Obesity paradox in joint replacement for osteoarthritis – truth or paradox?

Setor K Kunutsor, Michael R Whitehouse, Ashley W Blom

Research output: Contribution to journalEditorial (Academic Journal)peer-review

5 Citations (Scopus)
33 Downloads (Pure)


Obesity is associated with an increased risk of cardiovascular disease (CVD) and other adverse health outcomes. In patients with pre-existing heart failure or coronary heart disease, obese individuals have a more favourable prognosis compared to individuals who are of normal weight. This paradoxical relationship between obesity and CVD has been termed the ‘obesity paradox’. This phenomenon has also been observed in patients with other cardiovascular conditions and diseases of the respiratory and renal systems. Taking into consideration the well-established relationship between osteoarthritis (OA) and CVD, emerging evidence shows that overweight and obese individuals undergoing total hip or knee replacement for OA have lower mortality risk compared with normal weight individuals, suggesting an obesity paradox. Factors proposed to explain the obesity paradox include the role of cardiorespiratory fitness (“fat but fit”), the increased amount of lean mass in obese people, additional adipose tissue serving as a metabolic reserve, reverse causation and confounding by smoking, and the co-existence of older age and specific comorbidities such as CVD. A wealth of evidence suggests that higher levels of fitness are accompanied by prolonged life expectancy across all levels of adiposity and that the increased mortality risk attributed to obesity can be attenuated with increased fitness. For patients about to have joint replacement, improving fitness levels through physical activities or exercises that are attractive and feasible, should be a priority if intentional weight loss is unlikely to be achieved.
Original languageEnglish
Early online date27 Aug 2021
Publication statusE-pub ahead of print - 27 Aug 2021

Bibliographical note

Funding Information:
This study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (BRC-1215–20011). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. These sources had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Publisher Copyright:
© 2021, The Author(s).


  • obesity paradox
  • cardiovascular disease
  • osteoarthritis
  • hip replacement
  • knee replacement


Dive into the research topics of 'Obesity paradox in joint replacement for osteoarthritis – truth or paradox?'. Together they form a unique fingerprint.

Cite this