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


  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.
  2. Neeland IJ, Poirier P, Despres JP. Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management. Circulation. 2018 Mar 27;137(13):1391-1406.