Xu J, et al. - Researchers examined how the link between body mass index and stroke is impacted by insulin resistance in this study involving 1,227 candidates. The Abnormal Glucose Regulation in Patients With Acute Stroke Across-China registry involved patients with ischemic stroke but not diabetes mellitus. Overweight/obese patients among insulin-resistant patients had half the risk of death following stroke vs their low/normal weight counterparts; no significant difference of mortality risk was found among insulin-sensitive patients, and the trends were similar for poor functional outcome and after adjustments for confounders. They observed significant interactions between body mass index and homeostasis model assessment–insulin resistance with respect to the risks of mortality and poor functional outcome. In patients with insulin resistance, they saw the obesity paradox for mortality and functional outcome but did not find the paradox in patients with insulin sensitivity. The authors concluded that insulin resistance could be a mechanism underlying the obesity paradox of the outcome in ischemic stroke patients.