Baloney Mass Index

April 4, 2012 9:04 AM

A new study conducted by Dr. Eric Braverman, president of the nonprofit Path Foundation in New York City, and Dr. Nirav Shah, New York State’s Commissioner of Health suggests that the Body Mass Index significantly underestimates the rate of obesity in America, especially for women. Based on BMI, about one-third of Americans are considered obese, but when other methods of measuring obesity are used, that number may be closer to 60%.

Dr. Braverman and Dr. Shah used dual-energy X-ray absorptiometry (DEXA) scanning equipment to evaluate body composition. While BMI is a simple ratio of a person’s height and weight, the DEXA scan, normally used to measure bone density, can distinguish between bone, fat and muscle mass.

Among the study participants, about half of women who were not classified as obese according to their BMI actually were obese when their body fat percentage was taken into account. Among the men, in contrast, about a quarter of obese men had been missed by BMI. Further, a quarter who were categorized as obese by BMI were not considered obese based on their body fat percentage. Overall, about 39% of participants who were classified as overweight by their BMI were actually obese, according to their percent body fat.

The full study, Measuring Adiposity in Patients: The Utility of Body Mass Index (BMI), Percent Body Fat, and Leptin, is available on PLoS ONE, an open access peer-reviewed scientific journal published by the Public Library of Science.

posted by 2bucksplus (118 comments total)

BTW, the title comes from a quote from Dr. Braverman "We call BMI the 'baloney mass index.'"
posted by 2bucksplus at 9:06 AM on April 4, 2012

PLoS One link.
posted by gurple at 9:09 AM on April 4, 2012

Oh, whoops! You did have a direct link in there. Sorry, 2bucksplus!
posted by gurple at 9:09 AM on April 4, 2012

If we push this science far enough we can sell diets and diet products to every American!

How much more science do you think it will take to prove that anorexics have been right all along?

GO SCIENCE!
posted by edheil at 9:16 AM on April 4, 2012 [13 favorites]

Finally, a bigger voice than the fitness community pointing out that BMI rewards skinny-fat people while punishing anyone with muscle.

I'm sure that the FDA will come out and strongly support scientifi-hahahhahaha, just kidding. Eat your MyPlate carb, kids.
posted by unixrat at 9:17 AM on April 4, 2012 [16 favorites]

Yeah well, according to my own personal scale, the WTF, you're all fucking fat.
posted by mattbucher at 9:18 AM on April 4, 2012 [3 favorites]

If we push this science far enough we can sell diets and diet products to every American!

Further, a quarter who were categorized as obese by BMI were not considered obese based on their body fat percentage.

Let's work on literacy first.
posted by Jpfed at 9:19 AM on April 4, 2012 [10 favorites]

If you can't tell, I hate hate hate the BMI and all this other quantifying body fat enumeration bs. "Among the study participants, about half of women who were not classified as obese according to their BMI actually were obese when their body fat percentage was taken into account." Fuck you, you are what is wrong with our society pseudo-science. "Obese" is a pejorative term you sling around so casually with your white lab coat on. These people are not "obese." Seriously, fuck off.
posted by mattbucher at 9:21 AM on April 4, 2012 [5 favorites]

I'm writing a paper right now that uses BMI in a statistical model to help tease out the relationship between two different controlled diets and the levels of a bunch of molecules in blood. Everyone involved in the paper knows that BMI is crap, but it's so easy and so noninvasive to measure, even compared with a blood-based surrogate for % body fat, that it's used all the time.

So, go papers like this, to help keep nudging people away from using BMI as though it were the value you really wanted to use!
posted by gurple at 9:22 AM on April 4, 2012 [2 favorites]

A serious question: how do we know what levels of adiposity are comparable between men and women? Women are known to have higher body fat percentages overall, and even this study uses different cutoffs for obesity for men and women. But my impression is that most public health studies of obesity use BMI, which is cheap to measure. So do we actually know that DXA predicts health outcomes better in women? There's sort of a throwaway line at the end to that effect but it's uncited.

The leptin stuff is pretty cool. Most biomarkers aren't nearly that robust.
posted by en forme de poire at 9:23 AM on April 4, 2012

(oh, whoops, c/blood/urine up above, as though anyone cares)
posted by gurple at 9:24 AM on April 4, 2012

"Obese" is a pejorative term you sling around so casually with your white lab coat on. These people are not "obese." Seriously, fuck off.

I can't tell if you're serious. On the assumption that you are, what word do you think they should use instead?
posted by Justinian at 9:24 AM on April 4, 2012 [4 favorites]

Folks bitch and moan about BMI, but, for me at least, it's pretty accurate. I've lost 30 pounds in the last 2 years, and am still 10 pounds above a 25 BMI. I can look at my (smaller-than-before) gut and see 10 pounds, easy. I've been 10 pounds lighter, and my BP was at a healthy level and I felt great, but, man, that was a hard weight to maintain--heavy aerobic workout 3 times a week, watching everything (everything) that I ate.

My point is, I know I was healthier at that weight, and I know it's possible to achieve--for me, it boils down to willpower.
posted by MrMoonPie at 9:24 AM on April 4, 2012

These people are not "obese."

What are they, then? Rather, what do you call people that are at an unhealthy weight, assuming that a) there is such a thing as a healthy weight for each person and b) it's useful to measure and categorize this, and c) whatever it is, we need a name for it so we all know we're talking about the same thing.
posted by Cool Papa Bell at 9:25 AM on April 4, 2012 [4 favorites]

"Obese" is a pejorative term you sling around so casually with your white lab coat on. These people are not "obese." Seriously, fuck off.

Are you denying the existence of obese people or just objecting to the term? There are people whose body makeup (weight, fat percentage, etc.) is unhealthy. I don't really care what we call that state of being, but we do need a term for it.
posted by Bulgaroktonos at 9:26 AM on April 4, 2012 [4 favorites]

Rather, what do you call people that are at an unhealthy weight

Well they do have overweight category for BMI too.
posted by smackfu at 9:27 AM on April 4, 2012

fine, we get it we're all monstrous butter trolls who need to be reminded of this lest we forget for one second.
posted by The Whelk at 9:29 AM on April 4, 2012 [25 favorites]

Overall, about 39% of participants who were classified as overweight by their BMI were actually obese, according to their percent body fat.

It's interesting, because this seems completely dependent on the details of where you set the BMI cutoff between overweight and obese (which is currently at 30).
posted by smackfu at 9:29 AM on April 4, 2012

We could call it something that makes it sound sexy and exciting, like "oh!bese."
posted by hermitosis at 9:30 AM on April 4, 2012 [13 favorites]

Sorry, I kinda lost it there. I guess I take this personally because I am 5' 10" & weigh about 209, which gives me a BMI of 30 = OBESE. Not overweight, not a few lovehandles with an endomorphic bodytype, just a blunt label of obesity. Here are some pics of me.

"In recent years, some experts have looked at using waist circumference as a measure of weight gain and body fat composition, and some studies show it may be more accurate than BMI." You don't say...

