It is well accepted that obesity contributes to cardiovascular risk and adverse outcomes secondary to more frequent diabetes mellitus and hypertension [ , ]. However, observational studies have suggested improved acute outcomes for obese patients undergoing percutaneous coronary intervention (PCI) as well as in patients with heart failure. This so-called obesity paradox has remained poorly explained and debated as to the validity as well as meaning [ , ]. Furthermore, these same studies have noted an increased risk for low weight patients as well as increased adverse risk for morbidly obese patients, suggesting a “sweet spot” for only “modest” obesity as a favorable finding. Theoretical mechanisms have been suggested including lower inflammatory markers for obesity, larger vessels improving the outcome for stents, and vasodilatory advantages based on the endocrine effects of obese tissue. However, such studies, as noted above are observational and do not prove causation and definitive mechanisms do not exist.