The “Obesity Paradox”—Obesity and Cardiovascular Disease

| March 1, 2023

by Carl Lavie Jr., MD, FACC, FACP, FCCP 

Dr. Lavie is the Associate Editor and Cardiovascular Section Editor of the Mayo Clinic Proceedings. He serves on over 50 editorial boards, including the Journal of the American College of Cardiology and American Journal of Cardiology.

Funding: No funding was provided.

Disclosures: The author has no conflicts of interest relevant to the content of this article. 

Bariatric Times. 2023;20(3–4):10.

Carl Lavie Jr., MD, FACC, FACP, FCCP, discusses the “obesity paradox,” a finding that describes the complex relationship between cardiovascular disease (CVD) and obesity.  

Can you briefly describe the “obesity paradox” and why it affects individuals with obesity in the way that it does?   

Dr. Lavie: Despite the effect that obesity has the potential to worsen all the risk factors and increase the prevalence of CVD, once patients have CVD, generally, patients with overweight and obesity have a better prognosis than others, and patients with underweight almost always have the worst prognosis. The reasons for this are unclear, but I suspect that many patients with obesity would not have developed CVD if not for their 50- to 100-pound weight gain in adulthood, whereas the person who develops the CVD without obesity probably developed the disease for another reason, such as genetic predisposition.

What is the relationship between obesity and CVD risk factors and outcomes?   

Dr. Lavie: Obesity worsens almost all CVD risk factors, such as lipids, especially increasing triglycerides and lowering the cardioprotective high-density lipoprotein (HDL); raises blood pressure (BP); and independent of BP, also increases the risk of left ventricular hypertrophy (LVH), high blood sugar, metabolic syndrome, and Type 2 diabetes; and increases inflammation. Therefore, the risk of CVD increases with obesity, especially heart failure. Heart failure with preserved ejection fraction is more prevalent than heart failure with reduced ejection fraction among patients with obesity. Additionally, obesity increases the risk of atrial fibrillation, hypertension, coronary heart disease, myocardial infarction, peripheral arterial disease, and venous thromboembolic disease.

What else would you like to note regarding obesity and CVD?   

Dr. Lavie: The obesity paradox is generally only noted in those with low physical activity (PA) and cardiorespiratory fitness (CRF).

What role does CRF or physical activity play in the obesity paradox?  

Dr. Lavie: Higher PA and CRF always improve CVD prognosis, regardless of weight. 

What are two strategies clinicians could incorporate into an obesity treatment plan to address the obesity paradox? 

Dr. Lavie: Encourage patients to increase physical activity to improve CRF, as well as muscle or resistance exercises to increase muscle mass and strength. This would also help prevent obesity from progressing to higher stages. 

Join the Obesity Medicine Association today to stay in the know about preventing, treating, and reversing the disease of obesity. Join now at

Tags: ,

Category: Medical Methods in Obesity Treatment, Past Articles

Comments are closed.