Rather than get rid of the term "obese" I guess I'm just asking for more shades of gray, or changing the scale so that you can call me overweight but not obese. I regret stepping into this topic, but for some reason it really bothers me. Everyone complains about the portrayal of the perfect body type for women in magazines and unrealistic expectations of models and girls self-esteem, but we just accept BMI 30 = obese?
posted by mattbucher at 9:31 AM on April 4, 2012 [5 favorites]

A good test for a man is to look down while taking a shower:
If you can see your penis and your feet without sucking in your gut, you are healthy
If you can't see your penis, you are overweight
If you can't see your feet, you are obese (or "fat", if the term "obese" offends you)

I call it the Renoroc Penile/Podiatry Visual Test.
posted by Renoroc at 9:31 AM on April 4, 2012 [22 favorites]

What if your penis blocks out the view of your feet?
posted by hermitosis at 9:32 AM on April 4, 2012 [93 favorites]

What are they, then? Rather, what do you call people that are at an unhealthy weight

Well I'm not really sure what the answer is in terms of messaging and whatnot, but it makes sense to think about these kinds of labels and what impact there is in using them. For example, you don't see headlines like "New study shows 60% of Americans are mentally defective" based on the amounts of psychiatric drugs proscribed for issues like depression or anxiety. There's a difference between talking about a problem and talking about a people as if they are sub-normal.
posted by burnmp3s at 9:34 AM on April 4, 2012 [8 favorites]

Ofeetse?
posted by Blazecock Pileon at 9:36 AM on April 4, 2012 [2 favorites]

Whatever term was created to replace "obese" but make it sound nice would become an insult within months of adoption.

Which is sort of an interesting thought... hmm, I nominate "ultraconservative".
posted by gurple at 9:37 AM on April 4, 2012 [8 favorites]

Rather than get rid of the term "obese" I guess I'm just asking for more shades of gray, or changing the scale so that you can call me overweight but not obese.

This study is not about you, personally. It was not designed to belittle you or make you feel bad. It is about asking questions about problems with a commonly-used health metric. It's not about you.
posted by Blazecock Pileon at 9:39 AM on April 4, 2012 [10 favorites]

Dear science: just learn to laser away the fat while I Internets, k?
posted by Theta States at 9:40 AM on April 4, 2012 [7 favorites]

Quick! We're not panicking enough about fat women - let's move the goalposts again!
posted by Space Kitty at 9:41 AM on April 4, 2012 [18 favorites]

This study is not about you, personally.

Fair point. I said I regret commenting in the thread. Please don't let my dumb comment derail the thread. Sorry.
posted by mattbucher at 9:43 AM on April 4, 2012 [1 favorite]

It seems to me that the very idea of BMI being useful relies on there being an "average" body composition. Obviously the very lean and the very fat are composed differently, and so their relative place would be over- or under-estimated. In a population that's just getting fatter in general, it would make pretty good sense that using BMI as a measure of obesity would, on average, underestimate. Is this really surprising?
posted by uncleozzy at 9:48 AM on April 4, 2012

mattbucher, my ex-boyfriend was and likely still is in the same boat -- at 28 and 29 he was 5'10" and around 210 lbs and basically very healthy and strong (without being "ripped" or a bodybuilder or anorexic), yet still "obese" according to the BMI index. Ridiculous. He kind of obsessed about getting down to an "ideal" 185, which was what he'd weighed at 17 (before musculoskeletal growth had stopped, notably), but he couldn't get below 200 pounds even with daily biking and 3x/week strength workouts, and eventually it was clear that he would be noticeably underweight at that size anyway. On the other hand, I am tallish but small-boned and can be at a "normal" weight according to the BMI, but with my high body fat % and small muscle development, I'm actually unhealthily overweight unless my BMI is at the lowest end of normal.
posted by FrauMaschine at 9:54 AM on April 4, 2012 [2 favorites]

This study is isn't just saying that the BMI is a terrible index (though it is saying that), it is saying that BMI actually underestimates the problem. Yes, it categorizes some people as obese who are not, but it undercounts the number of obese people by far more.
posted by Justinian at 9:56 AM on April 4, 2012 [3 favorites]

I'm just wondering why, honestly, it really *matters*. If I say I live "a mile" from something or I say I live "two kilometers" from something, those do mean slightly different things, but in practice, whether changing the measurement solves any given problem depends on the problem. I'm not convinced here that anything is best solved by more hand-wringing about exactly what criteria ought to constitute "obese". On a societal level, a broad measurement works fine, and more nitpicking and hand-writing haven't had much impact at this point so I don't know why we'd expect that to change. And on an individual level, well, I'm pretty sure that body fat percentage tells you a lot less about a person's health and what they need to do to improve it than how things like blood sugar, current eating habits, and how fast and comfortably they can run 3872 cubits.
posted by gracedissolved at 9:56 AM on April 4, 2012 [1 favorite]

Another good test for a man is to look down while taking a shower:

If you see one or both of your hands and they are holding food, it's time to cut back.
posted by delfin at 9:57 AM on April 4, 2012 [22 favorites]

In a population that's just getting fatter in general, it would make pretty good sense that using BMI as a measure of obesity would, on average, underestimate. Is this really surprising?

This isn't the point of the paper, though. The paper says that BMI underpredicts obesity for a lot of men and women, but especially women, and that it falsely predicts obesity for a subset of men and women. It also shows that leptin levels are pretty well correlated to body fat percentage, which is sort of cool and surprising (at least to me, it could've easily been that individual variation in leptin swamped any overall differences).
posted by en forme de poire at 9:57 AM on April 4, 2012 [1 favorite]

I think the real question here is this - how much of Dr. Braverman's DNA comes from a chicken?

Judging from the video, I would say 60%. At least.
posted by louche mustachio at 9:58 AM on April 4, 2012

I'm all for giving widely-used craptastic measures the heave-ho, so I hope the new study has legs. Sadly, I'm probably one of those who pass muster under the BMI but not under a better measure, but then again, I already know that...!
posted by Currer Belfry at 9:59 AM on April 4, 2012

It's extremely surprising to me that it underestimates. For my height, 5' 8", a weight of 165 pounds is classified as "overweight," which seems literally insane to me. I am not at all sure I even can lose 40 pounds of fat. Maybe I will surprise myself, but I think I will always be at least overweight by the BMI's standard, although hopefully not "obese" for long.
posted by adamdschneider at 10:00 AM on April 4, 2012 [1 favorite]

Another good test for a man is to look down while taking a shower:

If you see one or both of your hands and they are holding food, it's time to cut back.

I can endorse this since the one guy I've known who regularly drank beer in the shower seemed to be at an appropriate body weight.
posted by Bulgaroktonos at 10:02 AM on April 4, 2012 [2 favorites]

People have been hating on the BMI since it was developed in Belgium as the Quetelet index 160 fucking years ago. That 'discovery' is neither new, nor original, nor useful. The BMI has always been seriously flawed, which is why it is almost never used where alternatives are available. This work is awesome and has exactly nothing to do with your self-esteem, but what it does do is make a bad but useful assay better. The BMI does have a meaningful place in research and medicine as an inaccurate but easy measure and by knowing exactly how inaccurate it is we can now have a better idea of the statistical power of countless past and future studies. This is the point.

The Whelk: "fine, we get it we're all monstrous butter trolls who need to be reminded of this lest we forget for one second."

