The study, in Annals of Internal Medicine, found that people with normal weight and central obesity have worse long-term survival than anyone of any weight with normal fat distribution. For example, compared with an overweight or obese man with normal waist-to-hip ratio, men of normal weight with central obesity were at more than twice the risk for death, which may help to explain the “obesity paradox,” in which obesity seems to protect against heart disease in some people.