Published in:
01-03-2017 | Nutrition and Clinical Care (J Patel, Section Editor)
The obesity paradox: validity and clinical implications
Published in: Current Pulmonology Reports | Issue 1/2017
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Purpose of review
Obesity has been associated with increased incidence of diabetes, atherosclerotic disease, numerous cancers, and other comorbidities. Given the increased comorbidities and challenges associated with bedside care of the critically ill obese patient, the expectation would be worse overall clinical outcomes. However, it has been noted that there are improved outcomes in critically ill patients who are overweight or mildly obese compared to their underweight and morbidly obese counterparts. This has been termed the obesity paradox. The purpose of this article is to discuss the validity of the obesity paradox and to explore potential explanations for this seemingly illogical association.
Recent findings
Body mass index (BMI) represents a crude measurement of an individual’s metabolic health and may be, in part, responsible for the observed obesity paradox. Alternative markers, including lean muscle mass:adipose ratios, could better clarify which patients are prone to poor outcomes. In the event that the obesity paradox is not attributable to statistical aberrancies associated with the utilization of BMI, emerging findings regarding the role of the microbiome and systemic effects of adipokines during critical illness represent potential explanations for improved outcomes in this patient population.
Summary
The explanations for the observed obesity paradox are likely multifactorial. Obesity, as defined by BMI, may correlate poorly with overall metabolic health, and there may be better markers for assessment. Alternatively, the gastrointestinal microbiome and variable systemic effects of adipokines may truly contribute to improved overall survival in critically ill obese patients.