Right now we are suffering from an epidemic, which is correlated with obesity, that is killing millions of us and our neighbors, I certainly hope that we don't forget that. Research like this helps us to better understand the correlative relationship between obesity and metabolic syndrome, helps us to better assess the problem so we can develop more effective public health measures with the tools we have, and hopefully develop new tools to actually fight metabolic syndrome at its source.
posted by Blasdelb at 10:05 AM on April 4, 2012 [14 favorites]

Further, a quarter who were categorized as obese by BMI were not considered obese based on their body fat percentage.

Don't miss this part. The study is an indictment of BMI across the board, not really an indicator that *everyone* is fatter than suspected.
posted by stoneweaver at 10:05 AM on April 4, 2012 [2 favorites]

Space Kitty: "Quick! We're not panicking enough about fat women - let's move the goalposts again!"

ABSOLUTELY, the academic community honestly isn't panicking nearly enough about female obesity, or just about any other women's health issue. Hopefully having a better understanding of the current state of obesity in women, a better understanding of current assays to measure it, as well as perhaps a new and better standard assay in leptin measurements will help us understand obesity in women better and improve the lives of women in a way that kvetching on the internet simply can't.
posted by Blasdelb at 10:13 AM on April 4, 2012 [3 favorites]

BMI tells me that I 'should' weigh 184 lbs(maximum) at my height, in order to be a 'healthy weight.'

That would put me < 4% bodyfat percentage. BMI is broken, and its nice to have more info on that.
posted by the man of twists and turns at 10:27 AM on April 4, 2012 [1 favorite]

And all of this seems to skirt the main problem of, "The incredible number of calories in my over-consumptive diet aren't from fat/sugar, must be a great diet OM NOM NOM".
posted by Slackermagee at 10:27 AM on April 4, 2012 [1 favorite]

This whole thing is suspect. The fact is that being "overweight" is actually not any indication of poor or potentially poor health.

Whether over- or under-weight the best indication of poor health is the lack of basic daily exercise. You can get a healthy amount of low-impact exercise and still be considered "fat" by any standard.

Yet that standard has been created without anything that backs up the claim that some index of weight vs. height is unhealthy. Because there just *isn't* any such proof.

If you are in that percentile that isn't considered "obese" by any measurement, good for you. But if you are not getting modest daily amounts of low-impact exercise, you are actually at risk for early death regardless of your weight. And this *is* backed by several long-term studies.
posted by clvrmnky at 10:30 AM on April 4, 2012 [4 favorites]

Metagilter: OM NOM NOM
posted by smidgen at 10:30 AM on April 4, 2012 [1 favorite]

Darn fat fingers...
posted by smidgen at 10:31 AM on April 4, 2012 [3 favorites]

Slackermagee: "And all of this seems to skirt the main problem of, "The incredible number of calories in my over-consumptive diet aren't from fat/sugar, must be a great diet OM NOM NOM"."

I'm just going to mention that if you think you can sum up the fantastical complexities of the human endocrine system, and how it interacts with modern society, in one sentence or less; you probably can't.
posted by Blasdelb at 10:31 AM on April 4, 2012 [4 favorites]

Here's the problem with the obese label as applied to individuals: it doesn't mean anything. Statistically, yes you can say that the US population is obese, and you can pick up increased risk factors based on this.

But what does the label 'obese' mean, for me as an individual? You can't extrapolate any statistical risk factors to me, the person. But doctors, although they should absolutely know this, don't. Instead, they use it as a case for discrimination and to deny care to the obese.

Let me give you an example. I tore my PCL (a knee ligament) taking a bad fall during a roller derby scrimmage. I go into the doctor and tell them that I'm pretty sure I damaged my knee during the fall. You know what they do? They refer me to a fucking dietician, like that's a cure for a torn ligament. They don't offer me pain medication. It's a total case of discrimination, as though I must be unhealthy and in pain because I'm fat.

I ended up having to do a bunch of medical research on my own, figure out the tests to differentiate between the various potential knee issues, tried the tests and figured out it was almost certainly my PCL. One of the standard tests that you're supposed to do for a potential knee injury would have caught it. Instead, I had to go back a second and a third time, trying to convince a doctor to do the test and order me an MRI so I could get surgery and physical therapy referrals.

Now it's a whole hell of a lot of privilege on my part that I can read and comprehend medical journals, and apply their information to myself, and then argue with doctors until I get what I need. People without my advanced life sciences background have pretty much zero ability to do what I did. So either they believe the doctor and go to a dietician where they have a sub 2% change of losing weight (and continue to suffer meantime) or they skip the dietician and medical care altogether.

Statistical measures like obesity should be kept as statistics, and not applied to individuals. Period.
posted by zug at 10:31 AM on April 4, 2012 [15 favorites]

Statistical measures like obesity should be kept as statistics, and not applied to individuals.

Wouldn't that logic imply that there was no reason for any individual person to give up smoking, because--hey--it's only "statistically" likely to kill you.
posted by yoink at 10:36 AM on April 4, 2012 [1 favorite]

"We've measured people using advanced science, finally avoiding the inaccuracies of the BMI measure..."
[crowd cheers]
"... and it turns out you're even fatter than we imagined"
[pitchforks, torches appear out of nowhere; crowd storms the stage]
posted by 0xFCAF at 10:37 AM on April 4, 2012 [7 favorites]

But what does the label 'obese' mean, for me as an individual? You can't extrapolate any statistical risk factors to me, the person. But doctors, although they should absolutely know this, don't. Instead, they use it as a case for discrimination and to deny care to the obese.

It sounds like you've encountered some crummy doctors, but I don't think it follows from that that you can't extrapolate statistical risk factors for individuals from statistics about groups. That's basically all statistics does.
posted by Bulgaroktonos at 10:39 AM on April 4, 2012 [2 favorites]

Yoink is correct; the fact that someone may be obese and die from an unrelated cause is no more an indication that obesity isn't a problem than the fact that a smoker usually dies from something besides lung cancer means that smoking isn't a problem.
posted by Justinian at 10:40 AM on April 4, 2012

Another good test for a man is to look down while taking a shower:

If you see one or both of your hands and they are holding food, it's time to cut back.

what about a beer, does that count
posted by en forme de poire at 10:42 AM on April 4, 2012 [2 favorites]

But if you are not getting modest daily amounts of low-impact exercise, you are actually at risk for early death regardless of your weight. And this *is* backed by several long-term studies.

I'd be interested in links to well-conducted longitudinal studies showing that weight is irrelevant to long-term health.
posted by yoink at 10:45 AM on April 4, 2012

Sounds more like you got a shitty doctor rather than the statistics being inapplicable in general.

If someone comes in who is obese and complaining of general foot pain, it would be irresponsible not to diaagnose the condition as it exists now. But once the condition is diagnosed and treated, and assuming it is stress-related, it's not out of line to indicate that obesity might add risk -- just like practicing ballet would.
posted by smidgen at 10:45 AM on April 4, 2012

I seriously will never understand drinking a beer in the shower.
posted by adamdschneider at 10:48 AM on April 4, 2012

Right now we are suffering from an epidemic, which is correlated with obesity, that is killing millions of us and our neighbors, I certainly hope that we don't forget that.

