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Although the negative health consequences of obesity in the general population are well supported by the available evidence, health outcomes in certain subgroups seem to be improved at an increased BMI, a phenomenon known as the obesity survival paradox.[60] The paradox was first described in 1999 in overweight and obese people undergoing hemodialysis,[60] and has subsequently been found in those with heart failure and peripheral artery disease (PAD).[61] In people with heart failure, those with a BMI between 30.0 and 34.9 had lower mortality than those with a normal weight. This has been attributed to the fact that people often lose weight as they become progressively more ill.[62] Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, the risk of further cardiovascular events is increased.[63][64] Even after cardiac bypass surgery, no increase in mortality is seen in the overweight and obese.[65] One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event.[66] Another found that if one takes into account chronic obstructive pulmonary disease (COPD) in those with PAD, the benefit of obesity no longer exists.[61] |
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