Obesity Paradox - Dubai Cardiology Clinic

Obesity is one of the risk factors for cardiovascular disease but in the case of already developed disease, overweight and obesity are associated with a favorable prognosis, the overall mortality is less in overweight and obese people than normal or underweight people, the exclusion for that paradox is marked obesity when the BMI over 40 kg/m2.

“During the last the past decade, there is increasing evidence that patients, especially elderly, with several chronic diseases and elevated BMI may demonstrate lower all-cause mortality and cardiovascular mortality compared with normal weight or underweight patients.” That what we call “obesity paradox”.

Explanation of obesity paradox:

There some idea can explain this phenomenon such as:

• The comorbid factors in elderly people often result in loss of body weight.
• The increase level of serum lipoproteins in obese person may neutralize bacterial toxins and circulating cytokines by anti-inflammatory effect.
• Cardiovascular diseases are usually diagnosed and treated earlier in obese patient than in thin patient.
• With overweight and obese patients, the dose of medication and compliance is better than normal weight and slim patients.
• Obese patients have larger blood vessels and so in the course of revascularization they get better result than narrowed blood vessels in underweight patients.
• Antithrombotic medication adjusted in obese people better than in normal or underweight people and so fewer bleeding complications.
• “Cardiorespiratory fitness” in obese and overweight, has positive effect.
• lipoprotein hypothesis, it known that obese patients have high lipoprotein levels, which may have anti-inflammatory action and probably also protect from arrhythmia.

There is recent review about the Protective effects of overweight and obesity in some chronic diseases such as:

1 – Peripheral arterial disease, (PVD) it noticed that the overall mortality is 54% in underweight, 50% in normal weight 40% in overweight, 31% in obese subjects.

2 – Stroke; overweight and obese showed better survival.

3 – Thromboembolism.

4 – Complication after cardiac surgery as non-cardiac surgery apart from bariatric surgery is less in obese people.

5 – Ablation for atrial fibrillation via catheter is less complication in obese than in normal or underweight people.

6 – In- hospital mortality in surgical intensive care unit.

7 – Patient with diabetes 2.

8 – Chronic obstructive pulmonary disease (COBD) and its acute exacerbation.

9 – Hemodialysis patients.

10 - Obese critically ill patients in intensive care units had lower mortality (0.77).

11 – Osteoporosis seems affected positively by obesity (increase level of leptin, insulin, estrogens that stimulate bone growth and inhibit bone remodeling in women).

Criticisms to Obesity Paradox

There is some criticism to obesity paradox such as:

• It is depending more on observational studies which may cause some artifact and biases.
• Smoker usually leaner but smoking cessation reduce mortality in slim and overweight subjects.
• It is well known that weight reduction by healthy life style modification is effective in reducing the risk of premature death.
• Unintentional weight loss is an extremely significant predictor of mortality ( illness- induced weight loss).
• Most study used BMI for obesity parameter but is not enough, so we should use waist circumference and waist to hip ratio then the obesity paradox may be questionable.

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