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Disproving the obesity paradox: Why it’s not a paradox at all

The “obesity paradox” is not only a fatphobic and stigmatizing term, but it’s also misleading since it’s not a paradox at all. But what does it mean exactly? And why is the term inaccurate?

Last updated on 
March 15, 2023
Disproving the obesity paradox: Why it’s not a paradox at all
In this article

What is the “obesity” paradox?

The “obesity” paradox refers to the seemingly incongruous observation that, although the medical community considers “obesity” to be a major cause of various diseases, that is actually not true. Extensive evidence-based research consistently demonstrates that being at a higher weight can actually decrease mortality from a variety of illnesses or diseases. In fact, “obesity” has been found to be a survival benefit in many populations, such as those with chronic conditions. (1)

For this reason, experts refer to this seeming contradiction as the obesity paradox. Although, it is hardly contradictory when you look at the actual research examining “obesity” and disease states, as well as the weight stigma that’s driving this false assumption.

Why “obesity” is hardly a paradox

It’s believed that “obesity” is a risk factor for cardiovascular disease. Yet, once someone experiences congestive heart failure or a heart attack, “obesity” can be a protective factor and result in reduced mortality. (1,2)

Additionally, research indicates that men living in larger bodies who have chronic hypertensive heart disease tend to live longer than their peers of normal body weight. And research also suggests that “obese” patients may have better outcomes after surgeries like coronary artery bypass surgery. (1)

Overall, research shows that being “overweight” is a survival advantage for individuals with: (2)

  • Kidney disease
  • Respiratory disease
  • Diabetes
  • Cancer
  • Cardiovascular disease

There's no such thing as "normal weight"

A growing body of research also indicates important racial differences related to weight. Black women and men tend to be healthier at higher weights and with bigger waist circumferences than their white counterparts. This may be because they have lower visceral fat, the fat around the organs that is associated with an increased risk of various health conditions. (4,5,6)

Although higher visceral fat alone doesn’t increase risk, it is merely associated with increased risk and is not a proven cause of these health conditions. There are many other factors that increase the risk of certain health conditions, and weight or fat alone has not been proven to do so.

Given the evidence, it’s undeniable that “obesity” can be a survival benefit among various populations. So much so that it’s likely not a paradox at all, but an example of weight stigma and fatphobia because associating weight and health is incorrect. 

BMI’s influence on false beliefs about “obesity”

“Obesity” is defined as a body mass index (BMI) of 30 or higher. And BMI is not a viable measurement for health (or "normal" weight), given that it doesn’t take into account bone density, muscle mass, biological and environmental influences, and racial and sex differences, among other factors. It simply measures a person’s weight-to-height ratio—nothing more. 

The fatphobia of the “obesity” paradox

Fatphobia, which is the hatred and fear of fat bodies, can lead to weight stigma or discrimination based on someone’s body weight. It is a prevalent force in our society that can lead to harmful psychological consequences for someone living in a larger body—none of which are related to their weight. 

Fatphobia is present everywhere, such as in medical settings, schools, workplaces, grocery stores, pop culture, social media, athletics, as well as scientific literature. 

“Obesity” as a social construct

When researchers refer to their findings as the “obesity” paradox, they are essentially saying that they can’t believe people with higher-weight bodies could be healthy. This is a fatphobic perspective that perpetuates weight stigma.

The outdated, uninformed, and inherently fatphobic research that determines “obesity” as a major risk factor for various negative health outcomes incriminates the wrong influence—the person’s weight or fat. It is the experience of living in a larger body and being subjected to chronic body weight stigma that has a known negative impact on health and well-being, as well as biological, environmental, and social determinants. 

Research has consistently found that weight stigma can increase the risk of diabetes, high cholesterol, stomach ulcers, and heart disease. (8

“Obesity” as a victim of flawed research methods and false assumptions

So, really, it is our discrimination against people in larger bodies and other known factors that contribute to negative health effects—not their weight. The words we use matter. The findings related to “obesity” and survival benefits are not contradictory. People can be healthy at all different sizes, shapes, and weights.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Amundson, D. E., Djurkovic, S., & Matwiyoff, G. N. (2010). The obesity paradox. Critical Care Clinics, 26(4), 583–596. https://pubmed.ncbi.nlm.nih.gov/20970043/ 
  2. Donini, L.M., Pinto, A., Giusti, A.M., Lenzi, A., and Poggiogalle, E. (2020). Obesity or BMI Paradox? Beneath the Tip of the Iceberg. Frontiers in Nutrition, 7(53). https://www.frontiersin.org/articles/10.3389/fnut.2020.00053/full 
  3. Banack, H., Stokes, A. (2017). The ‘obesity paradox’ may not be a paradox at all. International Journal of Obesity, 41, 1162–1163. https://www.nature.com/articles/ijo201799 
  4. National Public Radio. (2020). Fat Phobia and Its Racist Past and Present. https://www.npr.org/transcripts/893006538 
  5. Katzmarzyk, P. T., Bray, G. A., Greenway, F. L., Johnson, W. D., Newton, R. L., Jr, Ravussin, E., Ryan, D. H., & Bouchard, C. (2011). Ethnic-specific BMI and waist circumference thresholds. Obesity (Silver Spring, Md.), 19(6), 1272–1278. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933952/ 
  6. Carroll, J.F., Chiapa, A.L., Rodriquez, M., Phelps, D.R., Cardarelli, K.M., et. al. (2012). Visceral Fat, Waist Circumference, and BMI: Impact of Race/ethnicity. Obesity, 16(3): 600-607. https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2007.92 
  7. Powell-Wiley, T.M., Poirier, P., Burke, L.E., Despres, J., Gordon-Larsen, P., Lavie, C.J., et. al. (2021). Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 143: 984-1010. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000973 
  8. Udo, T., Purcell, K., & Grilo, C. M. (2016). Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity. International Journal of Clinical Practice, 70(12), 1003–1011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215793/

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