Current Heart Failure Reports

, Volume 11, Issue 1, pp 111–117 | Cite as

The Obesity Paradox in Chronic Heart Failure: What Does It Mean?

  • Paul J. Chase
  • Paul G. Davis
  • Daniel R. Bensimhon
Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)


Heart failure (HF) is a growing health problem, at least in part due to the concurrent obesity epidemic plaguing developed countries. However, once a patient develops HF, an elevated BMI appears to confer a survival benefit – a phenomenon termed the “obesity paradox.” The exact explanation for this paradox has been difficult to ascertain. Numerous plausible mechanisms have been asserted, including the fact that obese patients tend to be younger and more symptomatic, leading them to seek medical attention earlier in the course of their HF. Obese patients may also have larger energy reserves that help to offset the catabolic changes seen with HF. Other hypotheses highlight the limitations of BMI as an obesity classifier. The purpose of this review is to examine the various theories for the obesity paradox in HF and discuss the implications for the clinical management of obese patients with HF.


Obesity paradox Body mass index Heart failure Cardiorespiratory fitness Total fitness Body fat distribution Weight management 


Compliance with Ethics Guidelines

Conflict of Interest

Paul J. Chase, Paul G. Davis, and Daniel R. Bensimhon declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Paul J. Chase
    • 1
    • 2
  • Paul G. Davis
    • 2
  • Daniel R. Bensimhon
    • 1
    • 3
  1. 1.LeBauer Cardiovascular Research FoundationCone HealthGreensboroUSA
  2. 2.Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroUSA
  3. 3.Advanced Heart Failure ClinicCone HealthGreensboroUSA

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