How do you interpret elevations in ESR and CRP in the setting of increased BMI?

Increases in BMI (overweight and obesity range) have been shown to be associated with elevated CRP and ESR, with stronger associations shown with CRP specifically. Interestingly, the association between elevated CRP and obesity seems to be stronger in female populations than in male patients.

In the ...

ESR & CRP can be modestly more elevated in obese patients. Obesity is a pro-inflammatory state. I have noticed this in my practice.

I also use SPEP to help differentiate inflammation from just obesity effecting the numbers.

In obesity, there could be release of adipokines causing the rise in ESR and cRP.