The Obesity Paradox: When Thinner Means Sicker and Heavier Means Healthier

by Carl J. Lavie

Most of us think that longevity hinges on maintaining a normal Body Mass Index. But research conducted over the last decade hit the media in January with explosive Overweight and even moderately obese people with certain chronic diseases—from heart disease to cancer— often live longer and fare better than normalweight individuals with the same ailments.

In this groundbreaking book, Carl Lavie, MD, reveals the science behind the obesity paradox and shows us how to achieve maximum health rather than minimum weight. Lavie not only explains how extra fat provides additional fuel to help fight illness, he also argues that we’ve gotten so used to framing health issues in terms of obesity that we overlook other potential causes of disease. Picking up where the bestseller Fat Chance left off, The Obesity Paradox will change the conversation about fat—and what it means to be healthy.

Genres: Nonfiction, Health, Nutrition, Science, Food, Research, Audiobook

288 pages, Hardcover

First published March 13, 2014

Reviews

[Lori · Rating 1 out of 5]

It is refreshing to read something by someone in the medical community who publicly admits how flawed most of the RCT studies are and how most researchers have specific agendas when conducting their studies and an even more specific goal in reporting results; however I must give it a low rating due to its redundancy and the hypocritical nature of the author. He completely promotes the negative harm of practicing medicine with the mindset that correlation proves cause, but he does plenty of it himself.

Every single chapter drilled into the reader over and over- BMI matters but it doesn't matter, fat is both good and bad, the body is a very complicated system and we only have pieces of how it works so we could be wrong, we could be right and that's okay because as a scientist being wrong is a fantastic way to challenge ourselves and learn more, blah, blah blah. He never once gives us anything definitive other than we should eat less and exercise more. I couldn't quite figure out what the objective of this book? Was it supposed to be a condensed, easy-to-read meta analysis of hundreds of abstracts or a call for people over the age of 45 to find themselves a cardiologist?

I was also incredibly bothered that he kept going on and on about good cholesterol and bad cholesterol without ever mentioning that it is VLDL that is the actual so-called bad cholesterol. Plus he never really talked about why plaque forms on artery walls in the first place and that one of cholesterol's jobs, other than to basically build every hormone in the body, is as an immunological response and repair substance to fix damaged arteries. He left out very critical pieces of information about anatomy and physiology.

He did a horrible job of explaining lipoproteins and chylomicrons; therefore I wasn't surprised when I get to the recommendations section and his drug of choice is statins. At some point early on he cited Ancel Keys as the father of some great achievement in medicine without talking about all the ways Ancel Keys kept cardiac medicine in the dark for 50+ years.

After an entire book of redundant information and proselytizing the negative harm of correlation implying cause, he promotes the use of statins without including any of the studies that have shown statins cause heart disease, increase insulin resistance, block the mevalonate pathway, depletes the COQ10 in the body, blocks the synthesis of K2, leads to severe side effects? And he gives us a value for how much is too much running in the case of marathoners and then goes on to tell us he himself runs 35-40 miles a week?

I think he offered valuable advice for the layperson to eat better and exercise more and it did contribute some decent quality physiology and biochemistry, but this isn't some romance novel and serious gravity should be given to how a reader will interpret and apply the medical advice contained within. It is ill advised to dumb things down for a broader audience when the state of healthcare in the U.S. forces patients to become their own medical advocates. These readers who are patients should be given ample evidence to intelligently form their own decision making process when it comes to healthcare, fitness, or dietary advice.

[Felicia · Rating 4 out of 5]

I'm glad I listened to this after salt sugar and fat because I needed it. I've become a bit afraid of eating and neurotic about ingredients, and this book eased a bit of that. BUT it just goes to show you that health is all genes and mostly luck. I mean with my desk job I have no way to get up every hour and run in place for five minutes like a loon. so I'm prob in the unhealthy range in the end. (regular exercise is near impossible for working people let's be honest). I do feel people should read this, it brings health to the forefront rather than the whole "your bmi is high lose weight!".
there's a lot of science to back up the claims that may go over peoples heads but it really does make you doubt whether fat is bad. definitely would flip peoples worlds upside down.

