The 'obesity paradox' extends to Veterans

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In medical circles, the so-called "French paradox" is well-known: The French eat lots of fatty foods, but they have less heart disease than Americans. Theories abound as to why that is: Maybe it's the compounds in the red wine they drink, or other factors related to the Mediterranean diet or their overall lifestyle.

There's another phenomenon that's emerged in the medical literature in recent years called the "obesity paradox." For reasons researchers have yet to understand, obese people with certain health conditions—including heart disease and diabetes—seem to outlive their normal-weight counterparts with the same diseases. Several studies have found the same effect among people without chronic disease. Some of these studies have focused on specific occupational or ethnic groups, such as longshoremen, farmers, or Native American women.

Add Veterans to the list. That's the pattern seen in several studies by Kokkinos' team. He has a theory as to why this is, and perhaps similar factors underlie the paradox seen in the groups mentioned above. He thinks years spent in the military may delay the onset of obesity and stave off its bad effects.

"The general population starts to get fatter and decrease in fitness during their mid 20s, no later than their 30s," explains Kokkinos. "Many Veterans, on the other hand—not all, but certainly those who spend a few years in the military, including the Reserves—have to maintain their weight and fitness level during that time. They probably have a 10- or 20-year delay, on average, in obesity." That's enough, he says, to skew the later-life mortality figures that would otherwise be seen in the general population.

Kokkinos is quick to emphasize, though, that being obese is by no means healthy—notwithstanding the curious results from his and others' epidemiologic studies.

Like his clinical colleagues, he is not telling folks to load up on burgers, fries, and donuts in an effort to put on weight. That's not the take-home message of the study findings.

"The medical profession does not advise patients to become fat," he says bluntly.

Cracking the mystery of the obesity paradox, he says, continues to be a goal for researchers. Kokkinos says one way to do it, at least in theory, would be a long-term randomized clinical trial that would "take skinny people, fatten half of them and keep the rest the same, and track who dies over 50 years. Obviously, this is not only unethical but also impossible to do."

Meanwhile, he and others will work up a sweat—intellectually, at least—trying to solve the puzzle.