The Obesity Myth.?!?
December 6, 2013 8:29 AM   Subscribe

Study may bust myth of 'fat and fit' healthy obesity. Being healthy and obese is a myth, researchers say. People who are obese and have normal blood pressure, cholesterol and blood-sugar readings will still be unhealthy and die sooner compared with people who have a normal body weight, according to researchers.

The researchers wanted to consider whether [obese] people were actually at any more risk of death or heart problems. Their meta-analysis used data on more than 60,000 people across three weight categories – normal, overweight and obese – in eight studies carried out over the last decade. While metabolically healthy obese people showed a similar risk of problems compared to those with normal weight, this wasn't the case when the researchers looked only at studies that had ten years of follow up. Study participants in all weight categories with unhealthy metabolisms showed an increased risk of mortality and cardiovascular problems."

Research article is here.

Editorial by the researchers.

More: Healthy obesity a myth, say researchers at Mount Sinai Hospital

Similar results were found by researchers in Texas a couple of weeks ago.

This study conflicts with earlier work on the relationship between health and obesity.
posted by MisantropicPainforest (183 comments total) 20 users marked this as a favorite
 
"Study participants in all weight categories with unhealthy metabolisms showed an increased risk of mortality and cardiovascular problems."

Um... yeah, sorry. That doesn't really equate to ZOMG ALL FAT PEOPLE ARE UNHEALTHY!!!1!!!!1!!!!!!, does it.
posted by palomar at 8:33 AM on December 6, 2013 [11 favorites]


Keep reading.

If you're wondering about the definition used for "obese," the sample size, and how the research was carried out, here's a pull-quote from the Mount Sinai Hospital link:
Researchers reviewed the data of 61,386 individuals in eight separate studies from the past decade. Each study observed adults defined as normal weight, overweight, and obese (body mass index or BMI of 30 or greater). Each study evaluated the individuals’ metabolic status, i.e. cholesterol levels, blood sugar levels, and blood pressure. The studies compared fatal and nonfatal cardiovascular events such as heart attack and stroke, as well as other causes of death, across the three weight categories.

The comparative risks for premature death in the three weight groups became especially apparent after 10 years of follow-up.

The key finding is that even in the absence high blood pressure or cholesterol (in other words, a metabolic problem), an obese person whose BMI is 30 or greater may be at 24% additional risk for cardiovascular event or premature death compared to a person of normal weight, says Dr. Retnakaran.
There were additional findings and discussion, but for this quickly addresses the highlights.
posted by filthy light thief at 8:34 AM on December 6, 2013 [9 favorites]


Medical obesity is a ratio of fat to total body weight, it doesn't mean if you are 100 pounds you can't be obese.
posted by BrotherCaine at 8:35 AM on December 6, 2013 [6 favorites]


(Spoken as one who finds himself increasingly struggling with overweight in recent years.)

No, du-uhhh!!.. yuh think?!
posted by anguspodgorny at 8:35 AM on December 6, 2013


Yeah, that bit was hard to parse, but I think it's two different statements:

(1) Obese people who are metabolically healthy have a higher risk of premature mortality than overweight or thinner people.

(2) People who are metabolically unhealthy are at a risk of health problems, no matter their weight.
posted by muddgirl at 8:36 AM on December 6, 2013 [28 favorites]


And still, people who are obese and try to address it - walking, exercise, et cetera - will get abuse for the terrible, horrible crime of being fat in public around the sanctimonious.

(As a fat guy, the comments I get walking around from people driving by should, really, send me to the sniper-rifle-and-clock-tower level of rage.)
posted by mephron at 8:36 AM on December 6, 2013 [92 favorites]


mephron: "And still, people who are obese and try to address it - walking, exercise, et cetera - will get abuse for the terrible, horrible crime of being fat in public around the sanctimonious."

Exactly.
posted by zarq at 8:37 AM on December 6, 2013 [13 favorites]


From the Editorial link, it seems as if this meta-analysis found that "most studies had limited information about the participants' health behaviours". So it doesn't seem to address the hypothesis that an active but obese person could still be healthy, and the authors seem aware that further research needs to be done.

