Cited by 266Diabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, DietCardiovascular Disease and Adiposity

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Healthy obese versus unhealthy lean: the obesity paradox

Lavie, Carl J., De Schutter, Alban, Milani, Richard V.·2015·Nature Reviews Endocrinology

DOI 10.1038/nrendo.2014.165

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Abstract

Overweight and obesity have reached epidemic proportions in the USA and most of the rest of the world. Particularly concerning is the very high prevalence of class III obesity (BMI ≥40 kg/m(2)), which has reached ∼3% in the USA. In the past few years, controversy has surrounded the idea that some individuals with obesity can be considered healthy with regards to their metabolic and cardiorespiratory fitness, which has been termed the 'obesity paradox'. These controversies are reviewed in detail here, including discussion of the very favourable prognosis in patients with obesity who have no notable metabolic abnormalities and who have preserved fitness. The article also discusses the suggestion that greater emphasis should be placed on improving fitness rather than weight loss per se in the primary and secondary prevention of cardiovascular diseases, at least in patients with overweight and class I obesity (BMI 30-35 kg/m(2)).

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Authors: Lavie, C. J., De Schutter, A., & Milani, R. V.
Affiliations: The University of Queensland (AU)
Corresponding author: Lavie, Carl J.
ORCID: Lavie, Carl J.
Milani, Richard V.
Venue: Nature Reviews Endocrinology
Publisher: Springer Science and Business Media LLC
Published: 2014-09-30
Volume: 11
Issue: 1
Pages: 55-62
ISSN: 1759-5029 (ISSN-L)
1759-5037
DOI: 10.1038/nrendo.2014.165
OpenAlex: W2043273449
Cited by: 266
References: 83
Citations by year: 2026: 14 · 2025: 26 · 2024: 16 · 2023: 28 · 2022: 19 · 2021: 14 · 2020: 22 · 2019: 22 · 2018: 22 · 2017: 24 · 2016: 33 · 2015: 21 · 2014: 5
FWCI: 4.39
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Nature Reviews Endocrinology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Keywords: obesity paradox, metabolically healthy obesity, obesity, cardiovascular health, cardiorespiratory fitness, overweight, morbid obesity, cardiovascular disease prevention, weight loss, body mass index
MeSH terms: Cardiovascular Diseases, Humans, Obesity, Risk Factors, Thinness, United States, Kaplan-Meier Estimate, Physical Conditioning, Human

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Healthy obese versus unhealthy lean: the obesity paradox

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