The Obesity Paradox: Love handles and Longevity

We’ve all heard it a million times: eat well, exercise, lose weight—because thin is good and fat, any fat, is... well, bad

Just take a look at those BMI tables. They tell us that a ‘normal’ weight is having a BMI between 18.5 and 25, overweight is having a BMI between 25 and 30 and anything above that is in the obese category. So, the goal for us all then is a BMI of 25 and below, right?

But then we are presented with the ‘obesity paradox’

What’s that, I hear you ask? Oh, just the idea that carrying a little extra padding might actually prolong your life in certain situations.? Yes, those love handles might be your life raft in a storm

How Is This Possible?

It turns out, having a BMI in the "overweight" range (25–29.9) isn’t all doom and gloom. In fact, research shows that people with a little extra cushion tend to live about the same or even a little longer than the rest of us

Whether it’s a bout of pneumonia, a cardiac event, or some other stressful medical situation, that extra weight seems to give you an edge. Your fat is like the ultimate backup generator—it kicks in when the power goes out, especially in older individuals

Fat's Secret Weapon?

Scientists have a few theories for why this happens:?

Energy Reserves: Extra fat stores act as a reserve fuel tank during illness, when your body needs more energy to heal

Anti-Inflammatory Effects: Adipose tissue (that’s the fancy word for fat) releases certain hormones that might actually help regulate inflammation in moderate amounts

Proactive Healthcare: Overweight individuals are often flagged as “at risk” by doctors, leading to more frequent checkups and earlier interventions. Sometimes, paranoia pays off

The Sweet Spot

Before you start cancelling your gym membership, let’s be clear: the obesity paradox applies mostly to mildly overweight individuals—not those tipping into the "severely obese" category. Carrying a extra few pounds might save your life, but carrying a whole spare tyre could still lead to problems like diabetes, heart disease, and mobility issues

Think of it as a bell curve: too little fat and your body’s unprepared; too much and it’s overwhelmed

So, what’s the sweet spot? It seems having a BMI between 25–29.9, where your fat is juuuuust right

Now we have access to effective treatments for obesity in the form of GLP-1s and people are being treated widely it would seem sensible to treat patients with BMI’s that are above thirty and probably presenting with at least one co-morbidity.

How are we doing?

Let’s turn our attention to the typical patient profile and let’s use the world’s biggest market as a worked example, the US. The typical patient profiles are outlined below:

Non-Private ~30% of the patient population in the US

• Average age: 46.2 years
• Average BMI: 38.5
• Gender: 66% female
• Co-morbidities: 50–60% of patients prescribed GLP-1s for obesity also have diabetes. Other co-morbidities also include hypertension, dyslipidaemia, and non-alcoholic fatty liver disease are common

Private/private insurance ~ 70% of the patient population in the US

• Average age: 49 ?years
• Average BMI: 31.5
• Gender: 75% female
• Co-morbidities: Fewer co-morbidities

What do these trends reveal?

Non-private patients: Treatments start at more advanced stages of obesity with significant co-morbidities

Private patients: Treatments appear to be geared more towards weight management

Gender gap: Women are more likely than men to seek access to obesity treatments

What are the Implications?

This snapshot underscores the disparities in obesity treatment by insurance type, emphasising the need for more equitable access. It also highlights the dual role of GLP-1s in managing obesity and co-morbid metabolic conditions

The Takeaway

So, what’s the moral of the story? Should you embrace your dad bod as a badge of longevity? Not quite. The obesity paradox isn’t an excuse to skip the gym and dive headfirst into a pizza buffet. It’s more a reminder that health is complicated, and BMI is just one piece of the puzzle

Still, if anyone side-eyes you for that extra helping of pudding after the Sunday roast, just smile and say, “it’s my biological insurance policy”