But skinny or fat, sitting on your ass all day will work against your overall health. Anyone for an afternoon bike ride?
posted by maudlin at 8:38 AM on December 6, 2013 [2 favorites]


Neither of these statements seem particularly surprising to me as someone in the Health at Every Size camp. I'd like to see their data on premature mortality because that is a pretty broad category that encompasses a lot of socially-driven issues like lack of access to quality health care, etc.
posted by muddgirl at 8:38 AM on December 6, 2013 [10 favorites]


This statement highlighted by muddgirl is probably true but limited: "(1) Obese people who are metabolically healthy have a higher risk of premature mortality than overweight or thinner people."

Given that most people are inactive, they will see some detriment to their health because of this, but fat + inactive seems to be more deadly than skinny + inactive. What this study doesn't seem to have addressed is the minority of people who are fat and active, let alone comparing them to skinny and active people.
posted by maudlin at 8:42 AM on December 6, 2013


And still, people who are obese and try to address it - walking, exercise, et cetera - will get abuse for the terrible, horrible crime of being fat in public around the sanctimonious.

I think this is a total red herring. For one thing, it's likely that the people making the remarks to you are also technically "obese" according to the study, and will therefore also die younger.

This is not a problem about social stigma per se, this is a public health issue, and a personal issue.

It's something that I struggle with as well - so-called "metabolic syndrome" caused by working at a desk.

I suppose fat-shaming exists. I suppose I am the recipient of fat-shaming. I don't really care all that much though. I care more about trying to figure out how to get in shape in order to live longer!
posted by KokuRyu at 8:43 AM on December 6, 2013 [8 favorites]


The study doesn't address activity at all, as far as I can tell from the summary. It's looking purely at BMI and metabolic panels.

I care more about trying to figure out how to get in shape in order to live longer!

The science seems to show that the way to live longest is to stay overweight but not obese. If I had a pro-fat bias I might write sensationalist headlines about how getting in shape kills.
posted by muddgirl at 8:44 AM on December 6, 2013 [5 favorites]


When I see the word meta-analysis, I think of Dr Crislip (I never Meta Analysis I Really Like):

"Someone massaging preexisting data; hardly a study. Nice for an overview of a topic, but worthless for drawing conclusions definitive conclusions."
posted by wotsac at 8:47 AM on December 6, 2013 [7 favorites]


On a more serious note:
Duration of exposure to the metabolic–BMI phenotypes was not described in the studies and could partially affect the estimates.
I interpret this to mean that this study doesn't address whether "getting in shape" improves health outcomes or mortality.
posted by muddgirl at 8:48 AM on December 6, 2013 [1 favorite]


What this study doesn't seem to have addressed is the minority of people who are fat and active, let alone comparing them to skinny and active people.

Somewhere in the 60,000 person sampling (via the original studies) there are these people who are fat and active. And they either have the same risk of early mortality as everyone else in their BMI/weight category, they effects of activity while overweight aren't noticeable above the noise of the study, or there are so terribly few of them that they cannot be seen amidst the noise.

So if you are fat and active, you're banking on #3 as #1 and #2 leave you in the roughly the same boat.
posted by Slackermagee at 8:48 AM on December 6, 2013


"This is not a problem about social stigma per se, this is a public health issue, and a personal issue."

While the authors are only really trying to address one of these things, obesity is all of them.
posted by Blasdelb at 8:49 AM on December 6, 2013 [2 favorites]


Also from the same article (oops):
That meta-analyses are unreliable should not be surprising. Most reality based clinical trials are flawed, and if you collect a series of flawed studies, you end up with one big flaw. The idea behind the meta-analysis, collecting all the cow pies into one big pile and making gold, is only as good as the quality of the initial pies.
posted by wotsac at 8:49 AM on December 6, 2013 [2 favorites]


"... Nice for an overview of a topic, but worthless for drawing conclusions definitive conclusions"

Overviews of a topic don't get you impressive headlines, unfortunately for science.
posted by muddgirl at 8:49 AM on December 6, 2013


muddgirl: The science seems to show that the way to live longest is to stay overweight but not obese.

