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The study suggests that the obesity paradox could be associated with several biases. Obesity could lead to earlier testing, and earlier diagnosis could result in increased survival. In contrast, individuals with healthy weight have a lower pretest probability. Thus, they present with more advanced disease and a worse subsequent prognosis. When earlier detection of disease is confused with prolonged survival. Nutrition such as red meats and sedentary life style are risk factors for CHD. Despite the known adverse effects of obesity on the progression, it has repeatedly been shown that CHD patients with overweight have lower mortality. In this study, obesity can give people with cardiovascular disease the advantage of survival.

The study conducted by Chang et al., observed this obesity " paradox " is often studied in the context of a general disease, in which disease-related disorders of weight loss and selective survival are particularly problematic. The study primarily investigates the obesity relationship with mortality of people with accident CVDs where bias could potentially decrease and compare these results with those based on common diseases. This study used health and retirement research data, a representative longitudinal survey of American adults over the age of 50, to Medicare claims starting in 1992. Previous disease models used simultaneous weight states and disease models used early weight states showing obesity of mortality rates 18-36% lower, but it detected a wide range of disease-related weight loss can be a significant confounding in this setting. The study concluded that there was no evidence of the survival benefits of obesity when switching from the same data set to accident diagnosis of the same condition and pre-diagnostic weight.

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