[Rachel Blom · Rating 5 out of 5]

Great informative read that disproves many popular theories on how bad even a mild overweight is. Turns out it's not about weight or fat, it's about being fit. I loved the scientific approach and learned a lot. It's information-dense, yet very interesting...and it's such a relief to 'meet' a doctor who is open-minded and willing to accept the evidence, even when it is counter-intuitive.

[Zen Zoo · Rating 2 out of 5]

tl;dr : fit-fat outlives the thin-unfit

Could have been a great read on an interesting topic but the writing is so confusing. Instead of putting the studies as footnotes/references it is inserted in the main discussion which makes it hard to follow the main thread.

[Carrie Rose · Rating 3 out of 5]

I like the underlying premise of this book, but the message felt kind of confused. I'm not sure if that's because the author himself is confused (because some of the scientific evidence seems to be contradicting commonly accepted beliefs) or if his co-author was unhelpful. I'm actually thinking it might be the latter. Reading her bio on the jacket of the book, it looks like she has written several diet-type books, and I wonder if she had trouble getting on board with some of the ideas in this book.

I appreciate the author's willingness to consider data that doesn't support the cultural anti-fat messaging. I do wish he hadn't seemed to contradict his own points so much. For example, in one section of the book, he talked about the difference between obesity causing death versus just being correlated with it, but then in other sections he seemed to completely ignore that and just referred to obesity as a major cause of death. He really seemed to think that diabetes was caused by eating sugar, which frustrated me. And I would have appreciated it if his references had been included more clearly in the book (he did include references in the back, though).

I would probably have liked this book a lot more with a few more rewrites, better editing, and maybe a better co-author. But the idea is interesting.

[Leila Reads · Rating 5 out of 5]

The Obesity Paradox indicates that it may be better, in terms of longevity, to be heavier (even "mildly obese") than to be thin (or of "normal" weight). Earth-shattering. Read carefully.

I rarely consider a book to be life-changing. Books often cause a momentary shift in thinking or actions, but the effects often wear off in short order. Granted, it's only been a week or so since I finished The Obesity Paradox, but I am confident that it is one of those rare life-changers.

Like many women, I struggled with my weight for much of my life (the fact my childhood is included is extremely disturbing). Men and women alike experience such ridiculous levels of pressure to be thin (and therefore supposedly sexy and attractive); according to Dr. Lavie, all of us have been duped.

The crux of the Obesity Paradox (the scientific phenomenon as well as the book) is that when a group of individuals have the same medical problem, such as heart disease or cancer, often the heavier individuals, even those considered mildly obese (according to their BMI), tend to live longer than their thinner counterparts. Mind-blowing, right?!

Now, don't get Dr. Lavie wrong; he's not saying that thin or normal weight people should try to gain weight. What he is saying is that weight loss may not be the best way to maintain health and achieve maximum longevity.

The thing is, when most people lose weight, it's usually through diet alone. If exercise is involved, it's usually intense (which may actually be detrimental) and short-lived. Dr. Lavie argues that it is better to stop trying to lose weight, and start getting "fit". And by fit he doesn't mean marathons or that psycho CrossFit type stuff. We're talking more like 45 minutes of moderate activity (brisk walking, strength training, and stretching) most days of the week. Entirely doable and not at all intimidating, right?

Here's where the life-changing stuff is: The Obesity Paradox has freed me from my life-long obsession with losing weight (or always feeling like I should lose weight). It's infinitely easier to work up to the 45 minutes of moderate activity than to cut 500 calories per day from my diet (then feeling deprived and thus sabotaging my efforts). I'm already up to 20 minutes of walking at 3.5 miles per hour. And considering the history of heart problems in my family, I'm thrilled to turn away from a focus on weight loss and towards the infinitely more enjoyable goal of fitness.

Take It

[Jennifer · Rating 5 out of 5]

The war with weight has been a battle that most Americans have fought at one point in their life. It is a common thread that binds many strangers in an often faceless world of electronics. With the culture of the United States changing, it is no wonder that more and more people are becoming obese in an age were Facebook and twitter are the new norm. Exercise seems to be a thing of the past as even video game companies have begun to recognize the fitness crisis in America. Thin is the ideal goal of most people, but obesity is the new norm. This book takes a detailed look at the cause and conflict of being obese in America. It discusses the reasons why there are more obese people in the world of today and why there is a massive misconception about them. The author reveals the notion of ‘the obesity paradox’ or the concept that a thin person is actually obese on the inside and an obese person can be thin on the inside. Not all individuals that are heavy are unfit. There are many people that exercise at the gym daily who are considered ‘obese’, but are medically healthier than most thin people. The author goes into great detail about the importance of fit over fat and defines the definition of what being fit means.

