• Cardiovascular Diseases

Obesity has reached epidemic levels in the USA and much of the Western world.1 Obesity certainly contributes to most of the major cardiovascular diseases (CVD) risk factors, such as glucose levels and increasing the development of the metabolic syndrome and diabetes mellitus, increasing blood pressure and hypertension, worsening plasma lipid profiles, especially increasing triglycerides and lowering the cardioprotective high-density lipoprotein cholesterol, and increasing levels of systemic low-grade inflammation, all of which leads to increases in the risk of major CVD. Clearly, obesity increases the CVD, especially heart failure and atrial fibrillation, more so than ischaemic heart disease (IHD). However, despite the well-established relationship between obesity and CVD, numerous individual studies and meta-analyses consistently demonstrate an ‘obesity paradox’, where patients with obesity and established CVD generally have a better prognosis than leaner patients with the same condition.1 2 We have published substantially on the impact of physical activity (PA) and cardiorespiratory fitness (CRF) on the obesity paradox,1 2 but there is limited information on the impact of changes in weight on prognoses in patients with obesity, with or without CVD.

In their Heart manuscript, Zhang et al 3 examined 8297 patients with obesity and CVD from the UK Biobank and assessed the association between weight changes and major prognoses over a mean 13.9-year follow-up. They …