Overweight and grade I obesity in patients with cardiovascular disease: to treat or not to treat?

Obesity is a significant public health problem, associated with several comorbidities and complications. At the same time, the results of studies suggest that the relationship between obesity and survival in subjects diagnosed with cardiovascular disease is a U-shaped curve with a significantly worse prognosis among underweight and morbidly obese individuals. The association between overweight or grade I obesity and cardiovascular mortality is not clear, and numerous studies have shown an unexpected and paradoxical inverse relationship with better prognosis in this patient group, the so-called "obesity paradox". In the current review, we discuss the most important and most reliable studies regarding the prognosis and clinical course in patients with overweight or grade I obesity and essential hypertension, coronary artery disease, or heart failure, focusing on data for and against the obesity paradox.