Obesity ParadoxThe idea that a high BMI appears to be protective and decreases death in people, but also is associated with increased risk of death. ***More simply put - there is data out there that shows being overweight can be a good thing for some, yet a bad thing for others***AcronymsHTN : hypertensionNormal BMI (Nml) <25Overweight (OW) BMI 25-29.9Obese (Ob) >= 30Evidence showing OW+ is bad for our health:Tons of it out there, I don't think I need to list too many. But here are some as it is still important to remember this.Arch Intern Med. 2002 Sep 9;162(16):1867-72. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience.Wilson PW1, D'Agostino RB, Sullivan L, Parise H, Kannel WB.Looked at relationships between BMI and CVD risk factors, CVD endpoints prospectively from the Framingham HEart Study of ppl 35-75 who were followed for up to 44 years. CV endpoints the looked at: Angina, MI, Coronary hrt dz, or stroke. Conclusions: the overweight category is assoc with increased relative and population risk for HTN, and CVD. Ob risk of HTN was 42%OW risk of HTN was 27.8%Nml  risk of HTN 15.3%NHANES III (1988-1994) to NHANES III (1999-2000)Showed increase prevalence of Metabolic Syndrome (MetSyn) and that weight was associated with increased risk of MetSyn:Nml 5%OW 22%Ob 60%http://care.diabetesjournals.org/content/34/1/216.longN Engl J Med. 2002 Aug 1;347(5):305-13.Obesity and the risk of heart failure.Kenchaiah S1, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, Kannel WB, Vasan RS.5881 participants in Framingham. Used Cox proportional-hazards modelFound: For each 1 unit increase in BMI women’s risk of heart failure increased by 7%, 5% in men. Nurses’ Health Studyhttps://www.ncbi.nlm.nih.gov/pubmed/7872581114,281 female registered nurses aged 30 to 55 years who did not have diagnosed diabetes mellitus, coronary heart disease, stroke, or cancer in 1976. Over 11 states. Findings: BMI <22 assoc with lowest risk of T2DMBMI >35 was associated with 6X higher “relative risk” of T2DMLook AHEAD study and othersHave shown that even a 5% weight loss can improve risk profiles for diabetes and cardiovascular healthLancet. 2014 Aug 30;384(9945):755-65. doi: 10.1016/S0140-6736(14)60892-8. Epub 2014 Aug 13.Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults.Bhaskaran K1, et. al.“Assuming causality, 41% of uterine and 10% or more of gallbladder, kidney, liver, and colon cancers could be attributable to excess weight. We estimated that a 1 kg/m(2) population-wide increase in BMI would result in 3790 additional annual UK patients developing one of the ten cancers positively associated with BMI.”***granted i’m not sure any paper should have been published that uses the world “assume.” After all that just makes a “bleep” out of you and me. But as other studies do seem to show an assoc we’ll let it slide*****************************************************So there is a lot of data out there that shows associations between excess fat mass and MetSyn, HR, cancers, and 200+ diseases. From some evidence you would conclude that obesity does cause health problems. The Obesity Paradox:The strange thing is of the people getting diseases, the people who have the better prognosis are the ones overweight!!! And while all the above more talk about risk factors, we still do see patients of normal weight getting HTN, having coronary hrt disease, T2DM, getting the other 200+ diseases.Am J Med. 2007 Oct;120(10):863-70.Obesity paradox in patients with hypertension and coronary artery disease.Uretsky S1, et. al.22,576 ppl with HTN and CADOutcomes looked at:  first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke.Obese Class I(30-35) had a HR of 0.68 compared to Nml BMI patients. Lancet. 2006 Aug 19;368(9536):666-78. Association of bodyweight with total mortality and with cardiovascular events in coron...