title: Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox.
abstract: 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.
authors: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana. Electronic address: clavie@ochsner.org.
authors: Carl J
authors: CJ
authors: Lavie
authors: Department of Human Performance and Sport Sciences, Winston-Salem State University, Winston-Salem, North Carolina.
authors: Paul A
authors: PA
authors: McAuley
authors: Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana.
authors: Timothy S
authors: TS
authors: Church
authors: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana.
authors: Richard V
authors: RV
authors: Milani
authors: Department of Exercise Science and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
authors: Steven N
authors: SN
authors: Blair
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D005260:Female; D006266:Health Education; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D009767:Obesity, Morbid / Q000175:diagnosis / Q000453:epidemiology; D050177:Overweight / Q000175:diagnosis / Q000453:epidemiology*; D010809:Physical Fitness / Q000502:physiology; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate
keywords: cardiovascular disease; fitness; obesity