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Dr Prakash C Negi, Shimla 30 January 2022

Obesity increases the risk of mortality in the general population. However, paradoxically, mortality has been reported to be lower in patients with HF and other established CVDs with high BMI compared to normal and low BMI in a number of observational studies.
The obesity paradox reported in observational studies is the result of selection bias, thus creating heterogeneity among patients with HF across different categories of BMI for the severity HF, body composition and cardiopulmonary fitness.
Patients of HF with low BMI are high-risk patients and have decreased muscle mass, muscle strength, frailty, poor exercise tolerance, state of malnutrition and increased inflammatory state compared to their high BMI counterparts. The BMI is thus a marker of high-risk and not a mediator of the risk. Controlled clinical trials demonstrating the benefits of weight loss on mortality in patients with CVD/HF with obesity are lacking.
Observational studies demonstrated benefits of intentional weight loss with exercise training and nutritional intervention in cardiac rehabilitation programs in patients of CHD to reduce mortality and risk of MI and stroke.
Guidelines recommend weight reduction in patients with CVD only in morbid obesity.

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