When researchers have gone back and looked at these "obesity paradox" studies and included things like waist circumference and waist-hip-ratio in measuring their cohorts overall mortality the "obesity paradox" vanishes.
Also this article isn't very context specific. Different disease process are different and that has to be considered as well. For example, when looking a cohorts of cancer patients people who were initially heavy do typically tend to do better and that probably has to do with the fact their bodies take longer to get cachexic than do "normal weight" or underweight people.
Coronary artery disease (CAD) is another one that needs discussed in specifics. You can divide the pathophysiology of myocardial infarcts (MI) into two broad groups: think of it like the "suddens" and the "slows".
Its kind of counter-intuitive. Think of the blood vessels on the heart like a pipe carrying water. That pipe over time becomes occluded by fatty plaques due to inflammation and cholesterol deposition. You would think that having your pipe 70% occluded is worse than 40% occluded, but that isn't necessarily the case because the pathophysiology is different. In obese patients with high cholesterol the deposition is slow and collateral circulation develops to help meet myocardial oxygen demands. When these patients have MIs they tend to do better because this collateral circulation helps prevent some ischemic damage to the heart. These heavy patients with slow occlusion are likely due to more environmental factors--That is to say they have high cholesterol because they eat like crap and don't get enough exercise.
On the other hand you have this other group of people who may not be overweight and get "massive heart attacks" and die abruptly at young ages (smokers also tend to fall into this category). The pathophysiology of plaque deposition is different in these people. If you look at their "water pipes" you see they aren't as occluded--say 40%. So no problem right? The problem is their plaques are unstable and prone to rupture. When a plaque ruptures an emboli travels down stream to smaller "pipes" and occludes the blood supply. This is a major problem because in these people the plaques developed quickly and without time for collateral circulation to develop. Ergo when they have a myocardial event the ischemic damage is usually massive and fatal.
Thanks for the information Copasetic.That explains why smokers are at high risk then. Haven't seen you on here for a while so good to see you