Obesity paradoxes
Abstract
In this review, we examine the original obesity paradox phenomenon (i.e. in cardiovascular disease populations, obese patients survive better), as well as three other related paradoxes (pre-obesity, "fat but fit" theory, and "healthy" obesity). An obesity paradox has been reported in a range of cardiovascular and non-cardiovascular conditions. Pre-obesity (defined as a body mass index of 25.0-29.9 kg · m⁻²) presents another paradox. Whereas "overweight" implies increased risk, it is in fact associated with decreased mortality risk compared with normal weight. Another paradox concerns the observation than when fitness is taken into account, the mortality risk associated with obesity is offset. The final paradox under consideration is the presence of a sizeable subset of obese individuals who are otherwise healthy. Consequently, a large segment of the overweight and obese population is not at increased risk for premature death. It appears therefore that low cardiorespiratory fitness and inactivity are a greater health threat than obesity, suggesting that more emphasis should be placed on increasing leisure time physical activity and cardiorespiratory fitness as the main strategy for reducing mortality risk in the broad population of overweight and obese adults.
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Changes in humoral factors are necessary for improvement in health status.
“The changes elicited in humoral factors (e.g., hormone/cytokines, blood lipids and biomarkers of inflammation) are necessary for improvement in health status that many have previously discussed in a number of reviews on this topic [18-21,26,31,32,34,42].”
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- Authors
- McAuley, P. A., & Blair, S. N.
- Affiliations
- Winston-Salem State University (US)
- University of South Carolina (US)
- Corresponding author
- McAuley, Paul A.
- Venue
- Journal of Sports Sciences
- Publisher
- Informa UK Limited
- Published
- 2011-05
- Volume
- 29
- Issue
- 8
- Pages
- 773-782
- ISSN
- 0264-0414 (ISSN-L)
- 1466-447X
- OpenAlex
- W4235277499
- Cited by
- 170
- References
- 85
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 3 · 2020: 14 · 2019: 9 · 2018: 7 · 2017: 15 · 2016: 20 · 2015: 20 · 2014: 22 · 2013: 13 · 2012: 11
- FWCI
- 2.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Sports Sciences (publishedVersion)
- PubMed (publishedVersion)
- Scholar Commons (University of South Carolina) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- obesity paradox, pre-obesity, overweight, metabolically healthy obesity, cardiorespiratory fitness, physical inactivity, mortality risk, cardiovascular disease, body mass index, physical activity
- MeSH terms
- Aged, Female, Humans, Male, Middle Aged, Models, Theoretical, Obesity, Physical Fitness, Body Mass Index
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