February 9, 2013
Weight Loss Strategies in Light of the Obesity Paradox
"To know that we know what we know, and that we do not know what we do not know, that is true
By: Victor Battles
A phenomenon recognized as the obesity paradox might change the paradigm of weight management and weight-loss
strategies in the future. The obesity paradox is a phenomenon which has been observed in several clinical studies
in recent years showing that individuals who are overweight or slightly obese live longer their underweight or
ideal weight counterparts. The obesity paradox was initially recognized with chronic illnesses, most notably type 2
diabetes, heart disease, chronic lung disease and chronic kidney disease, but according to the most recent study
reported in the January 2, 2013 issue of the Journal of the American Medical Association the improved
survival rate for overweight and slightly obese individuals was noticed across the board irrespective of any
To understand how the relationship between body weight and the risk of dying is studied it is important to note
that weight categories are arbitrarily defined based on the body mass index or BMI which is a person's weight in
kilograms divided by height in meters squared (kg/m2). A BMI less than 18.5 is considered underweight. A BMI
between 18.5 and 29.9 is considered ideal weight. A BMI of 30 or greater is categorized as obese. In the study
mentioned above obesity was sub categorized into grades 1, 2, and 3. Grade 1 obesity is a BMI between 30 and 34.9.
Grade 2 obesity is a BMI between 35 and 39.9. Grade 3 obesity is a BMI of greater than 40.
The study was a meta-analysis of 97 past studies conducted in various countries throughout the world in which the
records of 2.9 million people and 270,000 deaths were reviewed. According to the study results being obese in
general was linked to a greater risk of dying compared to being of normal weight and being severely obese was
associated with a 29% greater risk of death. Being merely overweight however was linked to a 6% lower risk of dying
and being slightly obese (grade 1) was linked to a 5% lower risk of death compared to normal weight. The study did
not provide any explanation for the link between being overweight or slightly obese and a lower risk of dying, but
certainly illustrated the degree of disconnect between reality and conventional wisdom.
How these results will impact future recommendations with respect to weight-loss programs and weight management
strategies in general remains to be seen, pending additional clinical research necessary to better understand the
apparent protective benefits of being overweight or slightly obese. Until the link is better understood, it would
behoove one to be more thoughtful in setting weight-loss goals and more meticulous while engaging in weight-loss
efforts including dieting.
The weight-loss goals should be reasonable so that the rate of weight loss does not exceed 1 to 2 pounds per week
and the BMI does not drop below 18.5. Additionally, during a weight-loss program, special attention should be given
to any change that might occur with any known chronic disease or any signs of development of a new chronic disease.
Ideally, a weight loss program should be closely supervised by a physician but for the individual who is
inclined otherwise, early disease detection home test kits or an online lab service should at least be used for
chronic disease monitoring and early disease detection, and abnormal or questionable test results should be
immediately reported to a physician.
Since it is possible that deficiency of organ-specific nutrients might have played a role in the higher death rate
seen among underweight and ideal weight individuals in the study discussed, it is important that weight-loss diets
are nutritionally balanced and not just crash diets or diets with marked restrictions of calories and fat and an
abundance of protein.
The obesity paradox brings to remembrance the words of Henry David Thoreau (1817-1862). "To know that we know what
we know, and that we do not know what we do not know, that is true knowledge." Despite the lack of knowledge
resulting from the obesity paradox, the known knowledge is not defied. Morbid obesity is associated with an
increased risk of death. Therefore, acknowledgment of the obesity paradox is not license to pig out.
This article is for informational purposes only and is not intended to be legal advice or a substitute for medical
consultation with a qualified professional. If you are seeking legal advice or are unsure about your medical
condition you should consult an attorney and/or physician.
Victor E. Battles, M.D. is a board-certified internist with 30 + years of patient contact. Dr. Battles has been a
principal investigator in several clinical research trials and is the founder of Proactive Health Outlet, a
resource providing self-help for improving health.
Calculate your BMI. Learn more about early disease detection
home test kits and the online lab service. Choose a nutrionally balanced diet meal plan.