For years, we've been warned that being overweight or obese puts us at risk for heart disease. But some studies show that in heavy patients with cardiovascular disease,  obesity may play a protective role. Obese patients with heart disease seem to do better and live longer than skinny ones, according to a review article in the May 26, 2009 issue of the Journal of the American College of Cardiology.

"Obese patients with heart disease respond well to treatment and have paradoxically better outcomes and survival than thinner patients," said Carl Lavie, medical director of Cardiac Rehabilitation and Prevention at the Ochsner Medical Center in New Orleans and lead author of the article, which was reported in Medical News Today. "Although these patients have a more favorable short and long-term prognosis, we don't yet understand the mechanisms of why this might be the case."

The so-called obesity paradox in heart disease patients is complicated. Some experts theorize that excess weight may be protective, and that obese heart disease patients are more able to fight off illness than thinner patients. Another possible explanation is that obese patients seek medical attention earlier than thin patients because they're out of shape or because of other symptoms not related to heart disease. Once at the doctor, they're diagnosed with heart disease while it is still milder.

Thinking maybe you should put on a few pounds? Don't pick up the phone to order a pepperoni and extra-cheese pizza just yet. Experts say gaining weight is not the solution. "The fact is that the emphasis is overwhelming that larger people have more cardiovascular problems and other types of health problems," says Dr. Gerald Fletcher, professor of medicine at the Mayo Clinic College of Medicine. "Obesity is one of the six risk factors for heart disease." (The others are smoking, high blood pressure, abnormal LDL cholesterol, diabetes, and lack of physical activity, he says.)

Thinner patients could also have other medical conditions that are keeping them thin, like lung disease or cancer, Fletcher says, which would also explain the obesity paradox.

Overall, he says, it's best to maintain an ideal weight to keep your heart healthy. "While a small number of studies show that some of the heavier people do better," Fletcher says, "In larger studies done over time, it's been shown that obesity is very detrimental to one's health."  

To help you make nutritious family meals that will help everyone maintain ideal body weight, the American Heart Association offers the following tips:

  • Eat foods that are low in saturated fat, trans fat, cholesterol, salt (sodium), and added sugars.

  • Go easy on the butter. Make sure most of your fats come from fish, nuts and vegetable oils.

  • Serve fat-free or low-fat dairy foods, and whole-grain/high-fiber breads and cereals rather than refined grain products. Look for "whole grain" as the first ingredient on the food label and make at least half your grain servings whole grain. Serve a variety of fruits and vegetables daily, while limiting juice intake.