Obesity paradoxes
McAuley PA and Blair SN (2011) J Sports Sci 29: 773 - 782
Objective: Summarise information for 4 different obesity-related paradoxes in relation to mortality risk: Classic obesity paradox (obesity is protective in chronic disease states); Pre-obesity (overweight is protective in normal populations); Fat but fit (obesity is not a risk factor for mortality in fit individuals); and Healthy obesity (a sizeable population of obese adults has normal cardiometabolic risk profiles)
Design: Narrative review
Results & Conclusions: Obesity paradox is evident in a number of disease states. Overweight (and obesity) in some studies has been associated with lower mortality risk. Higher fitness can attenuate/eliminate mortality risk from obesity. However, the likelihood of having high fitness is influenced by BMI with the number of fit individuals falling as BMI increases. ~30% of obese population are 'healthy' as defined by no more than 1 cardiometabolic risk factor, although they may have other non-cardiometabolic disorders. A large proportion of overweight and obese populations are not at risk for premature death and low cardiovascular fitness and inactivity are a greater health risk.
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