S757 The Obesity Paradox: Nationwide Analysis Using the National Inpatient Sample

Introduction: Obesity is a well-established risk factor for numerous chronic conditions, including cardiovascular disease, respiratory illness, and metabolic disorders. However, the “obesity paradox” suggests that obese individuals may experience lower in-hospital mortality rates despite their higher burden of comorbidities. This study evaluates the impact of comorbid obesity on in-hospital outcomes for patients admitted with congestive heart failure (CHF), acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), sepsis, and cirrhosis. Methods: Using data from the National Inpatient Sample (NIS), we conducted a retrospective analysis of inpatient outcomes, including all-cause mortality, length of hospital stay, and total hospital charges. Multivariate logistic regression analyses were performed to assess the association between obesity and in-hospital survival, accounting for potential confounders such as age, sex, race, and socioeconomic status. Results: Obesity was associated with significantly lower in-hospital mortality for CHF (odds ratio [OR]: 1.26, 95% confidence interval [CI]: 1.17-1.36, P-0.), AMI (OR: 1.19, 95% CI: 1.10-1.29), COPD (OR: 1.57, 95% CI: 1.29-1.92), and sepsis (OR: 1.48, 95% CI: 1.43-1.54), but not for cirrhosis (OR: 1.13, 95% CI: 0.92-1.39). However, obesity was associated with increased hospital length of stay and higher hospitalization costs across all conditions. Conclusion: This nationwide study confirms the obesity paradox, showing lower in-hospital mortality among obese patients with CHF, AMI, COPD, and sepsis, but not in those with liver cirrhosis. Proposed mechanisms include greater metabolic reserve and anti-inflammatory effects, though outcomes vary by disease. Despite survival benefits, obesity was linked to longer hospital stays and higher costs. The paradox remains poorly understood and highlights the need for further prospective studies to guide care for obese patients with chronic illnesses.