Here's a summary of a much larger meta-study with more information on this: Being Overweight Is Linked to Lower Risk of Mortality
The somewhat surprising conclusion comes from an enormous, detailed review of over 100 previously published research papers connecting body weight and mortality risk among 2.88 million study participants living around the world. The new research confirms that obese people, and particularly those who are extremely obese, tend to die earlier than those of normal weight. But the findings also suggest that people who are overweight (but not obese) may live longer than people with clinically normal body weight.
So it also includes the warning about health issues coming from being obese, making this new study is nothing new, but more interesting as it is cast as going against prior studies.
posted by filthy light thief at 8:51 AM on December 6, 2013 [2 favorites]


Great, way to make my favorite eating holidays more merry! Thanks medical researchers.
posted by The 10th Regiment of Foot at 8:52 AM on December 6, 2013 [2 favorites]


And still, people who are obese and try to address it - walking, exercise, et cetera - will get abuse for the terrible, horrible crime of being fat in public around the sanctimonious.



Don't worry- sanctimonious people, even if otherwise metabolically healthy, have a significantly greater risk of fat lips, busted noses, and other punching-related conditions.
posted by TheWhiteSkull at 8:53 AM on December 6, 2013 [34 favorites]


Wasn't an FPP just deleted in the past couple of days on this? Perhaps I'm misremembering.

I would not discount the possibility I am from a different timeline - this one isn't very pleasant based on the past week.
posted by Celsius1414 at 8:54 AM on December 6, 2013 [2 favorites]


Incidentally, if anyone would like access to the research itself, or any related papers, so you can review the evidence yourself, please feel free to memail me with an email address I can send a PDF to, a link to the abstract(s) you want, and a promise not to distribute that PDF(s) further. It would then make me embarrassingly happy if you were to then come back to the thread with either questions or answers from the paper, but if not no worries.
posted by Blasdelb at 8:54 AM on December 6, 2013 [6 favorites]


Also from the same article (oops):
That meta-analyses are unreliable should not be surprising. Most reality based clinical trials are flawed, and if you collect a series of flawed studies, you end up with one big flaw. The idea behind the meta-analysis, collecting all the cow pies into one big pile and making gold, is only as good as the quality of the initial pies.


So what do we do with this? Ignore all clinical trials?
posted by MisantropicPainforest at 8:56 AM on December 6, 2013 [3 favorites]


mephron: "And still, people who are obese and try to address it - walking, exercise, et cetera - will get abuse for the terrible, horrible crime of being fat in public around the sanctimonious.

(As a fat guy, the comments I get walking around from people driving by should, really, send me to the sniper-rifle-and-clock-tower level of rage.)
"

I wonder if we should encourage a campaign for people who DO support us fatties for exercising to publicly praise in a drive-by praising (unlike the haters). The haters are the vocal ones, but I've hard many friends of mine (who aren't "fat" - well they might think they are, but they know they aren't obese like I am or those like me)... They are appreciative of obese people working out and trying to make a change. Maybe if they worked on being more vocal and supportive in general, that might help counteract the psychology of all the assholes. Maybe.

I went exercising for the second time in a week yesterday w/my coworker. We're supporting each other in this. She's fairly healthy weightwise, IMO, but you know... society.
posted by symbioid at 8:56 AM on December 6, 2013 [1 favorite]


So if you are fat and active, you're banking on #3 as #1 and #2 leave you in the roughly the same boat.

True, Slackermagee. There's no evidence from this study that fat + active is better for your health than fat + inactive, nor is there evidence that it has no effect or even a poor effect.

