State-of-the-Art Paper
Obesity and Cardiovascular Diseases: Implications Regarding Fitness, Fatness, and Severity in the Obesity Paradox

https://doi.org/10.1016/j.jacc.2014.01.022Get rights and content
Under an Elsevier user license
open archive

Obesity has been increasing in epidemic proportions, with a disproportionately higher increase in morbid or class III obesity, and obesity adversely affects cardiovascular (CV) hemodynamics, structure, and function, as well as increases the prevalence of most CV diseases. Progressive declines in physical activity over 5 decades have occurred and have primarily caused the obesity epidemic. Despite the potential adverse impact of overweight and obesity, recent epidemiological data have demonstrated an association of mild obesity and, particularly, overweight on improved survival. We review in detail the obesity paradox in CV diseases where overweight and at least mildly obese patients with most CV diseases seem to have a better prognosis than do their leaner counterparts. The implications of cardiorespiratory fitness with prognosis are discussed, along with the joint impact of fitness and adiposity on the obesity paradox. Finally, in light of the obesity paradox, the potential value of purposeful weight loss and increased physical activity to affect levels of fitness is reviewed.

Key Words

cardiovascular disease
fitness
obesity

Abbreviations and Acronyms

AF
atrial fibrillation
BF
body fat
BMI
body mass index
CHD
coronary heart disease
CV
cardiovascular
HF
heart failure
LV
left ventricle/ventricular
MET
metabolic equivalent

Cited by (0)

Dr. Lavie has served as a consultant and speaker on fitness/obesity for the Coca-Cola Company; and is publishing a book on the obesity paradox with potential royalties. Drs. Church and Blair have served as consultants for weight loss and fitness companies and for the Coca-Cola Company, which has also provided them un-restricted research grants. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.