Morbidity, mortality, and obesity paradox

We read with great interest the article by Abdelaal et al. (1) titled “Morbidity and mortality associated with obesity”. The authors state that the prevalence and disease burden of high body-mass index (BMI) are increasing. The escalating prevalence of obesity and its link to substantial increase in metabolic and cardiovascular disease is a known fact (1). Current studies and meta-analyses, though, demonstrate with consistent effects, the presence of an “obesity paradox” among patients with several diseases such as coronary artery disease, chronic kidney disease, heart failure, atrial fibrillation, diabetes and patients undergoing cardiac surgery (2-10). This obesity paradox shows that lower (rather than higher) BMI is a risk factor for increased mortality (2-10).