Obesity paradox: Does being overweight really protect against heart disease? Here's the truth

Obesity paradox: Recent studies have shown that the "obesity paradox" might not be as true as once thought. When researchers used waist-to-hip ratio instead of BMI, they found that obese people had a higher chance of dying from heart disease (Image: Canva)

Obesity is when a person has too much body fat, often measured using Body Mass Index (BMI). A BMI over 25 is considered overweight, and over 30 is classified as obese. Obesity is linked to many health problems, like heart disease, high blood pressure, and diabetes. However, there has been some confusion around the idea of the "obesity paradox," which suggests that in certain cases, being overweight may actually help people with heart conditions have better outcomes. But is this really true?

The obesity paradox

The "obesity paradox" is a term used to describe how some studies have shown that people with a BMI over 25 who have heart disease seem to do better than thinner people with the same condition, says Dr Mayur Jain, Consultant Cardiothoracic Surgeon, P.D. Hinduja Hospital & MRC, Mahim. He adds, “This goes against what we usually believe about obesity being bad for heart health. The idea is that, in some cases, heavier patients may recover better from heart problems like coronary artery disease or heart failure.”

Dr Jain continues, “Obesity paradox is confusing, but recent research suggests that the benefits of being overweight may have been overstated. When we look at factors like waist-to-hip ratio instead of just BMI, we see that obesity is still a big risk for heart problems. Recent studies have shown that the "obesity paradox" might not be as true as once thought. When researchers used waist-to-hip ratio instead of BMI, they found that obese people had a higher chance of dying from heart disease.”

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“One reason some of the early studies seemed to show better outcomes for obese patients is that many of them were younger and had higher blood pressure, which affected the results. So, it wasn’t their weight helping them, but other factors like age and health conditions,” Dr Jain adds.

BMI isn’t perfect:

One of the reasons for the confusion is that BMI doesn’t differentiate between fat, muscle, and bone, and it doesn’t show where fat is stored in the body. “For instance, a wrestler, with lot of muscle, and a sumo wrestler, with more fat, could have the same BMI, but their risk for heart disease would be very different.” explains Dr Jain.

He informs that to get a clearer picture, doctors are now using other ways to measure body fat, like waist circumference and waist-to-hip ratio. “They also look at other factors, like hormones called natriuretic peptides, which are released when the heart is under stress. People with obesity often have lower levels of these hormones, making it harder to understand how their weight affects their heart.”

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Research suggests that obesity itself doesn’t protect against heart disease. The idea that heavier patients had better outcomes was due to factors like their age and health, not their weight. Obesity remains a major risk for heart disease and heart failure. “Obesity is still one of the biggest risk factors for heart disease. While the obesity paradox raised some interesting questions, the best way to prevent heart problems is to manage weight and live a healthy lifestyle."

Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis.