World Health O. Obesity and Overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (2024). Accessed 01 March 2025.

Lee SH. Cardiovascular risk reduction in type 2 diabetes: further insights into the power of weight loss and exercise. Endocrinol Metab (Seoul). 2023;38(3):302–4. https://doi.org/10.3803/EnM.2023.1751.

Article  PubMed  Google Scholar 

Hainer V, Aldhoon-Hainerová I. Obesity paradox does exist. Diabetes Care. 2025;36(Supplement2):S276. https://doi.org/10.2337/dcs13-2023.

Article  Google Scholar 

Koirala S, Sunnaa M, Bernier T, Oktay AA. The role of obesity as a cardiac disease risk factor in patients with type 2 diabetes. Curr Cardiol Rep. 2024;26(11):1309–20. https://doi.org/10.1007/s11886-024-02129-z.

Article  PubMed  Google Scholar 

Han SJ, Boyko EJ. The evidence for an obesity paradox in type 2 diabetes mellitus. Diabetes Metab J. 2018;42(3):179–87. https://doi.org/10.4093/dmj.2018.0055.

Article  PubMed  PubMed Central  Google Scholar 

Donini LM, Pinto A, Giusti AM, Lenzi A, Poggiogalle E. Obesity or BMI paradox?? Beneath the tip of the iceberg. Front Nutr. 2020;7:53. https://doi.org/10.3389/fnut.2020.00053.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Ralston MR, McCreath G, Lees ZJ, Salt IP, Sim MAB, Watson MJ, et al. Beyond body mass index: exploring the role of visceral adipose tissue in intensive care unit outcomes. BJA Open. 2025;14:100391. https://doi.org/10.1016/j.bjao.2025.100391.

Article  PubMed  PubMed Central  Google Scholar 

Shakiba M, Soori H, Mansournia MA, Nazari SSH, Salimi Y. Adjusting for reverse causation to estimate the effect of obesity on mortality after incident heart failure in the atherosclerosis risk in communities (ARIC) study. Epidemiol Health. 2016;38:e2016025. https://doi.org/10.4178/epih.e2016025.

Article  PubMed  PubMed Central  Google Scholar 

Rohm TV, Meier DT, Olefsky JM, Donath MY. Inflammation in obesity, diabetes, and related disorders. Immunity. 2022;55(1):31–55. https://doi.org/10.1016/j.immuni.2021.12.013.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016;22(7 Suppl):s176–85.

PubMed  Google Scholar 

Huang X, Wu Y, Ni Y, Xu H, He Y. Global, regional, and National burden of type 2 diabetes mellitus caused by high BMI from 1990 to 2021, and forecasts to 2045: analysis from the global burden of disease study 2021. Front Public Health. 2025;13:1515797. https://doi.org/10.3389/fpubh.2025.1515797.

Article  PubMed  PubMed Central  Google Scholar 

World Obesity F. World Obesity Atlas 2022. https://data.worldobesity.org/publications/World-Obesity-Atlas-2022-updated.pdf (2022). Accessed 01 March 2025.

American Diabetes A. March: Statistics About Diabetes. https://diabetes.org/about-diabetes/statistics/about-diabetes Accessed 01 2025.

Lee AK, Woodward M, Wang D, Ohkuma T, Warren B, Sharrett AR, et al. The risks of cardiovascular disease and mortality following weight change in adults with diabetes: results from ADVANCE. J Clin Endocrinol Metab. 2020;105(1):152–62. https://doi.org/10.1210/clinem/dgz045.

Article  PubMed  Google Scholar 

Eckel RH, Kahn SE, Ferrannini E, Goldfine AB, Nathan DM, Schwartz MW, et al. Obesity and type 2 diabetes: what can be unified and what needs to be individualized? J Clin Endocrinol Metab. 2011;96(6):1654–63. https://doi.org/10.1210/jc.2011-0585.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Parker ED, Pereira MA, Stevens J, Folsom AR. Association of hip circumference with incident diabetes and coronary heart disease: the atherosclerosis risk in communities study. Am J Epidemiol. 2009;169(7):837–47. https://doi.org/10.1093/aje/kwn395.

Article  PubMed  PubMed Central  Google Scholar 

Costanzo P, Cleland JG, Pellicori P, Clark AL, Hepburn D, Kilpatrick ES, et al. The obesity paradox in type 2 diabetes mellitus: relationship of body mass index to prognosis: a cohort study. Ann Intern Med. 2015;162(9):610–8. https://doi.org/10.7326/M14-1551.

