The paradox grows-and that isn’t just myself and a colleague gaining weight (pair a docs…get it…never mind). During several of my last lectures/book signings I have discussed the concept of the obesity paradox. For those unable to attend, the obesity paradox refers to a number of well-done of studies showing that among patients with established heart disease, other medical conditions and even the general population at large, those who are overweight or even mildly obese by BMI standards fare better and survive longer than those of “normal” or” ideal” weight.

A most recent study was particularly interesting[i]. It pooled the data from five previous studies examining over 2500 patients, both men and women over age 40 with newly diagnosed diabetes (DM).Participants were classified as normal weight if their body mass index (BMI) was 18.5 to 24.99 or overweight/obese if the BMI was 25 or greater. Although only about 12% of the study group was normal weight, they had the highest rates of total, cardiovascular, and noncardiovascular mortality. After adjusting for other variables, the “ideal” weight group still had higher mortality levels in every category. The study concluded that adults “who were normal weight at the time of incident diabetes [italics mine] had higher mortality than adults who are overweight or obese.”

The take away regarding obesity by BMI and morbidity/mortality is three-fold. Firstly, BMI while it can be applied as a population measure, should be applied to individuals with great discretion and restraint. Secondly, at some level of increasing weight (BMI) there is increasing morbidity/mortality when you exceed it. Lastly and perhaps most importantly, where that level lies is currently quite debatable. What is “ideal” today may be more deadly tomorrow.