Can we reconcile ‘the obesity paradox’ with recent cardiovascular outcome trials in diabetes?

Recent cardiovascular (CV) outcome trials of treatments for type 2 diabetes mellitus (T2DM) including Glucagonlike peptide-1 (GLP-1) receptor agonists (1,2) and sodiumglucose co-transporter-2 (SGLT2) inhibitor (3) have shown beneficial effects on both CV outcomes and body weight. The so-called obesity paradox refers to the epidemiological inference that obesity, defined by a body mass index (BMI) >30 kg m, when compared to normal weight (probably incorrectly defined as a BMI of 18.5–25 kg m), is associated with ‘counterintuitive improved health in a variety of disease conditions, including cardiovascular disease’ (4)? Do the trial findings further undermine the belief in a paradox, and can they provide support for the benefits of intentional weight loss?