But I'd hate to see obese people (and caring family, and fat shamers, and everyone else) get the message from media summaries that welp, you're fucking doomed, buddy. Staying active and losing enough weight to meet whatever the current criteria are, staying active and losing only 10% of their weight, or staying active while their weight stays stable may all be good enough outcomes compared to staying inactive and maintaining/increasing weight. It's just so easy to get defeatist about these things.
posted by maudlin at 8:56 AM on December 6, 2013 [3 favorites]


Incidentally, if anyone would like access to the research itself, or any related papers, so you can review the evidence yourself, please feel free to memail me with an email address I can send a PDF to

Ack, so no lab manager or post-doc has accidentally hosted it on a lab website thinking it was only accessible via the school intranet?

Damn. That's how I usually get these new, shiny papers.
posted by Slackermagee at 8:57 AM on December 6, 2013 [3 favorites]


I wonder if we should encourage a campaign for people who DO support us fatties for exercising to publicly praise in a drive-by praising (unlike the haters).

Personally, I feel a little weird when people do this to me. Not enough to get discouraged or anything though.
posted by BrotherCaine at 9:01 AM on December 6, 2013 [3 favorites]


muddgirl: "The science seems to show that the way to live longest is to stay overweight but not obese. If I had a pro-fat bias I might write sensationalist headlines about how getting in shape kills."

There was this interesting chart years ago showing that "overweight" had the best survival rates, followed by "proper" weight, then "skinny" then "obese"...

As an obese person, I do worry about "healthy at any size" as an excuse to not actually BE healthy at any size. Just because you CAN be healthy "at any size" (assuming such is true), doesn't mean you ARE healthy at your size (and this includes every single size).
posted by symbioid at 9:02 AM on December 6, 2013 [5 favorites]


So what do we do with this? Ignore all clinical trials?

Regard all clinical trials with suspicion - we see wave after wave of headline grabbing trials that are ultimately deceptive or plain wrong. Look for replication and plausibility. And don't put too much stock in meta-analyses - which, rather than replicate results (hopefully with different or fewer errors), perform statistical wankery on a pile of flawed studies, likely compounding the errors of each study.
posted by wotsac at 9:02 AM on December 6, 2013 [2 favorites]


This is why I always yell "Come on, you sons of bitches, do you want to live forever?" at anyone within earshot before I enter a fast food restaurant.
posted by The Card Cheat at 9:03 AM on December 6, 2013 [32 favorites]


I know this has been said before, but I really wish we could move beyond BMI as the be-all-and-end-all of obesity measurement. Honestly, I am very close to "obese" according to my BMI, and I'm in better shape than I have been in years, and I don't think anyone I know IRL would consider me to actually be "obese" with a straight face.

For me, using the BMI alone sortof undercuts all the rest of the findings.
posted by likeatoaster at 9:04 AM on December 6, 2013 [16 favorites]


"That meta-analyses are unreliable should not be surprising. Most reality based clinical trials are flawed, and if you collect a series of flawed studies, you end up with one big flaw. The idea behind the meta-analysis, collecting all the cow pies into one big pile and making gold, is only as good as the quality of the initial pies."

MisantropicPainforest: "So what do we do with this? Ignore all clinical trials?"
My recommendation?

Ignore journalists who repeat things they don't understand and lack both the knowledge and the judgement to weigh evidence presented in a scientific paper, be cautious about the findings of meta-analyses as they can be statistically fraught for both good and bad reasons, and learn how to read a scientific paper(PDF).
posted by Blasdelb at 9:05 AM on December 6, 2013 [26 favorites]


Damn, Blasdelb beat me to the journalist angle.

On top of how to read a scientific paper, it can be useful to get an inside look at what some of the jargon and phrasing can, in some cases, actually mean.

Overly Honest Methods and to a much lesser (but far funnier) extent What Should We Call Grad School.

Sometimes its a joke. Sometimes the sample was actually incubated for 96 hours because I forgot it on the bench top over the weekend.
posted by Slackermagee at 9:10 AM on December 6, 2013 [3 favorites]


Is there a science journalism equivalent to probublica? Because it seems like there needs to be.
posted by BrotherCaine at 9:11 AM on December 6, 2013 [1 favorite]


I think this calls for huskies like myself to start pushing gym bunnies in front of buses.

