‘obesity paradox’: a parsimonious explanation for relations among obesity, mortality rate and aging

Objective: Current clinical guidelines and public health statements generically prescribe body mass index (BMI; kg m–2) categories regardless of the individual's situation (age, risk for diseases, and so on). However, regarding BMI and mortality rate, two well-established observations are (1) t...

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Bibliographic Details
Published in:International Journal of Obesity 2010-08, Vol.34 (8), p.1231-1238
Main Authors: Childers, D.K, Allison, D.B
Format: Article
Language:English
Subjects:
Age
Aging
Aging - physiology
Animals
Biological and medical sciences
Body Mass Index
Causality
Clinical medicine
complications
Disease
disease prevention
Epidemiology
General aspects
human diseases
Humans
Hypotheses
Injuries
longevity
mathematical models
Medical sciences
Metabolic diseases
Mortality
Nutrition research
Obesity
Obesity - mortality
obesity paradox
Overweight
Physiological aspects
Practice Guidelines as Topic
probabilistic models
probabilistic risk assessment
probability analysis
Public health
Public health. Hygiene
Public health. Hygiene-occupational medicine
Random variables
reference standards
risk groups
senescence
Survival Analysis
United States
validity
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Summary:Objective: Current clinical guidelines and public health statements generically prescribe body mass index (BMI; kg m–2) categories regardless of the individual's situation (age, risk for diseases, and so on). However, regarding BMI and mortality rate, two well-established observations are (1) there is a U-shaped (that is, concave) association—people with intermediate BMIs tend to outlive people with higher or lower BMIs; and (2) the nadirs of these curves tend to increase monotonically with age. Multiple hypotheses have been advanced to explain either of these two observations. In this study, we introduce a new hypothesis that may explain both phenomena, by drawing on the so-called obesity paradox: the unexpected finding that obesity is often associated with increased survival time among people who have some serious injury or illness in spite of being associated with reduced survival time among the general population. Results: We establish that the obesity paradox offers one potential explanation for two curious but consistently observed phenomena in the obesity field. Conclusion: Further research is needed to determine the extent to which the obesity paradox is actually an explanation for these phenomena, but if our hypothesis proves true the common practice of prescribing overweight patients to lower their BMI should currently be applied with caution. In addition, the statistical modeling technique used here could be applied in such other areas involving survival analysis of disjoint subgroups, to explain possible interacting causal associations and to determine clinical practice.
ISSN:0307-0565
1476-5497
DOI:10.1038/ijo.2010.71