Abstract

Although it has been confirmed that excessive body fat increases health risks and all-cause mortality, several epidemiological studies have reported that overweight or obesity in patients with chronic diseases and in older adults is advantageous with respect to mortality. Several mechanisms have been proposed to explain the biological basis of this obesity paradox. The marked heterogeneity of findings observed across studies and the possibility of systematic errors in these studies have cast doubt on the actual existence of the obesity paradox. However, the obesity paradox questioned the validity of body mass index as the best indicator for obesity in terms of predicting its comorbidities and urges clinicians to focus more on changes in body composition and related metabolic derangements, rather than body weight per se.