The obesity paradox in the surgical population

Abstract Background Despite the medical hazards of obesity, recent reports examining body mass index (BMI) show an inverse relationship with morbidity and mortality in the surgical patient. This phenomenon is known as the ‘obesity paradox’. The aim of this review is to summarize both the literature...

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Bibliographic Details
Published in:The surgeon (Edinburgh) 2013-06, Vol.11 (3), p.169-176
Main Authors: Valentijn, Tabita M, Galal, Wael, Tjeertes, Elke K.M, Hoeks, Sanne E, Verhagen, Hence J, Stolker, Robert Jan
Format: Article
Language:English
Subjects:
Body Mass Index
Comorbidity
Global Health
Humans
Morbidity - trends
Mortality
Obesity paradox
Obesity, Morbid - epidemiology
Risk Factors
Surgery
Surgical Procedures, Operative
Survival Rate - trends
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Summary:Abstract Background Despite the medical hazards of obesity, recent reports examining body mass index (BMI) show an inverse relationship with morbidity and mortality in the surgical patient. This phenomenon is known as the ‘obesity paradox’. The aim of this review is to summarize both the literature concerned with the obesity paradox in the surgical setting, as well as the theories explaining its causation. Methods PubMed was searched to identify available literature. Search criteria included obesity paradox and BMI paradox, and studies in which BMI was used as a measure of body fat were potentially eligible for inclusion in this review. Results The obesity paradox has been demonstrated in cardiac and in non-cardiac surgery patients. Underweight and morbidly obese patients displayed the worse outcomes, both postoperatively as well as at long-term follow-up. Hypotheses to explain the obesity paradox include increased lean body mass, (protective) peripheral body fat, reduced inflammatory response, genetics and a decline in cardiovascular disease risk factors, but probably unknown factors contribute too. Conclusions Patients at the extremes of BMI, both the underweight and the morbid obese, seem to have the highest postoperative morbidity and mortality hazard, which even persists at long-term. The cause of the obesity paradox is probably multi-factorial. This offers potential for future research in order to improve outcomes for persons on both sides of the ‘optimum BMI’.
ISSN:1479-666X
2405-5840
DOI:10.1016/j.surge.2013.02.003