Is the Obesity Paradox Changing Our Understanding of Health Risks?

[zoobyshoe]

And quite a paradox it is. Goes against everything we have been taught:

A few years ago, Mercedes Carnethon, a diabetes researcher at the Feinberg School of Medicine at Northwestern University, found herself pondering a conundrum. Obesity is the primary risk factor for Type 2 diabetes, yet sizable numbers of normal-weight people also develop the disease. Why?

In research conducted to answer that question, Dr. Carnethon discovered something even more puzzling: Diabetes patients of normal weight are twice as likely to die as those who are overweight or obese. That finding makes diabetes the latest example of a medical phenomenon that mystifies scientists. They call it the obesity paradox.

In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments. The accumulation of evidence is inspiring some experts to re-examine long-held assumptions about the association between body fat and disease.

Dr. Carl Lavie, medical director of cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute in New Orleans, was one of the first researchers to document the obesity paradox, among patients with heart failure in 2002. He spent more than a year trying to get a journal to publish his findings.

“People thought there was something wrong with the data,” he recalled. “They said, ‘If obesity is bad for heart disease, how could this possibly be true?’ ”

But there were hints everywhere. One study found that heavier dialysis patients had a lower chance of dying than those whose were of normal weight or underweight. Overweight patients with coronary disease fared better than those who were thinner in another study; mild to severe obesity posed no additional mortality risks.

In 2007, a study of 11,000 Canadians over more than a decade found that those who were overweight had the lowest chance of dying from any cause.

To date, scientists have documented these findings in patients with heart failure, heart disease, stroke, kidney disease, high blood pressure — and now diabetes.

Experts are searching for explanations...

http://www.nytimes.com/2012/09/18/h...uggests-fitness-matters-more-than-weight.html

 

[Ryan_m_b]

This is Dr Carnethon's faculty profile
http://fsmweb.northwestern.edu/faculty/facultyProfile.cfm?xid=14797

The publication list has not been updated since March so whatever study it is that prompted this article is not listed.

 

[ApplePion]

The "paradox" does not seem so paradoxical. For example, if a thin person has type 2 diabetes then it might be because he has some bizarre severe underlying problem--normally thin people do not get type 2 diabetes. Indeed the person mght have some partial type 1 diabetes (or may have simply been misdiagnosed as having type 2). While type 2 is commonly thought to be insulin resistance, there is actually often a component of low insulin production, the hallmark of type 1.

Type 1 diabetes is positively associated with thinness (not because thinness is intrinsically causing it, but rather because type 1 causes wasting) and is more serious than type 2.

 

[Evo]

This is Dr Carnethon's faculty profile
http://fsmweb.northwestern.edu/faculty/facultyProfile.cfm?xid=14797

The publication list has not been updated since March so whatever study it is that prompted this article is not listed.

That was just a brief mention in the first two paragraphs, the article itself mentions a dozen different studies and is probably best summed up here

Research that does tease apart weight and fitness — like a series of studies conducted by Steven Blair at the Cooper Institute in Dallas — shows that being fat and fit is better, healthwise, than being thin and unfit.

The article isn't about diabetes either, it's about all diseases previously considered to be "obesity related".

Since the article is a hodgepodge of "this and that", you have to read the entire article to get the "gist".

 

[zoobyshoe]

This is Dr Carnethon's faculty profile
http://fsmweb.northwestern.edu/faculty/facultyProfile.cfm?xid=14797

The publication list has not been updated since March so whatever study it is that prompted this article is not listed.

Several different doctors from different fields of medicine are quoted in the article. The "paradox" ranges over a wide list of diseases. Dr. Carl Lavie is cited as "one of the first researchers to document the obesity paradox, among patients with heart failure in 2002." He's quoted the most in the article, so I suspect, if I had to guess, the author had the most contact with him, that he prompted the article.

 

[zoobyshoe]

The article isn't about diabetes either, it's about all diseases previously considered to be "obesity related".

Since the article is a hodgepodge of "this and that", you have to read the entire article to get the "gist".

Yes, the "gist" seems to be that, under stress of disease, fat people fare much better than thin people, which goes against expectation.

 

[ApplePion]

The article isn't about diabetes either, it's about all diseases previously considered to be "obesity related".

Most of the diseases associated with obesity are in some way connected with diabetes. For example, the article mentions kidney disease. Diabetes is a major risk factor for kidney disease. It also is a major risk factor for high blood pressure which is also a major risk factor for kidney disease.

One way we can pretty much know that it is the diabetes (and pre-diabetes) that is causing the obesity related diseases is that people who are obese but have their excess weight on their lower body are not at increased risk of diabetes...and turn out not to be at increased risk for heart disease either. That is quite a coincidence.

And even forgetting the diabetes connection, the same general principle I gave for diabetes likely applies elsewhere. For example, a person with 160/100 blood pressure who is not overweight might very well need to be pretty sick to have that high a pressure, while an obese person with that same blood pressure might have little else4 wrong with him except things relating to obesity.

An interesting thing in your article, and one that is quite true, is that very thin people have a much higher death rate than slightly obese people, and that slighly overweight people have the lowest death rates.