Obesity Paradox: Three Examples

An obesity paradox is like catnip for the media — unfortunately. And so various forms of obesity paradox have been in the news lately. Here are three examples getting a lot of attention.

1. Diabetes Obesity Paradox. A study in the New England Journal of Medicine this week debunked the notion that people with excess weight and type 2 diabetes might have a survival advantage. They don’t. Said the research team, “We found no evidence of lower mortality among patients with diabetes who were overweight or obese at diagnosis, as compared with their normal-weight counterparts, or of an obesity paradox.” Prior studies were inadequately controlled for smoking, chronic diseases, and frailty.
    
2. Obesity Mortality Paradox. The mortality associated with obesity has been hotly debated in popular media, using fragmentary reporting of scientific publications. The latest reports come from the American Journal of Public Health and the American Journal of Epidemiology, both affirming a substantial cost in mortality risk for obesity. Those who wish to keep contrary thinking alive will point to data from people with excess weight, but not obesity, showing no excess mortality risk in this group. Though epidemiologists continue to debate that particular point, the harmful health effects of obesity are indisputable.
    
3. Cardiovascular Disease Obesity Paradox. More than a decade ago, Luis Gruberg coined the phrase “obesity paradox” to describe lower mortality in coronary interventions for people with higher BMIs. This observation spawned a series of obesity paradox observations in cardiovascular disease. The puzzle cleared up with subsequent research that showed cardiorespiratory fitness was an important predictor of mortality, perhaps more so than obesity alone. But arguments that obesity might not be a problem in cardiovascular disease are specious.

 
A paradox is “a statement or proposition that, despite sound (or apparently sound) reasoning from acceptable premises, leads to a conclusion that seems senseless, logically unacceptable, or self-contradictory” (Oxford English Dictionary). Often, a paradox is an invalid argument or it’s based on arcane nuances meant to stimulate critical thought. Unfortunately, critical thought seldom shines through in popular media reporting of an obesity paradox. So in the end, the coverage often serves to confuse more than enlighten. Advocates for denying that obesity is a health problem use the confusion to advance their agenda.

Click here to read more about the diabetes obesity paradox in the LA Times, here to read the study in the NEJM, here and here to read two recent studies of obesity and mortality risk, and click here to read a new review of the cardiovascular disease obesity paradox.

There Is and There Is Not, photograph © Hartwig HKD / flickr

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