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Therefore, the obese patients may have been either slightly "healthier" with respect to CHF or in earlier stages of CHF than their normal/underweight counterparts. So obese survival rates were better. Again, obese patients could be "healthier" or in earlier stages of these chronic diseases. Chronic disease patients with low BMIs do not have low BMIs intentionally, but because of the nature of the wasting disease. None of the studies discriminated between intentional weight loss (from diet and exercise) and unintentional weight loss (from disease). Obese patients may have a better metabolic reserve than their normal/underweight counterparts. Few of the studies looked at extreme obesity (BMI more than 35). In some studies that did, the extremely obese did not have a greater chance of survival than the underweight. Therefore, the survival curves may be U-shaped. Normal and overweight patients would have better survival probabilities than those at the extremes -- underweight and extremely obese.




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