Obesity is an increasingly frequent condition associated with increased adipose, systemic and pulmonary inflammation. There is an emerging and unexpected finding that obese individuals may not be at a greater risk for ARDS and, indeed, may even be partially protected against ARDS. This finding is known as the Obesity-ARDS Paradox. In this review we discuss the observations regarding this intriguing phenomenon and begin to elaborate on the theoretical rationale that obesity-triggered low-grade

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... flammatory processes may constitute pre-conditioning insults or trigger anti-inflammatory adaptive mechanisms that confer protection against ARDS. Several mechanisms have been proposed as responsible for preconditioning development, including an increase of TNFα and other cytokines [29, 34, 35] , and of heme oxygenase-1 (HO-1) [36], among others [37] [38] [39] . Interestingly, obesity raises the adipose and plasma levels of TNFα and other cytokines [40] and of 42]. For example, one could hypothesize that the adipose-triggered first hit inflammatory mediators (e.g. adipose-released TNFα or other cytokines) locally J o u rn al of Pu lm o n ar y & Re sp ir a to ry Medic in e