This reversal of traditional epidemiology, or the obesity paradox, has now been well documented in numerous studies in the HF medical literature. Given the high prevalence of obesity not only in the general population but also in HF populations, discussion of obe- sity and its treatment is highly relevant. In an initial study of 1203 patients with advanced HF fol- lowed up at a single university HF referral center, obesity, as defined by BMI, was not associated with worsened out- A subsequent analysis of the Digitalis Investiga- tion Group database of 7788 patients with chronic, stable HF also revealed lower risk-adjusted mortality rates in the overweight and obese compared with normal-weight pa- Similarly, in a substudy of the CHARM program, including 7599 subjects with symptomatic HF with a wide range of LVEF, higher BMI was incrementally associated with lower mortality. Furthermore, a BMI 35.0 kg/m2 was not associated with excess risk, and the group with the highest mortality rates was the group of patients with (Figure 5). 