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JACC has yet another report by database doctors on the relationship between obesity and STEMI outcomes.  As expected, we are treated to reems of data placed  in hypnotic tables.  The punch line comes with a graph showing a U-shaped relationship between BMI and in-hospital mortality as another example of the obesity paradox.  The relationship flattens out after multi-variable adjustment except for the super obese, who remain subject to increased mortality.

The authors claim to be “surprised” that there were few meaningful differences in “process of care” according to BMI.  In other words, obese patients are treated by doctors and hospital staff like other human beings.

This is unlike the attitude of academic and public health experts who are determined to make obese people the subject of the most intense scrutiny and intervention (at the risk of causing body image and eating disorders), despite the fact that obesity is not an independent risk factor for anything.

Unless it causes a functional abnormality that bothers the person, obesity may be best characterized as a “proto-”risk factor, ie. a risk factor for risk factors. Singling out the obese seems to be a perfect example of “profiling.”  But where is the outrage?

On the contrary, instead of finding comfort in the meager benefit that obese people can expect once they develop heart disease, the accompanying editorial states that the obesity paradox itself must be “combated.”

Truth is the first casualty of war.  This applies to public heath wars as much as it does to military ones.

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