Your comment illustrates the extreme hysteria that is the real epidemic in this country. There is a huge difference between correlation and causation. A blogger I read said it really well recently:

If all we have is correlation, even if the two things ALWAYS happen at the same time, we still can’t prove causation until we know how one causes the other. This is the most basic pillar of research. If all we know is correlation, then we have to leave room for the possibility that the two things are caused by a third factor, or that they are unrelated... Obesity is correlated with diseases, but causation isn’t proven. It’s possible that both things are caused by a third factor (for example the stress of constant stigma has also been correlated to many of the same diseases as obesity in Peter Muennig’s work). There are some chemicals that are in food that are correlated to both obesity and the disease that are commonly correlated with obesity.

From a book* I've been reading recently:

That “obesity kills” has been the backbone of the federal public health campaign. Yet that is not supported by evidence examined by federal employees. Their research found that “even severe obesity failed to show up as a statistically significant mortality risk”236 and suggested that overweight may actually be protective.235*

You may be getting your "millions" number from the infamous CDC study that stated 400,000 people died from obesity every year--but the study was proven gravely erroneous by an updated federal report that "acknowledged that the analysis suffered from computational errors.235 Using better methodology and newer data, CDC epidemiologists reduced the estimate fifteen-fold, determining that obesity and overweight were only associated with an excess of 26,000 annual deaths, far fewer than guns, alcohol, or car crashes.235"*

I can also give you a reference list of 8 comprehensive and well-respective studies (including one that studied 1.7 million people in Norway) that determined that overweight people were living at least as long as if not longer than normal weight people.

The reality of a lot of the obesity research that is being done is that it is sponsored by companies making the food that is messing with our systems and by the $59 billion dollar diet industry (that would make considerably less than $59 billion dollars a year if it were actually possible for more than 5% of people to keep weight off for more than 5 years). They have a well-documented vested interest in making us feel like being fat is a horrific health crisis and further that it must be a will-power issue rather than processed food that is subsidized by the government or a system designed to add "value" to food by reducing nutrition.


Sources*:
The book is: Bacon, Linda (2010-02-02). Health At Every Size: The Surprising Truth About Your Weight (p. 125-130). Perseus Books Group.

Sources mentioned in the quotes above from the book:
235 Flegal, Katherine M., et al., “Excess Deaths Associated with Underweight, Overweight, and Obesity,” Journal of the American Medical Association 293, no. 15 (2005): 1861-67.

236 Gibbs, W., “Obesity: An Overblown Epidemic?” Scientific American. Vol June; 2005.
posted by Kimberly at 10:48 AM on April 4, 2012 [11 favorites]

I'm just going to mention that if you think you can sum up the fantastical complexities of the human endocrine system, and how it interacts with modern society, in one sentence or less; you probably can't.

Its not complex or difficult to grasp, 60% of the country doesn't fall under the label of obese/over weight/fat/over consumptive by way of being a metabolic outlier. I could believe up to 20% would fall into that category and even then you'll fix quite a bit of them tangentially by simply cutting down calorie intake.

FFS, people are drinking soda when they're thirsty instead of water. Soda. Its like a goddamn meal in a bottle, but you don't get hours of sugar release you get something like ten minutes of super sugar blasting your bloodstream before it all uptakes and you're left wanting more. You don't just piss it all out, your body soaks it up into the cells designed to soak it up.

This isn't fat shaming, or finger pointing, or accusatory. Its constructive: Stop putting (way) more into the body than it can use in a day. Hell, you want a really constructive solution to the obesity problem? Make it illegal to market a drink with a calorie content higher than 2-4% of your daily calorie requisite.
posted by Slackermagee at 10:50 AM on April 4, 2012 [4 favorites]

Also, I'd love to know what they consider 'deadly' in the obesity/mortality studies. I have a nasty feeling the list is quite narrow.
posted by Slackermagee at 10:52 AM on April 4, 2012

Can't we just call obese people "People who have difficulty overcoming an ancient, outdated bioevolutionary mechanism which causes them to store, bodily, more energy than is necessary or practical in their 21st century life style?"
posted by TheRedArmy at 10:54 AM on April 4, 2012 [4 favorites]

And to address a few of the comments that were posted while I was working on that long screed, research indicates that sedentary lifestyle is the real health risk, not weight of the person. Thin people who are sedentary are just as likely if not moreso at risk for health issues as fat people who are sedentary. In fact, fat people who exercise at least 30 minutes a day five times a week are much more likely to live longer and be healthier than thin people who do not. There are thin people who drink soda and eat Bugles all day who are a lot less healthy than fat people who eat salads and drink water. This is not about a number on a scale, it's about lifestyle choices.

Popular media/culture has convinced us that fat = unhealthy and thin = healthy and research does not support this. Research does support that eating unprocessed foods and exercising = healthy and eating processed foods and being sedentary = unhealthy. And despite what many people think, you cannot tell if a person eats well or exercises just by looking at them.
posted by Kimberly at 10:54 AM on April 4, 2012 [19 favorites]

And to address a few of the comments that were posted while I was working on that long screed, research indicates that sedentary lifestyle is the real health risk, not weight of the person.

That fits pretty well with this study. Those who are low on the BMI scale but still obese by body fat percentage are people with low muscle mass.
posted by chrchr at 10:58 AM on April 4, 2012

Theta States: "Dear science: just learn to laser away the fat while I Internets, k?"

I know you're just being an ass, but there are laser treatments that can actually do this, and the concepts involved are pretty cool. They work by directly killing adipocytes, the cells in your body responsible for storing and retrieving fats from fatty tissue. It turns out that adipocytes are more sensitive to cold than other cells and so you can kill them with cooling lasers without killing the cells around them. The treatment itself is kind of worthless, but only because it is thousands of dollars and you can replicate it at home with a couple bucks worth of ice in your bathtub, in a technique that fitness folks have known for decades.

Treatments that involve killing adipocytes haven't really been taken that seriously until recently because it was always, quite logically, assumed that doing so would cause massive endocrine disruption and renal failure really easily. Adipocytes do a heck of a lot more than just store and release fats, they are also central to the insulin pathway that regulates blood sugar, they play a role in blood clotting, hell they are even significantly involved in creating sexual dimorphism. It stood to reason that fucking with that would cause big problems. However, there was recently a post about a paper using a cell toxic peptide targeted to adipocytes in monkeys that changed at least my mind. The thread starts out with roughly the same level of ignorant threadshitting as this one, but improves dramatically.
posted by Blasdelb at 10:59 AM on April 4, 2012

If you see one or both of your hands and they are holding food, it's time to cut back.

What if...what if one of your hands is holding your penis?
posted by Mr. Bad Example at 10:59 AM on April 4, 2012 [3 favorites]

There is a huge difference between correlation and causation.

DRINK!
posted by Justinian at 10:59 AM on April 4, 2012 [12 favorites]

"It sounds like you've encountered some crummy doctors, but I don't think it follows from that that you can't extrapolate statistical risk factors for individuals from statistics about groups. That's basically all statistics does."

No, no it absolutely does not. Statistics pulls risk factors for *groups* from data about individuals. But you can't go back the other way without a lot more work. You have to prove the link is causal and not merely correlated, the direction of the causality, and to understand the reason behind it before that statistical knowledge is helpful for individual people. As several others have mentioned, that link, as best medical science understands it today, is stress and exercise, not weight.


America's food culture is fucked up. I lost a large amount of weight (>60lbs) without trying living in South America. I gained it right back when I got back here. I'm willing to bet money that the crappy food we get shoved down our throats in America is a big part of both the obesity epidemic and the health crisis.
posted by zug at 11:07 AM on April 4, 2012 [3 favorites]

I think that the problem that people have with the label "obese" is that it means something completely different in a medical context than it does in a social context.