I found this book to be very interesting and resourceful. I happen to be a person that is considered mildly obese, yet I work out 6 days a week strength training. It was refreshing to know that other people like myself exist! After a hysterectomy at 35 years of age and learning I had lupus I struggle with weight loss due to the medications I take. I love to exercise, but just don’t see the results that I should see. This book was encouraging because it made me realize that it is not the pounds that matter, but the fitness level of a person that matters. I have a very high muscle mass and have no intention of changing that. I love to lift weights and it makes me feel better. My doctor cringes because I weigh more. Muscle weighs more than fat! I can’t tell you how many times I have talked to body builders that complain about their BMI charts because they are considered to be obese! This books goes over this same problem, which I find both surprising and refreshing. Finally someone is paying attention to what is going on in the gym community. I have to recommend this book to anyone who is struggling with their weight or needs some encouragement.

[Ruth · Rating 3 out of 5]

The "obesity paradox" is that public health studies document that people who get the diseases the that kill people the most in the US--diseases that doctors assume obesity causes or contributes to--die at a slower rate if they are fatter. At least, if they are overweight to moderately obese. So-called normal weight and underweight people die faster, and so-called morbidly obese people experience no benefit from their weight in death rates. This author calls this a U curve in mortality.

I started this book knowing about the obesity paradox and looking for some kind of scientific explanation for it. One that occurred to me was that we've set the BMI cutoffs for obesity too low. Another I'd considered was that the diseases associated with obesity weren't really caused by obesity.

From this book, I learned that those possible explanations don't seem to work. It really is harder on the heart to carry a lot of weight, and people with heart disease (and kidney disease, and several others) are most likely to survive it if they are heavy. I am not satisfied that I understand anything new.

The only thing I come away with is that BMI or weight might not measure anything meaningful at any stage, whether one is sick or healthy. I consider this as a possible explanation, even though, to my extreme irritation, the doctor tells everyone in the last chapter of the book that they should try to lose weight in spite of everything he's said in the previous chapters. Well, he does specify that really one should work on being "fit," and how to measure that aside from weight. Still, he tells the reader to go on a diet, but to call it an "eating plan." Dude.

I appreciate that the doctor, and his cowriter, took the time to discuss all the big studies and popular books that dealt with this subject, and on that basis, I do recommend the book to anyone who doesn't know anything about this. I had, unfortunately, read about most of these before.

[Tatiana Gomez · Rating 5 out of 5]

Fantastic read that should be required for all Americans concerned about their health and/or their weight. Dr. Lavie explores the very controversial (and yet, somehow intuitive) "obesity paradox," the phenomenon by which some obese and overweight individuals are healthier than those of normal weight, through a cardiovascular lens, which is particularly important given that heart disease is the number one American killer.

Until Chapter 10 this book is essentially one long literature review, and although Lavie tries to break it down into layman's terms it does become a bit dense and hard to follow. However, if you are interested in the specifics, it is very informative and even motivating as Lavie cites many statistics, previously unknown to me, that made me even more committed to a steady exercise regimen. Some might think that Lavie relies too much on his own research, however, to me it seemed that he really is one of the most knowledgeable in this area. Besides his own studies, most of his references are startlingly up to date and I felt confident I was being given the best available information.

If you are in a hurry, skip to Chapter 10 and read his simple principles and recommendations a healthier life. They are well laid out and supported by good evidence. I also really appreciated his breaking down of the values to look for in bloodwork on pages 196-197, and I will definitely be copying those pages and saving them for reference.

In short, this is a book I plan to refer to in the future concerning my personal health, not to mention recommending it to all my friends and relatives who are concerned with their health or their weight. If you are looking for a summary of the best available information today concerning your weight and your health, I highly recommend this book.

[Pamela · Rating 4 out of 5]

Very good 4.6 I worked at Ochsner Clinic and knew of Dr. Carl Lavie, also on staff, as a highly respected cardiologist and prolific researcher. I read this book with surprise as the message stands in contrast to the absolute conviction that fat is bad and always unhealthy. He provides a clear outlaying of evidence from a variety of sources indicating that "you can be fat, fit and remarkably healthy." Fitness is an important part of this finding as "the fitter you are the less weight or BMI matters." How about this, "in a study on heart failure, the individuals who lived the longest(after heart failure) were the fattest."

