Obesity paradox

Obesity paradox

Obesity paradox is that people with established cardiovascular diseases including hypertension, heart failure, coronary artery disease and peripheral arterial disease, have better prognosis if they are overweight or obese [1].

Four obesity related paradoxes have been listed:

  1. Classic obesity paradox: obesity is protective in chronic disease states
  2. Preobesity paradox: overweight is protective in normal populations
  3. Fat-but-fit concept: obesity is not a risk factor for mortality in fit individuals
  4. Metabolically healthy obesity: phenotype associated with younger age, higher levels of physical activity, better nutritional quality and low levels of visceral adipose tissue

This does not mean that obesity is a negative risk factor for cardiovascular disease. Obesity has an important causal role in insulin resistance, metabolic syndrome, type 2 diabetes mellitus, hypertension, dyslipidemia, abnormal left ventricular geometry, endothelial dysfunction and heart failure. Obesity can predispose to coronary artery disease, obstructive sleep apnea and atrial fibrillation.


  1. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009 May 26;53(21):1925-32.