In a social context, obese is understood to mean a very overweight body-shape - for example, where one's stomach is larger than one's shoulders. We reinforce this with our imagery of obese people - we don't take pictures of people like Jennifer Hudson when she was medically overweight (but looked awesome) but look for someone who may have the same BMI but wears the weight differently. It is very much a judgement of appearance, to which we also attach a lot of judgements of character.

But in the medical context, "obese" BMI really is "at what height-weight ratio do we see an increased risk of heart disease, diabetes, etc." It's not about what people look like; it's about what are risk factors for ill health. The heavy but healthy muscular people are undermining these connections a little, but not enough to wash out the effect from the rest of the population.

I actually happen to be lucky -- I have an "obese" BMI but I still have somewhat of an hourglass figure because I have very wide hips and shoulders. I look "better" than other people of my height and weight. So I'm not that worried about my weight when it comes to my appearance.

But I am worried about my weight in regard to my health.
posted by jb at 11:12 AM on April 4, 2012 [2 favorites]

Can't we just call obese people "People who have difficulty overcoming an ancient, outdated bioevolutionary mechanism which causes them to store, bodily, more energy than is necessary or practical in their 21st century life style?"

That's far too long and unwieldy. Let's use the acronym PWHDOAAOBMWCTTSBMETINOPIT21CLS instead.
posted by echo target at 11:12 AM on April 4, 2012 [4 favorites]

Overweight is correlated with arthritis and diabetes - both of which are major causes of disability (more costly than mortality).

Good news (for people who hate salads) is that diets aren't the best way to deal with your weight - exercise is.
posted by jb at 11:16 AM on April 4, 2012

No, no it absolutely does not. Statistics pulls risk factors for *groups* from data about individuals. But you can't go back the other way without a lot more work. You have to prove the link is causal and not merely correlated, the direction of the causality, and to understand the reason behind it before that statistical knowledge is helpful for individual people. As several others have mentioned, that link, as best medical science understands it today, is stress and exercise, not weight.

But that's also just "statistics." In the end, the only proof of causality we ever get in medical studies is based on statistical studies.

"Correlation doesn't equal causation" is one of the most annoying half-truths I know of. It is certainly true that no single test of correlation, by itself, demonstrates causation. On the other hand, it is also the case that the only proof of causation that we ever have is constant correlation. All "causes" that have ever been identified in any instance whatsoever are, in fact, merely constant correlations that have not yet been given a counter-instance.

Now, I'm prepared to believe that the obesity/diabetes link, for example, is rooted in the correlation between low exercise and obesity, and that the low exercise is the actual trigger for the obesity--but the only way you're going to "prove" this is by a statistical study which shows that the correlation of low-exercise/high diabetes risk is constant and the correlation of obesity/high diabetes risk is not. Then, when you've conducted those studies it will be perfectly reasonable for individuals to base their individual lifestyle decisions on the basis of those statistical findings. In other words, it will be perfectly rational to say "the statistics strongly suggest that a failure to exercise regularly involves serious health risks, therefore I will commit to a regular exercise regime."

You are conflating a criticism of a particular statistical study which you see as flawed with a criticism of statistical inference in general--which your particular criticisms do not, in fact, warrant.
posted by yoink at 11:17 AM on April 4, 2012 [1 favorite]

Why do some slightly heavier people live long lives, and skinny people live shorter ones. Do these tests control for ethnic variation. For instance, Pacific Islanders are a lot bigger than most people, and their *traditional* diet is pretty good.

I think there's some validity in this stuff, but it's not the be-all-and-end-all for health.
posted by Vibrissae at 11:22 AM on April 4, 2012 [1 favorite]

Diabetes is actually a great example of the whole correlation causation thing. As annoying as some people find it, ignoring that point results in a lot of erroneous conclusions.Yes, many of the people with type 2 diabetes are overweight. However, the risk of type 2 diabetes includes a genetic component and there is strong evidence to support the idea that the genes that play a role in causing diabetes also cause weight gain. Which means that it is possible that it is not weight in and of itself that is causing diabetes, it is the genetic factors causing diabetes that are also responsible for higher weight.

As others have alluded to previously in the thread, insulin resistance supports storage of fat during times of famine (or the modern day equivalent, high calorie restriction diets). So it makes sense that if someone has insulin resistance, they are better at producing and storing fat especially in response to dieting. People may lose weight initially, but unless they continue to reduce their caloric intake for the rest of their lives, their bodies (products of evolution) say "Oh crap! We didn't have enough food there, I need to make sure that if that happens again I'm ready."
posted by Kimberly at 11:27 AM on April 4, 2012 [1 favorite]

Blasdelb: "Right now we are suffering from an epidemic, which is correlated with obesity, that is killing millions of us and our neighbors, I certainly hope that we don't forget that."

Kimberly: "Your comment illustrates the extreme hysteria that is the real epidemic in this country. There is a huge difference between correlation and causation. A blogger I read said it really well recently:"

I hope that we can expect MetaFilter to at least understand that there is a huge difference between correlation and causation, and move on to the more exciting parts in the philosophy of science that relate to how incredibly fucking important correlation is to our understanding of things. Ultimately, just about all the things. We know that obesity, especially when defined more powerfully than with the BMI, is very strongly correlated with metabolic syndrome. This means that a relationship exists between the two, and that better understanding that relationship will allow us to better understand the disease. Studying obesity will indeed help us to address the deaths that are associated with it, I'm not sure how this can be controversial

I also don't know where the 26,000 number your book gave you came from, but it wasn't from the study your book cited. That JAMA paper (PDF) [Abstract] calculates 112,000 deaths annually and, for the most part, represents the current scientific consensus. So yes, unless you are asserting that the author of your book knows better than the rest of the scientific community, obesity has indeed killed millions of our neighbors.
posted by Blasdelb at 11:29 AM on April 4, 2012 [5 favorites]

Pacific Islanders are a lot bigger than most people, and their *traditional* diet is pretty good.

Diabetes is absolutely epidemic in Pacific Island communities.
posted by yoink at 11:30 AM on April 4, 2012 [1 favorite]

Which means that it is possible that it is not weight in and of itself that is causing diabetes, it is the genetic factors causing diabetes that are also responsible for higher weight.

Of course that is possible. And how will you go about demonstrating that it is the genes that are the causal factor and not the obesity per se? Why, you will do it by conducting large scale statistical studies that show that the risk of developing diabetes correlates consistently with the presence of the genes and that that correlation is stronger than the correlation between obesity and diabetes.

And until such time as someone comes up with a study that demonstrates an even stronger correlation with some other factor (or co-factor) we will be justified in considering that correlation as good evidence of causation.
posted by yoink at 11:36 AM on April 4, 2012 [1 favorite]

Diabetes is also linked to blood circulation - and if you are overweight, you have poorer blood circulation through your extremities.

/if I have any details incorrect - please forgive me. I'm repeating half-remembered stuff from epidemiologist housemate

Difficulties with arthritis - specifically osteoarthritis - is linked to being overweight due to the pressure on weight-bearing joints (which may contribute to the damage but also certainly increases pain).