He also noted that excessive exercise is counterproductive and "moderate exercise is the ideal."

Certainly many obese patients have severe weight problems, but he notes, "the fact that more than 2/3 of us are overweight or mildly obese, and yet a third of those people are healthy by every measure besides weight." Also, "obese individuals who are metabolically normal don't improve their healthy by weight loss."

It will be interesting to see whether this book with its collection of reports on extensive research, will make in dent in medical opinion and popular beliefs.

[Kathryn · Rating 4 out of 5]

Lavie explores fat, our cultural feelings about fat, what fat's purpose is (and yes we have fat in our bodies for a reason!) and proposes looking at metabolic health instead of just BMI to measure a person's propensity for diseases currently blamed on obesity. Obesity alone isn't to blame for diabetes or cardiac issues - there are people with low BMIs that are diabetic or have heart problems. At the same time there are people who have higher BMIs but are very fit and have low metabolic statistics (cholesterol etc.).

I don't think this will be the book to overcome our culture's hatred of fat and affection for fat shaming but it's a good read. At times I wasn't sure who the intended audience was - it seemed aimed at the average person in places and at more scientific folks (that is, not me) in other sections. I did learn more about abdominal fat vs fat in other areas - why being apple shaped is less healthy than being pear shaped. (It has to do with how fat cells in the abdomen behave.)

I read an advance copy with a few errors and lacking some charts that will probably add to the final published edition.

[Mark · Rating 4 out of 5]

The author asserts that our focus on fatness over fitness is impeding our ability to best help patients. He notes that overweight patients with a variety of health problems, from cardiac issues to diabetes, often live longer than those patients who not overweight. One of his important emphasis is on the metabolically obese. These are people who aren't overweight and have healthy BMI's, yet have blood sugar levels, cardiac problems, diabetes and other ailments typically associated with obesity. Though cautious about asserting that it's OK to be overweight, he does not that being metabolically fit is more important than having a healthy BMI. He discusses the problems of the BMI measurement, which he asserts is not a good indicator of an individual's health.

I found his explanations a bit technical at times, but that's more an indication of my scattered brain than his writing. He seems to know everyone who's anyone in the cardiac world and generously sites studies that both support and muddle his hypothesis.

A solid, pleasantly contradictory look at obesity.

[Bonnie Samuel · Rating 4 out of 5]

I initially picked this book up because I read a review that labeled it "controversial". I don't really see it as being controversial at all, though. The ideas and science presented by Dr. Lavie make perfect sense. It's not so hard to believe that a 6'2" supermodel who weighs 125 lbs, never works out and lives on a diet of cigarettes and caffeine would be significantly less healthy than someone who may be considered overweight by conventional standards, but who works out regularly and eats a healthy diet. Diet and exercise are the most important components of staying healthy. Not everyone can or should be very thin, but maintaining moderate levels of fitness will help your body function efficiently and maintain a weight that is healthiest for you, no matter what the BMI scale or Vogue might have to say about it.

[Lisa Morrow · Rating 4 out of 5]

This was a great book. I would have given it five stars. However, I take umbrage at Dr. Lavie's views on the "evolution of man," which I do not believe in.

The premise of this book is that if one is overweight and fit ("fat and fit"), he/she is healthier than one who is thin, but not physically fit. Dr. Lavie is a cardiologist who has done his own studies on this subject.

After reading this book, I still do need to lose some weight. However, I'm going to start with exercise and go from there. My goal is not to be a "normal" weight, but "overweight." A must read for anyone who has struggled with their weight and suffered guilt. This book is not a diet plan, but a recipe for a healthy life that includes daily exercise.

Years ago, I read a book called "The Obesity Myth." Exercise was also stressed as much more important than following a particular "diet plan."

[Alison · Rating 4 out of 5]

This was a very interesting book, looking at the world of 'fat' from a cardiologist point of view. There is always the 'worry' about heart health and weight, but so much out there are contradictions that you don't know if you should be worried about fat or sugar or fitness. Lavie's research and observations with his cardo patients have left him with clear evidence that being fit and healthy seems to be the key, not necessarily what you weight, even if by BMI standards you are overweight or even obese, hence the paradox - that he's found that those who are slightly over weight or even more so seem to fare better at surviving heart disease than those who are slim. He also talks a lot about the nutrition of fat, and how to 'get fit', and with all things including fitness, all things in moderation is best. Easy to read and not too over the top technical.

