The obesity paradox.  I want to say a few words about it today.  I think I recently mentioned this phenomenon in passing with the plan to return to it.
I am especially sensitive to the issue because I am a low to low-normal weight person to whom the paradox applies.

Some 13 years ago, researchers and physicians began noticing something odd regarding differences in outcomes between low weight and overweight people who were in the hospital with certain diseases.  The diseases included diabetes and several manifestations of heart disease, e.g., heart failure, peripheral vascular disease, coronary heart disease - especially at end stages or  during severe acute episodes.

When people get sick enough that they end up in hospital intensive care units, low weight people (like me) are more likely to die than obese people.  That is the paradox. Its a paradox because being overweight is bad for people (so bad the AMA has just today determined that obesity is a disease) but seems to 'protect'  from death in the ICU.

There are several "ideas" for what is going on here.  One that gets a lot of press and one that food companies LOVE is ...."being thin is  actually a bad thing".  

Before you go grab that box of donuts, there are a few things to consider.  First a disclaimer... as much as I want to read all the studies and give this issue its proper due, I just don't have the time right now.  

This blogger did a good job explaining the history of the issue and some of the actual studies that led to the term.  He does not conclude that being overweight is a good thing - just in case you were looking for that.

My thoughts:

  • We have already established that something about obesity - inflammation, fat processing, metabolism, etc increases the risk for the diseases I mentioned (and several others).  This means that more overweight and obese people have diabetes and heart disease.  There will be more of these people in the hospital to begin with..  
  • It is also possible that the thin person in the hospital with end stage renal failure from diabetes - is thin because they have diabetes, but he or she was not thin when diagnosed.  One study I saw refutes what I just said.  However, they looked at people who were low weight at diagnosis but were over the age of 40.  (what if a person is low weight in their 20s, 30s, 40s, i.e, their normal weight is low?)
  • I also 'wonder' about the person who was a low or normal weight because they followed recommendations on nutrition and physical activity but still got diabetes or heart disease.  Suppose that person got sick for genetic reasons and their disease was more progressive than the one the obese person got which was related to their lifestyle?
  • I would like to see a study that was able to compare people based on some of these factors.  Especially looking at the thin person who is in the ICU with heart disease or diabetes complications.  What was that persons lifecourse?  Were they always thin?  Did they eat right and exercise?  Did they smoke?
  • I believe people who are thin because of a healthy lifestyle are much less likely to end up in hospital.  I do agree that once in the ICU they have less reserve (fat store) to call upon to fight off hospital acquired infections and prolonged periods of supplemental feedings (ng tube, etc).

Bottom line for me?  For goodness sakes, stay out of  the hospital!