Arthritis and other musculoskeletal problems is the number one cause of disability in Canada. (And probably the US and other places as well, but the graph we had at the seminar the other week was for Canada).
posted by jb at 11:37 AM on April 4, 2012

Kimberly: "Diabetes is actually a great example of the whole correlation causation thing. As annoying as some people find it, ignoring that point results in a lot of erroneous conclusions.Yes, many of the people with type 2 diabetes are overweight. However, the risk of type 2 diabetes includes a genetic component and there is strong evidence to support the idea that the genes that play a role in causing diabetes also cause weight gain. Which means that it is possible that it is not weight in and of itself that is causing diabetes, it is the genetic factors causing diabetes that are also responsible for higher weight.""

It really wasn't so long ago that adult-onset diabetes, the original name for Type II diabetes, had to be abandoned in favor of the current nomenclature because so many kids (and now infants) were suddenly getting it. Genetic variation clearly plays a large role in why some people get Type II diabetes and others don't, but it can't be said to be the source of the disease as the genetics of the human population hasn't changed significantly in the last 50 years whereas rates of both diseases have. Obesity has several well established pathways for a direct causal relationship to Type II diabetes, and there are several factors that are well established to have a causal relationship to both diseases.
posted by Blasdelb at 11:42 AM on April 4, 2012 [3 favorites]

My BMI is 34.4

According to my doctor at my last physical: I am over weight, but it's not the end of the world, BUT it would be a good idea to start adding some 30-minute excercise to my weekly routine. He also explicitly advised that I don't need to go on a diet, unless I simply want a smaller pant size.

Charts aren't very useful without a competent healthcare worker to help you navigate them.
posted by Doleful Creature at 11:46 AM on April 4, 2012 [1 favorite]

Question for the knowledgeable: why is obesity considered a cause of diabetes and not a side effect of other possible factors (diet, activity level, etc.)? Is there something about body fat that triggers the disease?
posted by El Sabor Asiatico at 11:49 AM on April 4, 2012

Another question for the knowledgeable:

Any benefit (or harm) drinking diet Coke as opposed to regular?
posted by notreally at 11:59 AM on April 4, 2012

Aspartame is 200 times sweeter than sugar. It has calories, but so little of it is required to make something sweet, that the calorie content is negligable. So Diet Coke won't make you fat in itself. I had seen some speculation that low-calorie sweeteners might stimulate increased appetite (by stimulating your digestive system but giving it nothing to digest), but this page cites several studies which would seem to refute that idea.

Unless you have phenylketonuria (you would know -- PKU patients suffer from mental disability unless treated from infancy) Diet Coke and other aspartame containing products aren't dangerous, and won't make you fat. They do contribute to acid erosion and staining of tooth enamel, though.
posted by OnceUponATime at 12:18 PM on April 4, 2012

Good news (for people who hate salads) is that diets aren't the best way to deal with your weight - exercise is.

Where does this come from? I've read that exercise can usually only account for a small portion of calories burned, and that diet trumps all. "Abs are made in the kitchen, not in the gym," etc.
posted by adamdschneider at 12:19 PM on April 4, 2012 [2 favorites]

massively simplified:

El Sabor Asiatico, fat-storing cells have insulin receptors on them, to recieve insulin as part of the triglyceride uptake/release process. As these cells increase in number and size, the body requires more insulin, which contributes to insulin resistance. Type II diabetes is correlated with bf%, activity levels, diet, etc.

notreally, while diet drinks contain low or no calories when compared to the regularly-sugared kind, insulin production begins with the taste of eating or drinking sweet things, before the sugar is detectable in the blood. Repeated stimulation of the relase of insulin could contribute to insulin resistance and metabolic syndrome
posted by the man of twists and turns at 12:20 PM on April 4, 2012 [2 favorites]

Good news (for people who hate salads) is that diets aren't the best way to deal with your weight - exercise is.

Where does this come from? I've read that exercise can usually only account for a small portion of calories burned, and that diet trumps all. "Abs are made in the kitchen, not in the gym," etc.
---------

I don't know, but you are correct. Unless you're a pro athlete, an hour of moderate exercise a day burns around 300 Calories, which is close to the equivalent of a 24oz soda (i.e. 2 cans). You can lose weight, if that is your goal, by diet more easily than exercise.

Exercising seems to be a lot more important for overall health, but it won't help you lose (much) weight.
posted by zug at 12:24 PM on April 4, 2012

err, that should be "You are correct, unless you're a pro athlete. An hour of moderate exercise burns 300 Calories." A pro athlete doing the same amount of exercise as you will burn roughly the same amount of calories as you.. they just do more intense exercise more regularly.
posted by zug at 12:27 PM on April 4, 2012

Yeah, the BMI is total bullshit. I'm 5'8", and according to the BMI chart, a weight of 163 gets me just barely into upper end of the BMI's "normal weight" range, at BMI 24.9. To be at the lower end of "normal weight", I'd have to weigh 125 pounds. (Seriously, I would look skeletal at 125 pounds!)

I'm at 195 (BMI 29.6) now, and healthy, even though the BMI says I'm "borderline obese." A few years ago I was really sick and wound up in the hospital, and weighed in at 165 (BMI 25.1, overweight) And every doctor I saw said "Oh my god, you are crazy underweight, we need to get some pounds on you like, yesterday."

Doctor says I should shoot for and maintain about 185-190 (BMI 28-29, still "borderline obese"), and stay active.

I worry about how many people suffer depression or do harmful things to themselves because of this stupid BMI chart. :(
posted by xedrik at 12:28 PM on April 4, 2012 [4 favorites]

Where does this come from? I've read that exercise can usually only account for a small portion of calories burned, and that diet trumps all. "Abs are made in the kitchen, not in the gym," etc.
posted by adamdschneider at 3:19 PM on April 4 [+] [!]

I'm getting it from an epidemiologist. Health people don't care what your abs are like, they just care what your morbidity/mortality risks are. And exercise is linked to good health - not just for burning calories, but for aerobic health, muscle-strength and lots of things - including a lower chance of depression.

Also, the calculation for weight gain isn't calories in/calories out; our body doesn't process all calories the same way.

also - re diet drinks and diabetes (pubmed link).
posted by jb at 12:40 PM on April 4, 2012

review article on artificial sweetners and obesity
posted by jb at 12:42 PM on April 4, 2012

Yoink: I get statistical inference. I really do. I use it every day.

The inherent problem when you're talking about weight and health is that there are a whole bunch of changes that have happened regarding food in American society roughly simultaneously in the last 60 years. Increased weight is certainly one of them, but so is the addition of any number of preservatives, food dyes, and additives, increased processing of food, massive increases in consumption of corn and soy, creation of weird stuff like left-handed sugars and indigestible fats, among a bunch of other things.

That is a big fucking mess of stuff to sort through to try and understand casuality statistically. I suspect that we've focused on weight because it's easy to measure and there is so much cultural capital surrounding it. But that doesn't mean it's the causal link, and there are so many studies focused on weight and so few focused on other factors that co-occurred with American weight gain that I remain very skeptical of the inferences.