[Chuck · Rating 3 out of 5]

Pretty interesting, but not yet convincing. There are confounding variables that have not yet been teased out so it seems a bit premature. For example, lots of the evidence for the paradox is because of comparisons of outcomes for already sick people of various weights, without accounting for genetic differences. Sick, thin people may have worse genetic predispositions than overweight or obese people that have developed the same disease. Lavie acknowledges that this is a shortcoming, and not something that can easily be researched. However, doing so is essential for his central thesis to stand on its own.

[Biogeek · Rating 4 out of 5]

A bit repetitive, but tackles the complexities without resorting to oversimplification. The author courageously leaves things gray rather than choosing an easy (but incomplete) black-or-white view on almost anything. Best of all, lots of real research referenced and listed at the end of the book - worth a look just for those.

[Carrie · Rating 3 out of 5]

Interesting but nothing shocking. Exercise regularly and eat less junk. Although I do like his point that it would be helpful in general for our society to be less focused on thinness and more concerned with fitness.

[Jacki Myers · Rating 3 out of 5]

can't finish, not worth the time and effort.

[Jen · Rating 5 out of 5]

This is a great book for exposing how out cultural expectations shape our common sense. Which turns out to be my so common.

This should be required reading for every health professional.

[Whole And · Rating 3 out of 5]

A VERY interesting read. Those on a health journey would benefit from this perspective.
Bottom line, staying fit is a saving grace.

[Wendy · Rating 1 out of 5]

If you are looking for a revolutionary, yet well researched examination on the destructive culture of our diet and weight loss obsessed world, this isn’t it. This author is still steeped in diet culture, and doesn’t make any conclusions beyond the subtitle. He also apparently gives bad medical and biological advice (see Lori's review).

The entire book can be summed up with less bias and more helpful advice in an article from the Center of Disease Control called Do No Harm: Moving Beyond Weight Loss to Emphasize Physical Activity at Every Size.

If you want a more in-depth deconstruction of diet culture, you can instead read What’s Wrong With Fat, or Health at Every Size. Both books are well cited and researched, and Javie himself references the both several times. He seemed to miss the point of the books, however, since his argument leans toward the “Fat but Fit” social construct that Saguy picks apart in her excellent examination of societal biases against fatness.

https://www.goodreads.com/review/show...

https://www.cdc.gov/pcd/issues/2017/1...

https://www.goodreads.com/book/show/1...

https://www.goodreads.com/book/show/4...

[Farhana Faruq · Rating 5 out of 5]

This was great!! Lavie sounds qualified enough to share a book like this. He's a cardiologist and researcher. It was nice to see the other angle on obesity and the science that backs it. We're not talking morbidly obese, just a little fluffy..haha

I KNOW the BMI system is flawed and I'm glad Lavie included that information. It's not that he contradicts himself (as some people mentioned in reviews), you can still use the BMI system you just have to keep in mind that it's not totally accurate for everyone.

This is an 8 hour audio.
Basically stop worrying about how fat you are or thin you are - just stay fit! or work on getting fit.

[Mohon_dp1]

Obesity is a complex health issue characterized by excessive body fat, increasing the risk of various diseases, including diabetes, heart disease, and certain cancers oral testosterone treatment can be a great addition to the general benefits of obesity. Addressing obesity requires a multifaceted approach, including balanced nutrition, regular physical activity, and supportive community resources to foster healthier lifestyles and well-being.

For more info visit here : https://www.rethinktestosterone.com/b...

[Viewpoints Radio · Rating 5 out of 5]

The cultural bias against obesity is often justified on health grounds. But recent studies show that people classified in the "overweight" BMI category actually have less mortality than normal weight people. We spoke w/ author Carl J. Lavie abour this theory and more on our weekly radio show Radio Health Journal. To hear the full story plus more insight from experts on the Obesity Paradox, check out this link https://radiohealthjournal.wordpress....

[Julie]

gave up.

[Camille · Rating 5 out of 5]

One of the most illuminating books I have ever read.