The Obesity Paradox: A Misleading Term That Should Be Abandoned

Abstract

The term "obesity paradox" is a figure of speech, not a scientific term. The term has no precise definition and has been used to describe numerous observations that have little in common other than the finding of an association of obesity with a favorable outcome. The terminology has led to misunderstandings among researchers and the public alike. It's time for authors and editors to abandon the use of this term. Simply labeling counterintuitive findings as the "obesity paradox" adds no value. Unexpected findings should not be viewed negatively; such findings can lead to new knowledge, better treatments, and scientific advances.

The evolution of body composition in oncology—epidemiology, clinical trials, and the future of patient care: facts and numbers

“…11 The International Agency for Cancer Research reviewed ≥1000 observational studies and concluded that there is convincing evidence that a high BMI is associated with an increased risk of developing 13 types of cancer. 15 There are several proposed explanations for the observation that higher BMI is associated with improved overall Figure 1 The effects of body mass index across the cancer continuum. cancer-specific survival or overall survival) is less consistent, and for many malignancies, overweight or obesity is associated with a survival advantage ( Figure 1).…”

Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysis

“…There is no precise definition to the term, and numerous and sometimes loosely related observations have been summarized under this seemingly paradoxical finding. 35 The core observation, however, of an inverse association of body weight with outcome in patients with prevalent diseases has been confirmed in multiple reports and in numerous patient cohorts, in different ethnic groups, 37 over a wide spectrum of cardiovascular diseases and disease severity and using various methods. With an increasing bulk of data confirming a survival benefit related to overweight and mild obesity in such diseases, and based on pathophysiologic concepts to explain these findings, there is sufficient scientific evidence to abandon the term 'paradox'.…”

“…The extra weight (if ‘extra’ is even a proper term here) may protect these patients against ravages of diseases such as heart failure, advanced chronic kidney disease, terminal cancers, as well as sarcopenia of old age . Arguments that this is just an artefact of selection bias are undermined by the observation that the same phenomenon is seen even for chronic diseases that are not obesity‐related …”

“…This terminology has led to misunderstandings among researchers and the public alike. There is no precise definition to the term, and numerous and sometimes loosely related observations have been summarized under this seemingly paradoxical finding . The core observation, however, of an inverse association of body weight with outcome in patients with prevalent diseases has been confirmed in multiple reports and in numerous patient cohorts, in different ethnic groups, over a wide spectrum of cardiovascular diseases and disease severity and using various methods.…”

“…34 Arguments that this is just an artefact of selection bias are undermined by the observation that the same phenomenon is seen even for chronic diseases that are not obesity-related. 35 The uncritical translation of findings in healthy nonsmoking individuals to patients with established chronic diseases exemplifies a common misconception about the significance of weight reduction in such patients. Promoting weight reduction in patients with established chronic disease goes against clinical evidence and guidelines 36 and may be harmful for patients.…”