The Obesity Paradox by Guest Blog writer Dr. James Beckerman

As a cardiologist with a strong interest in prevention, eating better and exercising more are a cornerstone of my prevention prescription. But every once in a while, I am intrigued by new scientific studies that provide data which contradict, challenge, or just clarify our basic understanding of how the body works. For example, a recently published paper found that consuming saturated fat from meat does not appear to increase our risk of heart disease – a later study specified that eating processed meat appears to account for the perception of increased risk. We need to be flexible with our recommendations and maintain an open mind as physicians so we can best counsel our patients and provide a consistent (and accurate) public health message.

One of the tougher things to negotiate is the so-called “obesity paradox.” This is the idea – supported by research – that mildly obese people (body mass index 30-35) with heart disease may do as well or even better than lower weight individuals. They do not appear to experience increased risk after heart surgery, or for future hospitalizations from congestive heart failure. They may even live longer. So what does this mean? We already know from other studies that obesity is a cardiac risk factor…so can being mildly obese somehow be protective once you already have been diagnosed with heart disease? Does this suggest that we should watch our weight until we have a heart attack, but then feel free to go nuts and gain weight without worry?

Probably not. There may be some confounders that can explain this apparent paradox. In general, people who are the sickest – from any cause – tend to lose weight rather than gain it. Therefore, less serious heart disease will be less likely to cause someone to lose weight and become cachectic. Another possible variable is aggressiveness of care. If an obese person with chest pain is more likely to be taken seriously by a paramedic than a normal weight individual, the obese individual might receive better care and therefore be expected to have better outcomes.

A key point is that while mild obesity may not be associated with worse outcomes, having a body mass index greater than 35 continues to be associated with significant risk, even after a diagnosis of heart disease. It’s true that we tend to focus most on numbers – like weight, body mass index, fat percentage – rather than on lifestyle choices like eating more fiber, fruit, and fish, or increasing our frequency and intensity of activity and exercise. We already know that the fittest individuals can safely fall in the “overweight” category of body mass index (25-30) without evidence of significantly increased risk. So it may be that the “obesity paradox” is more observation rather than a prescription that should significantly impact that we way we live our lives. And it suggests that doctors might focus more on lifestyle choices rather than just looking at the bottom line – in more ways than one!

James Beckerman, MD is a cardiologist in Portland, Oregon. He is the Heart Expert and runs the Weight Loss forum on He is the author of The Flex Diet, and evidence-based approach to healthy weight loss which emphasizes personalization and choice – it bends so that you don’t break. Read more at

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2 responses to “The Obesity Paradox by Guest Blog writer Dr. James Beckerman

  1. There is significant research on the “obesity paradox,” much more than one man’s opinion. If this film is intended to educate and not merely to promote fear and shame, it might be useful to find the researchers and actually discuss the issues with them. We all know about the “obesity epidemic” and all the horrible things that may (or may not) result from obesity. This is not news to anyone! What might be news is the research that isn’t sensationalized. What may also be news is how much of the research around obesity does not take into account surrounding factors. This is true of much academic research, which looks at pinhole issues, often out of context. One must look to the aggregate, which is NOT the same as making broad generalization!

  2. Very nicely written, the true is so many people are overweight because of processed foods, all these foods have chemicals in their which the liver has to eliminate into the waste instead of eliminating the fat.

    If everyone cuts out the processed and junk foods and eat little but often a day, they will see weight lose.
    Eating their 5 a day is essential as they all kick start the metabolism, which increase the rate your body burns fat.

    Eat but eat right!

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