The obesity paradox: weighing the benefit

Abstract

Obesity has become a medical and socioeconomic burden of epidemic proportions and the World Health Organization (WHO) has marked obesity as one of the most blatantly visible but most neglected public health problems. Indeed, being overweight is an established risk factor for the development of many different diseases including cardiovascular, metabolic, and orthopaedic illnesses. In contrast, obesity has not been associated with a worse outcome in all patient populations. In fact, substantial data have accumulated suggesting a survival benefit in patients with existing chronic cardiovascular diseases for patients who are overweight and moderately obese. In chronic heart failure (CHF), convincing evidence has accumulated from studies including >30 000 patients over a broad spectrum of disease severity, that being overweight is associated with decreased mortality.1–4 Similarly, in patients with acutely decompensated heart failure, higher body mass index (BMI) is associated with lower in-hospital mortality.5 Despite the known role of obesity as a major risk factor for cardiovascular events,6–8 the mortality risk after an acute myocardial infarction is no higher in overweight and obese patients compared with lighter patients.9 In a systematic review of 40 studies including a total of >250 000 patients with coronary artery disease, a better outcome for cardiovascular and total mortality was seen in the overweight and mildly obese groups … *Corresponding author. Applied Cachexia Research, Department of Cardiology, Charite Medical School, Campus Virchow-Medical Center, Augustenburger Platz 1, D-13353 Berlin, Germany. Tel: +49 30 450 553 507, Fax: +49 450 553 951, Email: wolfram.doehner{at}charite.de