohorts.
    • To explore potential reasons for the observed mortality differences in relation to obesity levels.
    • To highlight the limitations of Body Mass Index (BMI) in assessing cardiovascular risk.

    Summary:

    • In older patients with heart failure or coronary disease, moderate obesity (BMI 30-35) is linked to lower mortality than normal weight or severe obesity.
    • This phenomenon may stem from the healthier metabolic profiles and lifestyles of the moderately obese individuals studied.
    • Body Mass Index (BMI) is insufficient for evaluating abdominal obesity, a key factor in metabolic syndrome and CV risk, as it doesn't differentiate fat mass from lean mass.

    Impact:

    • Challenges the universal association between obesity and increased mortality, particularly in specific patient populations.
    • Underscores the need for nuanced understanding of obesity's role in cardiovascular health beyond simple BMI categorization.
    • Suggests further research into the interplay of body composition, metabolic health, lifestyle, and outcomes in obese cardiovascular patients.

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