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‘Obesity paradox’ misunderstands the biology of optimal weight throughout the life cycle


The ‘obesity paradox’ refers to observations that run counter to the thesis that normal weight (BMI 18.5–24.9 kg/m2) provides the lowest mortality and higher weight is associated with greater mortality. We argue that the weight of lowest mortality is influenced by aging and chronic disease, with mortality advantage extending into the overweight and even class I obese ranges under some circumstances. A focus on quality nutrition, physical activity, fitness, and maintaining function in these weight ranges may be preferable to a focus on intentional weight loss, which has uncertain effects. The ‘obesity paradox’ is no ‘paradox’ if one defines and interprets ‘ideal’ weight appropriately.

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Correspondence to J B Dixon.

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Competing interests

JD has received research funding and support from Allergan Inc. He is on the Optifast® Medical Advisory Board for Nestlé Australia and has received consultancy fees from Allergan Inc, Metagenics, and iNova Pharmaceuticals. EF has acted as a consultant for Allergan Inc. in the past and currently does consulting work for Jenny Craig and Vivus Inc. G.L.’s laboratory currently receives commercial research grant funding from Medtronic (formerly ARDIAN Inc.), Servier Australia, Abbott (formerly Solvay) and Allergan Inc.; he has acted as a consultant for Medtronic and has received honoraria or travel support for presentations from Pfizer, Wyeth Pharmaceuticals, Servier and Medtronic. GE and JK have no conflict of interest to declare.

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Dixon, J., Egger, G., Finkelstein, E. et al. ‘Obesity paradox’ misunderstands the biology of optimal weight throughout the life cycle. Int J Obes 39, 82–84 (2015).

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  • healthy aging
  • reverse causation
  • obesity epidemic
  • survival advantage
  • body mass index

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