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Blog Archives: Nov 2004 - present
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There is a common perception that excess adiposity, commonly
approximated by body mass index (BMI), is associated with reduced cancer
survival. A number of studies have emerged challenging this by
demonstrating that overweight and early obese states are associated with
improved survival. This finding is termed the “obesity paradox” and is
well recognized in the cardio-metabolic literature but less so in
oncology. Here, we summarize the epidemiological findings related to the
obesity paradox in cancer. Our review highlights that many observations
of the obesity paradox in cancer reflect methodological mechanisms
including the crudeness of BMI as an obesity measure, confounding,
detection bias, reverse causality, and a specific form of the selection
bias, known as collider bias. It is imperative for the oncologist to
interpret the observation of the obesity paradox against the above
methodological framework and avoid the misinterpretation that being
obese might be “good” or “protective” for cancer patients.
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