Article  PubMed  Google Scholar 

Fox CS, Pencina MJ, Wilson PWF, Paynter NP, Vasan RS, D’agostino RB. Lifetime risk of cardiovascular disease among individuals with and without diabetes stratified by obesity status in the Framingham heart study. Diabetes Care. 2008;31(8):1582. https://doi.org/10.2337/dc08-0025.

Article  PubMed  PubMed Central  Google Scholar 

Luciani L, Pedrelli M, Parini P. Modification of lipoprotein metabolism and function driving atherogenesis in diabetes. Atherosclerosis. 2024;394:117545. https://doi.org/10.1016/j.atherosclerosis.2024.117545.

Article  PubMed  CAS  Google Scholar 

Okoh P, Olusanya DA, Erinne OC, Achara KE, Aboaba AO, Abiodun R, et al. An integrated pathophysiological and clinical perspective of the synergistic effects of obesity, hypertension, and hyperlipidemia on cardiovascular health: A systematic review. Cureus. 2024;16(10):e72443. https://doi.org/10.7759/cureus.72443.

Article  PubMed  PubMed Central  Google Scholar 

Oktay AA, Akturk HK, Esenboga K, Javed F, Polin NM, Jahangir E. Pathophysiology and prevention of heart disease in diabetes mellitus. Curr Probl Cardiol. 2018;43(3):68–110. https://doi.org/10.1016/j.cpcardiol.2017.05.001.

Article  PubMed  Google Scholar 

Wu H, Ballantyne CM. Metabolic inflammation and insulin resistance in obesity. Circul Res. 2020;126(11):1549–64. https://doi.org/10.1161/CIRCRESAHA.119.315896.

Article  CAS  Google Scholar 

Defronzo RA. Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: the missing links. The Claude Bernard lecture 2009. Diabetologia. 2010;53(7):1270–87. https://doi.org/10.1007/s00125-010-1684-1.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Howard BV. Insulin resistance and lipid metabolism. Am J Cardiol. 1999;84(1, Supplement 1):28–32. https://doi.org/10.1016/S0002-9149(99)00355-0.

Article  Google Scholar 

Vergès B. Abnormal hepatic Apolipoprotein B metabolism in type 2 diabetes. Atherosclerosis. 2010;211(2):353–60. https://doi.org/10.1016/j.atherosclerosis.2010.01.028.

Article  PubMed  CAS  Google Scholar 

Yildiz M, Esenboga K, Oktay AA. Hypertension and diabetes mellitus: highlights of a complex relationship. Curr Opin Cardiol. 2020;35(4):397–404. https://doi.org/10.1097/HCO.0000000000000748.

Article  PubMed  Google Scholar 

Thethi T, Kamiyama M, Kobori H. The link between the renin-angiotensin-aldosterone system and renal injury in obesity and the metabolic syndrome. Curr Hypertens Rep. 2012;14(2):160–9. https://doi.org/10.1007/s11906-012-0245-z.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Yasue S, Masuzaki H, Okada S, Ishii T, Kozuka C, Tanaka T, et al. Adipose tissue-specific regulation of angiotensinogen in obese humans and mice: impact of nutritional status and adipocyte hypertrophy. Am J Hypertens. 2010;23(4):425–31. https://doi.org/10.1038/ajh.2009.263.

Article  PubMed  CAS  Google Scholar 

Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al. Obesity and cardiovascular disease: A scientific statement from the American heart association. Circulation. 2021;143(21):e984–1010. https://doi.org/10.1161/cir.0000000000000973.

Article  PubMed  PubMed Central  Google Scholar 

Oktay AA, Lavie CJ, Kokkinos PF, Parto P, Pandey A, Ventura HO. The interaction of cardiorespiratory fitness with obesity and the obesity paradox in cardiovascular disease. Prog Cardiovasc Dis. 2017;60(1):30–44. https://doi.org/10.1016/j.pcad.2017.05.005.

Article  PubMed  Google Scholar 

Raghuveer G, Hartz J, Lubans DR, Takken T, Wiltz JL, Mietus-Snyder M, et al. Cardiorespiratory fitness in youth: an important marker of health: A scientific statement from the American heart association. Circulation. 2020;142(7):e101–18. https://doi.org/10.1161/cir.0000000000000866.

Article  PubMed  PubMed Central