Body weight and mortality in COPD: focus on the obesity paradox

  • Francesco SpeltaEmail author
  • A. M. Fratta Pasini
  • L. Cazzoletti
  • M. Ferrari
Part of the following topical collections:
  1. Obesity Paradox



The positive association between overweight, obesity, and cardiovascular and all-cause mortality is well established, even though this relation is typically U shaped with an increased risk also in low-weight subjects. However, being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases, id est the “obesity paradox”. In both community-dwelling and hospitalized patients with COPD, several studies have reported a significant protective effect of obesity on all-cause mortality, indicating that also in obstructive pulmonary diseases, an obesity paradox may be present. Interestingly, the “paradox” is more evident for subjects with severe bronchial obstruction (i.e., a lower FEV1), while in mild–moderate conditions, the weight-related mortality shows a behavior similar to that observed in the general population. Several factors may confound the relation between COPD, obesity and mortality. The lower FEV1 found in obese people may be linked to a restrictive defect rather than to an obstructive one. Due to the modified chest wall mechanical properties—related to increased fat mass—obese COPD patients may present, respect to their lean counterpart, a lower lung hyperinflation which is associated with higher mortality. The traditional classification of COPD attributes to obese “blue bloaters” a low-grade emphysema in opposition to lean “pink puffers”; the fact that emphysema extent is related to mortality may bias the relationship between weight and survival. It is also to underline that the majority of the studies, consider BMI rather than body composition (a better predictor of mortality) when studying the intriguing relation between weight, COPD, and mortality. Reverse bias has also to be taken into account, hypothesizing that an unintentional weight loss may be the deleterious factor related to mortality, rather than considering obesity a protective one. Further prospective studies are needed to shed light on the complexity of this emerging issue.

Level of evidence

Level V: Narrative Review.


Overweight Obesity Visceral obesity Obesity paradox Pulmonary function COPD 


Compliance with ethical standards

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Section of Respiratory Disease, Department of MedicineUniversity of VeronaVeronaItaly
  2. 2.Section of Internal MedicineUniversity of VeronaVeronaItaly
  3. 3.Department of Diagnostic and Public HealthUniversity of VeronaVeronaItaly

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