"Obesity paradox," - the idea that overweight or obese people are not always at increased risk of heart disease - may be a myth, according to a study of nearly 300,000 people.
The research, published in the European Heart Journal, shows that the risk of heart and blood vessel problems, such as heart attacks, strokes and high blood pressure, increases as body mass index (BMI) increases beyond a BMI of 22-23.
Furthermore, the risk also increases steadily the more fat a person carries around their waist.
The study was conducted in 296,535 adults of white European descent who are taking part in the UK Biobank study, and who were healthy at the time they enrolled with the study.
UK Biobank recruited from 2006 to 2010, and follow-up data on participants were available up to 2015 for this latest analysis.
Researchers at the University of Glasgow in the UK found that people with a BMI between 22-23 had the lowest risk of cardiovascular disease (CVD).
As BMI increased above 22, the risk of CVD increased by 13 per cent for every 5.2 increase in women and 4.3 in men.
Compared to women and men with waist circumferences of 74 and 83 cm respectively, the CVD risk increased by 16 per cent in women and 10 per cent in men for every 12.6 cm and 11.4 cm increase in waist circumference for women and men respectively.
Similar increases in CVD risk were seen when the researchers looked at waist-to-hip and waist-to-height ratios and percentage body fat mass - all of which are considered reliable ways to accurately gauge the amount of fat a person carries, also known as adiposity.
It is already known that being overweight or obese increases a person's risk of CVD, as well as other diseases such as cancer.
However, there have been studies suggesting that being overweight or obese may not have any effect on deaths from CVD or other causes, and may even be protective especially if people maintain a reasonable level of fitness.
This is known as the "obesity paradox." However, the new study refutes these previous, conflicting findings.
"Any public misconception of a potential 'protective' effect of fat on heart and stroke risks should be challenged," said Stamatina Iliodromit, who led the study.
"This is the largest study that provides evidence against the obesity paradox in healthy people," said Iliodromit.
"It is possible that the story may be different for those with pre-existing disease because there is evidence that in cancer patients, for instance, being slightly overweight is associated with lower risk, especially as cancer and its treatments can lead to unhealthy weight loss," she added.
"By maintaining a healthy BMI of around 22-23, healthy people can minimise their risk of developing or dying from heart disease," she said.
The researchers suggest that the previous confusion over the "obesity paradox" may be due to many factors that can confound results of studies.
For instance, smoking changes the distribution of fat in the body, smokers may have lower weight as smoking depresses appetites and so BMI tends to be lower.
Another reason could be that some people have existing but undiagnosed disease, which can often lower their weight but also makes them more likely to die prematurely.