One of the things that stuck with me from reading Good calories, Bad Calories is that we can link increases with both obesity and disease with adoption of the US-style diet worldwide. Does the US-style diet cause obesity which causes disease? Does the US-style diet cause both obesity and disease? Does it cause disease, which causes obesity? I've yet to see a satisfactory answer, and nobody really seems to be asking.
posted by zug at 12:43 PM on April 4, 2012 [1 favorite]

MetaFilter : All Monstrous Butter Trolls
posted by jeffburdges at 12:50 PM on April 4, 2012 [1 favorite]

This is a nice video to watch: What is the single best thing we can do for our health?

(spoiler: the answer is exercise)
posted by thirteenkiller at 12:52 PM on April 4, 2012 [1 favorite]

One of the things that stuck with me from reading Good calories, Bad Calories is that we can link increases with both obesity and disease with adoption of the US-style diet worldwide. Does the US-style diet cause obesity which causes disease? Does the US-style diet cause both obesity and disease? Does it cause disease, which causes obesity? I've yet to see a satisfactory answer, and nobody really seems to be asking.


Honest question, if switching to something other than a US-style diet solves the problem not matter what the causal relationship is, what does it matter?

I get that it has research implications and there might end up being different things that we can do down the road once it's better understood but right now the only obvious solution seems to be "don't eat a US-style diet" so I don't understand why the average person should care.
posted by VTX at 12:59 PM on April 4, 2012

> The book is: Bacon, Linda (2010-02-02). Health At Every Size: The Surprising Truth About Your Weight (p. 125-130). Perseus Books Group.

Is there nothing bacon can't do?
posted by jfuller at 1:02 PM on April 4, 2012 [1 favorite]

Health people don't care what your abs are like, they just care what your morbidity/mortality risks are. And exercise is linked to good health - not just for burning calories, but for aerobic health, muscle-strength and lots of things - including a lower chance of depression.

No one is disputing this, however this is not the claim you initially made, which is that exercise is better than diet for managing weight, which doesn't seem to be true.
posted by adamdschneider at 1:02 PM on April 4, 2012

the man of twists and turns, thanks for the link to insulin production and sweeteners. That's long been my intuition, and something that I think tracks the metabolic syndrome explosion much more accurately than simple calorie intake, so it's nice to see a bit of confirmation of my guess. Of course, I'd like to look at a lot more before I start bringing this idea up in conversation. But I suspect that there's no harm in cutting out all sweet drinks, no matter the source. I suggest sparkling water as the alternative. (on preview, even more thanks, jb for your links).

I'm intrigued by the BMI study. As I understand it, BMI was a rough and ready indicator for population measuring. Given that fat is correlated with weight, that makes sense. The fact that musculature and skeleton size also influence weight isn't a big deal at a population level. Quantifying the size of that error looks like very positive work.

The trouble is that being able to measure obesity still isn't that useful if it's only, in the end, a risk factor for the illnesses it's correlated with. Because body identity carries so much more meaning than just "I like it when it's healthy", it is very hard to a sensible analysis of what the benefits of a given person losing weight will be. There's just such a multitude of factors like that person's metabolism, their relationship with food, with exercise that make it hard to gauge how difficult they'll find it, and then lots of other factors that make up the risk of not losing the weight. So people simplify that "everyone with a high BMI should lose weight", and that's where things get complex, especially because you can't hide how much you weigh, unless you're on the internet.
posted by ambrosen at 1:05 PM on April 4, 2012

I'm having flashbacks to my undergraduate philosophy degree here, but: what does it even mean to say "My new test shows that more people than we thought are obese?" Obesity isn't a natural kind, and the cutoffs between 'normal' weight, overweight, and obese don't exist in nature. When obesity was defined according to BMI, that was a definition, not a discovery. It wasn't, as far as I'm aware, that people thought that they had found the BMI which represented a certain fat percentage; it was that they wanted to be able to express the idea that some people have too much weight for their height.

If you have a concept which is defined one way - in terms of weight:height ratio - and redefine it another way - fat percentage - then, for certain cutoffs of fat percentage, it will be trivially true that more people would come under the concept. If they had set the fat percentage lower, fewer people would have come under it. If they had tried to make the new definition correlate as closely as possible with the old one, they might still have had more or fewer, but the change would have been smaller.

At the end of the day, aren't we really talking about two concepts here, ObesityB and ObesityA*, where ObesityB is defined according to BMI and ObesityA is defined according to adipose tissue percentage? Then there is the cutoff issue; really we have ObesityB(x) and ObesityA(y), where x is the chosen cutoff for BMI and y the chosen cutoff for fat %. It really remains to be seen whether ObesityA(y) is a better predictor of health outcomes than ObesityB(x); the fact that so many women come out as obese under this definition may be a bad sign for its efficacy as a predictive measure, because it's not going to be great at distinguishing between groups of people.

Possibly we would in fact be better off with ObesityA(z), where z is a different cutoff that actually gives you fewer or the same number of obese people. But denoting all these different concepts using the single word, 'obesity', doesn't strike me as helpful; it elides questions of definition and falsely presents obesity as a natural kind-type category. There are lions in nature, regardless of the fact that mediaeval people were confused about lions and leopards and whether they were or were not the same thing. The modern concept 'lion' gives us a better understanding of how many members of the species there are, because leopards are in fact not lions and never will be. But obesity is not a species. It is a statistical bin we have given a colourful name to. It is problematic to give the same colourful name to a differently-sized bin of different data.

*I would use subscripts here, could I be arsed
posted by Acheman at 1:42 PM on April 4, 2012 [5 favorites]

VTX: Because you can't really "just decide" to ignore all of the food culture all around you that tells you what to eat, how much to eat, and when. It's amazingly embedded and very hard to avoid.

I'm a vegetarian, and about 40-50% of my diet comes from the produce aisle. The other 50%, though, is really hard. If you're trying to avoid all the stuff I mentioned above, good luck.. it's nearly impossible unless you do all your own cooking yourself from scratch, including things like bread and cereals. You can manage to cut most of the crap if you spend hours at the grocery store reading labels, but a lot of people don't have the time or nutritional education to do that.
posted by zug at 1:43 PM on April 4, 2012 [1 favorite]

Any benefit (or harm) drinking diet Coke as opposed to regular?

There's an equilibrium between sodium benzoate and benzene, which pushes towards benzene in the presence of ascorbic acid. There are higher levels of ascorbic acid in diet sodas than regular, so you get a higher dosage of benzene drinking diet soda.

Benzene is a carcinogen. It inserts itself between bases in your DNA and causes replication errors. When it causes replication errors in parts of DNA that regulate cell division, the cell's division cycle can be disrupted and it can turn cancerous. If unlucky, that cell may form a varied population of cancerous cells which make up a tumor.

As there is no 'safe' dosage of benzene, you may be increasing your relative risk of contracting cancer from consumption of diet soda.
posted by Blazecock Pileon at 1:49 PM on April 4, 2012

Philosophy for the win - and it makes me wish I'd taken philosophy as an undergraduate.
posted by jb at 2:15 PM on April 4, 2012

Maybe it'd be better to measure 'fat' with 'jolly' ??
posted by Twang at 3:01 PM on April 4, 2012 [1 favorite]

I am lucky enough to lose weight by exercise and diet, but the ballooning of people, pets, and even wild animals around me make me think that we're going to find some completely unrelated cause, like BPA in the water supply or who knows what.

