August 28, 2008 at 6:21 pm #28964
November 17, 2006
Obesity Paradox #1
Several studies this week have tried to explain what is being called the obesity paradox: the fact that most fat people actually live longer than thin people.
At this weeks meeting of the American Heart Association, yet another study was reported which found that fatter cardiac patients were more likely to survive hospitalization and invasive treatments than thinner ones, even when adjusting for age and other contributing factors. In this analysis of 130,139 heart disease patients, 5.4% of normal weight patients died, as compared to 2.4% of obese and 3.1% of overweight. Yes, those whose were obese were more than two times more likely to survive!
This is really only a paradox because it goes against what everyone believes to be true…largely because we dont hear anything else.
While many may be incredulous, the largest body of evidence has found that fatness is not a risk factor for heart disease or premature death, even controlling for the effects of smoking. Ancel Keys and colleagues confirmed this nearly half a century ago upon examining 16 prospective studies in seven countries, as well as actual angiographic and autopsy examinations of 23,000 sets of coronary arteries which found no relationship between body fatness and the degree or progression of atherosclerotic build-up. And the most careful studies ever since have continued to support these findings.
Dr. Paul Ernsberger, of Case Western Reserve School of Medicine in Cleveland, Ohio, led a review of nearly 400 studies that was published in the Journal of Obesity and Weight Regulation in 1987 which corroborated these results. The idea that fat strains the heart has no scientific basis, he said. As far as I can tell, the idea comes from diet books, not scientific books. Unfortunately, some doctors read diet books.
This April, researchers at Cedars-Sinai Medical Center in Los Angeles reported their clinical study of 14,739 patients with coronary artery disease, that had been confirmed on tomography, who were followed for over three years. They found that obese and overweight patients were at significantly lower risks for cardiac death than normal weight patients.
The medical student presenting the paper at the AHA meeting tried to justify the obesity paradox in their study by claiming, with no apparent evidence, that the fatter patients had better outcomes because they may have received better and more aggressive treatment.
That hypothesis is unsupportable. It is well recognized among obesity researchers and doctors that obese people on the whole receive worse medical care, are denied or have less access to quality care, are treated less aggressively and are often sicker by the time they do get care than thinner people. The discrimination in health care has been well documented, as has very real weight bias even among health professionals specializing in obesity.
Look for another obesity paradox soon.
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