The ‘Obesity Paradox’ Paradox
What if a paradox is demonstrated to not be so paradoxical after all? Can a paradox be a double negative?
The “obesity paradox”, developed in 1999 from observations that patients undergoing dialysis for end-stage kidney disease had lesser mortality if overweight or obese (BMI of 25-29.9 and 30-34.9, respectively) compared to normal weight or lean patients. Subsequent findings showed this to be the case in heart failure, COPD, nursing home and heart attack patients.
Against all expectations, where being overweight or obese are often deemed greater risks for early death, it turned out that maybe being a bit overweight is actually protective! What a paradox!
However, it may be a wrong paradox if this study out of the UK is right.
The obesity paradox posits that there is such a thing as healthy obesity. So researchers at the University of Birmingham (England), with access to 3.5 million patients, an enormous subject pool that can only be mined where a national healthcare system exists, found that ‘metabolically healthy obese’ people – people without any prior diagnosis of diabetes, high blood pressure, or high cholesterol – weren’t all that healthy 5 years later.
Reviewing health data 5.3 years after initial assessment, they found that those who were initially metabolically healthy and obese developed higher rates of coronary heart disease (49% higher risk), cerebrovascular disease (7% higher risk), and heart failure (96% higher risk) than those who were metabolically healthy and normal weight.
As lead author, Dr.Rishi Caleyachetty says, “So-called ‘metabolically healthy’ obesity is clearly not a harmless condition and the term should no longer be used in order to prevent misleading individuals that obesity can be healthy.”
So what’s the paradox here?
It seems that being overweight or obese, even if you’re not diseased at the moment, carries the risk that you will be sooner rather than later after your normal weight peers. The burden on the heart, kidneys, vascular system, especially of the brain, is gradually building up. In some, slower than others because of good genes, healthy and active lifestyles, etc.
But statistically, more overweight people who then become obese tend to do so because they do not ascribe by the standard principles of healthy active lifestyles. And it is that, rather than pure excess weight alone, that may be turning the tide against cardiovascular health.
If there’s a paradox, maybe it’s that those who are overweight and/0r obese despite concerted efforts to eat well, maintain an appropriate caloric balance, exercise sufficiently and manage stress may be able to stave off disease longer than their weight or BMI would suggest. A recent study from Germany supports this model as an “important intermediate step” primary care docs should strive toward.
In other words, just do it.
Health Canal Sept. 11, 2017