The problem with obesity is that it has been allowed to become a moral issue- if people weren't such lazy slatterns, we could beat this "epidemic." If it was cancer, (well, around here, we'd still get that, as the Bay Area seems particularly susceptible to the Just World Fallacy, but in the rest of the world...) the populations suffering from it would get a lot less shaming.
posted by small_ruminant at 3:02 PM on April 4, 2012 [5 favorites]

I seriously will never understand drinking a beer in the shower.

Breakfast of champions.
posted by en forme de poire at 3:30 PM on April 4, 2012 [1 favorite]

Blasdelb:

It turns out that adipocytes are more sensitive to cold than other cells and so you can kill them with cooling lasers without killing the cells around them. The treatment itself is kind of worthless, but only because it is thousands of dollars and you can replicate it at home with a couple bucks worth of ice in your bathtub, in a technique that fitness folks have known for decades.

I have been a fitness folk for decades and I have never heard about this. Google returns no results for me on the first page.

Could you please provide some detail here?
posted by bukvich at 3:37 PM on April 4, 2012

Because you can't really "just decide" to ignore all of the food culture all around you that tells you what to eat, how much to eat, and when. It's amazingly embedded and very hard to avoid.

This kind of gets to my point though. For simplicity's sake, let's say that there are two possibilities:

A.) Obesity causes diabetes

B.) Something else causes both obesity and diabetes

Studies tell us that there is a correlation but we don't know if the cause is A or B. If the solution in either case is to change the food culture, it doesn't really matter which one it is.

Now, there we should keep doing research to figure out which one it is and that may reveal a better solution or at least one that is easier to implement but for now, if trying to change food culture is the best solution in either case, it doesn't matter to most people if it's A or B.
posted by VTX at 5:02 PM on April 4, 2012

Could you please provide some detail here?

I think he's talking about the semi-myth that exposure to cold makes you lose weight as the body burns energy to avoid hypothermia and maintain homeostasis. For example, some people will tell you that simply drinking cold water will help you lose weight, because you're inducing a bit of "hypothermic debt" as your body must spend energy to heat the cold water to body temperature.

Which is technically true, but doesn't amount to very much at all, calorie-wise.
posted by Cool Papa Bell at 5:06 PM on April 4, 2012

The googleable term is cryolypolysis. The basic idea is to induce cold panniculitis, also known as popsicle panniculitis, which is the other googlable term and has been known for some time. Here is some of the recent literature on it,

-----Manstein D, Laubach H, Watanabe K, Farinelli W, Zurakowski D, Anderson RR. (2008). "Selective cryolysis: a novel method of non-invasive fat removal." Lasers Surg Med. 2008 Nov;40(9):595-604.
-----Avram MM, Harry RS (2009). "Cryolipolysis for subcutaneous fat layer reduction". Lasers Surg Med. 2009 Dec;41(10):703-8. 41 (10): 703–8.
-----Zelickson B, Egbert BM, Preciado J, Allison J, Springer K, Rhoades RW, Manstein D. (2009). "Cryolipolysis for noninvasive fat cell destruction: initial results from a pig model". Dermatol Surg. 2009 Oct;35(10):1462-70.
-----Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. (2009). "Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on Peripheral Nerves". Aesthetic Plast Surg. 2009 Mar 19 33 (4): 482–8.
-----Nelson AA, Wasserman D, Avram MM. (2009). "Cryolipolysis for reduction of excess adipose tissue". Semin Cutan Med Surg. 2009 Dec;28(4):244-9.

This is distinct from the largely ridiculous and more than intuitively dangerous idea that one can lose weight by generating the heat necessary to maintain homeostasis in a cold environment like an ice bath, which looking back at my comment would likely have been what came up in google searches.

I first became familiar with the idea on an old defunct bodybuilding forum, the kind where straight guys all admire each others physiques but carefully and without the teensiest hint of the confusing feelings that they all obviously feel, where there was a long drawn out argument over whether the effect was real, came from brown fat somehow, or was related to panniculitis. It turns out that the guy with really nice abs who constantly talked about how nice some guys physiques were, but then managed to pick fights with them and talk about the sexual things he wanted to do to their mothers, was right about the panniculitis. I also once knew a SRS BZNS gymnast who would regularly bathe their ass in ice water for what they described was a similar effect.
posted by Blasdelb at 5:24 PM on April 4, 2012 [1 favorite]

Breakfast of champions.

Hey, no argument here, but I just drink mine on the couch.
posted by adamdschneider at 6:09 PM on April 4, 2012

This Eric Braverman?:

http://www.nytimes.com/1997/05/23/nyregion/doctor-s-license-reinstated.html
posted by noaccident at 9:00 PM on April 4, 2012 [1 favorite]

Someone needs to address the sample for this study! The authors seem to claim that 1400 patients from one clinic in Manhattan can be generalized to the population. Read this excerpt from the Limitations section:

"NHANES [6] estimates that 28.6% of adult American women are overweight (BMI 25–30 kg/m2) and an additional 35.5% are obese (BMI.30 kg/m2). Shifting those currently considered overweight into the obese category would clarify the magnitude of the issue of obesity. By our cutoffs, 64.1% or about 99.8 million American women are obese."

Really? The authors feel confident that their sample of 1400 racially homogeneous Manhattanites generalizes to the greater US population?
posted by hammerthyme at 5:36 AM on April 5, 2012

Noaccident, whoa, that's interesting. If you search for "eric braverman alternative medicine" you do indeed find some weird shit. Like this.
posted by en forme de poire at 7:39 AM on April 5, 2012

Uh, whoops! If you want to see a tiny kid breakdancing, you can follow that link. The page I meant to link to was here.
posted by en forme de poire at 7:40 AM on April 5, 2012

I will never understand why people continually argue about this crap. BMI, whatever. If you have a "overweight" BMI but don't look overweight and your actual weight is fine, consider that you are a weak jellyfish with no muscle mass and then go do some strength training. If you eat more calories in a day than you burn, consistently, you will gain weight. The opposite? You will lose weight. It is good for your heart to do some cardio, which means (and pay attention ladies and gents who spend two hours at the gym, but most of the time you are gabbing to friends or reading a book on the treadmill, which is just useless) you need to SWEAT. And maybe, once in a while, GET OUT OF BREATH. Shocking, I know.
posted by Kokopuff at 7:59 AM on April 5, 2012

Wow that is some profoundly quacky shit, it is the same guy too, check out his thoroughly dishonest biography on his own website.

I wonder how many people he has killed with shit like this
posted by Blasdelb at 8:54 AM on April 5, 2012 [1 favorite]

South Texas hospital bans obese employees
posted by mattbucher at 9:47 AM on April 5, 2012

A good test for a man is to look down while taking a shower:
If you can see your penis and your feet without sucking in your gut, you are healthy

So, if I'm reading this correctly, Renoroc, I'm skinnier when my lover is showering with me than when I'm getting ready for work alone?
posted by IAmBroom at 10:35 AM on April 5, 2012 [3 favorites]

It is definitely, by all practical standards, BETTER to start you day by showering with your partner.
Beer optional.
posted by Theta States at 1:02 PM on April 5, 2012

The authors seem to claim that 1400 patients from one clinic in Manhattan can be generalized to the population.

Do you have a specific critique of their method or do you just not really understand how statistics work?
posted by Justinian at 6:30 PM on April 5, 2012 [1 favorite]