contrary to experience in primary prevention, research shows that in secondary prevention for conditions such as cardiac insuffi ciency and coronary syndrome, obese patients have better prognoses than normal-weight patients. Nevertheless, the largest study relating mortality to BMI (pooled data from 19 prospective studies among 1.46 million non-Hispanic white adults in the USA) revealed that overweight and obesity are associated with increases in all-cause mortality.[5] It should also be noted that certain biases may have been introduced in studies reporting the obesity paradox, since such research does not always include multivariate analysis of important predictive factors related to renal function, clinical severity of acute events, biomarkers, and complex pharmacological variables. Consider the INTERHEART Study, carried out in 52 countries, which detected physical inactivity and obesity as two of the nine factors that account for 90% of the risk of acute myocardial infarction.[6] What value would be added to such a study by using ergo-anthropometric scoring to calculate the joint predictive infl uence of these two factors—giving fuller consideration to their interaction?