The obesity paradox

Numerous experiments demonstrate how muscle activity is associated with our health and it is interesting to ponder why?

Looking at obesity might give us a clue. Obesity is a “saving” strategy directing large amount of energy to savings (fat storage) for future less prosperous days. Until our times, we have evolved in a world with limited food resources, it is thus no wonder that economic considerations characterize our biology.

Muscles activity requires a lot of energy and so signals - energy abundance, times when one can take care of all the bodily needs (health); while at more limited times a more efficient strategy will be smarter. An interesting Scientific American article Fat Be Fit?

As we were “planned” to save energy, when there is abundance of food we halt some activities and concentrate on fat storing, we do not only gain weight, we also become unhealthy, not attending the health issues of that time. Such a saving policy causes us numerous health troubles but please note that at very stressful days it might be beneficial, it was thus termed - the obesity paradox (see the examples of the following 7 articles links). It is no wonder that there is a legitimate discussion among physicians about how patients should deal with their excess weight.

1. A German and Swiss study, involving 1,676 patients, found obese patients were less than half as likely to die in the three years after treatment as patients with a normal body mass index. Eur Heart J. 2007 Jul;28(14):1694-701

2. Once a health problem is established, there are certain conditions-congestive heart failure, rheumatoid arthritis, and other diseases that involve the utilization of oxygen-in which obese persons have been shown to have a better prognosis. The Illinois scientists have shown, through several different mechanisms, that in cases of obesity, there's a significant increase in the anti-inflammatory molecule IL-1RA (via leptin), which helps animals recover from a traumatic loss of oxygen Brain Behav Immun. 2009 Feb;23(2):169-75

3. In the US overweight was associated with significantly decreased mortality from non-cancer, non-CVD causes. JAMA. 2007;298(17):2028-2037

4. Results from over 20,000 participants (hypertension and coronary artery disease), further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention. Am J Med. 2007 Oct;120(10):863-70

5. Numerous studies have documented an obesity paradox in which overweight and obese people with established CV disease and peripheral arterial disease, have a better prognosis compared with nonoverweight/nonobese patients. J Am Coll Cardiol, 2009; 53, 1925-1932

6. An Israeli study has shown that body mass index is inversely related to mortality in elderly subjects. J Gen Intern Med. 2008 Jan;23(1):19-24

7. Obesity class I (BMI 25 to <30) was associated with a significantly decreased risk of death. Obesity (Silver Spring). 2009 Jun 18. Epub ahead of print

And last, teeth health. 8. Data from NHANES III and NHANES 1999-2002 suggest that being overweight may be associated with decreased rates of caries in older children. Community Dent Oral Epidemiol. 2008 Apr;36(2):157-67

Please note that losing weight might not always be beneficial. To become advantageous, losing weight must be smart (physical activity, lots of vegetables, maybe milk avoidance...) and I would speculate and say that only that will also inhibit weight re-gain. In a Norwegian study with over 40000 man and women it was found that people who lost weight had a higher total mortality rate compared with those who were weight stable. J Intern Med. 2005 Apr;257(4):338-45

I wonder if resveratrol, which improves mitochondrial function and protects against metabolic disease, is related to the obesity paradox. Cell. 2006 Dec 15;127(6):1109-22