Who's living longer now, slim? Mind you, it's not personal—it's just statistics.

Seriously, though, you can live by studies and myths and "common sense" and endless sources of contradicting data and philosophical agendas and rumors and happenstance and other roots of ruination fired up by a society that no longer has communism or nuclear war to fret over, or you can honestly do the best you can at whatever size you are, which generally leads you to the shape you're meant to occupy in a reasonable time and at a reasonable rate. Some people will be skinny. Some people will be fat. Most are in-between. Some of us even vary throughout our lives.

Of course, those of us built like human dachshunds have a lifetime hatred of the maniacal adoption of the E-Z BMI calculation most dipstick doctors seem to blindly worship, too, so we're extra growly.
posted by sonascope at 9:11 AM on December 6, 2013 [5 favorites]


As an obese person, I do worry about "healthy at any size" as an excuse to not actually BE healthy at any size. Just because you CAN be healthy "at any size" (assuming such is true), doesn't mean you ARE healthy at your size (and this includes every single size).

I'm sure this happens on an individual level at least, but it does seem like Health at Every Size and the International Size Acceptance Association at least pay lip service to the idea of exercise being important. And given that obesity is tough to fix, at least focusing on being active will definitely help.
posted by BrotherCaine at 9:14 AM on December 6, 2013 [1 favorite]


I know this has been said before, but I really wish we could move beyond BMI as the be-all-and-end-all of obesity measurement. Honestly, I am very close to "obese" according to my BMI, and I'm in better shape than I have been in years, and I don't think anyone I know IRL would consider me to actually be "obese" with a straight face.

For me, using the BMI alone sortof undercuts all the rest of the findings.


It doesn't, because at the population level these types of issues with BMI get smoothed over. BMI=not good for individuals, better for populations.
posted by MisantropicPainforest at 9:15 AM on December 6, 2013 [6 favorites]


Very germane to the discussion above about how fitness influences mortality in individuals of different BMI: another meta-analysis suggests that it is not just metabolic health but also fitness that is relevant in determining mortality risks. Obese and overweight individuals who are more fit seem to have similar hazard ratios for morality as normal weight fit individuals! (At least in the timescales assessed by the included studies). This is a crucial consideration for public health: fitness is easier to change than weight.
posted by Keter at 9:18 AM on December 6, 2013 [4 favorites]


BMI=not good for individuals, better for populations.

I'm not sure that is true, though. Part of the reason my weight is high(er) is because of muscle mass. If more people had more muscle mass, they might easily weigh more and have greater BMIs, and so might the population as a whole. Wouldn't make them less healthy. Which is to say that using the BMI presupposes a population whose weight is primarily based on fat, not muscle.
posted by likeatoaster at 9:19 AM on December 6, 2013 [1 favorite]


As an obese person, I do worry about "healthy at any size" as an excuse to not actually BE healthy at any size. Just because you CAN be healthy "at any size" (assuming such is true), doesn't mean you ARE healthy at your size (and this includes every single size).

It seems to me like it's impossible for anyone to be 100% perfectly healthy - we are all biological, mortal creatures who are going to die (unless we're Ray Kurzweil). To me, HAES is about prioritizing the quality of life that we have while we're alive, not trying to game the statistics to improve future health or mortality outcomes. Walking the dogs and playing golf makes me feel better than being inactive all day. Taking care of my mental health obviously makes me feel better. Eating a wide variety of foods makes me feel better than when I ate cheese and crackers for basically every meal. These all have immediate effects on my life right now. Could I 'be healthier'? Probably. Does that make me a HAES failure? I don't think so.
posted by muddgirl at 9:19 AM on December 6, 2013 [14 favorites]


"healthy at any size"

This movement completely ignores the huge issue of joint health. Unless you are super strong your joints cannot withstand the daily toll of carrying obesity (or even higher amounts of overweight) levels of weight. Once you get onto the downward spiral of joint pain and arthritis limiting your ability to maintain your health you're in for a lot of self-inflicted grief and regret.

Take it from someone with creaky arthritic knees. Your heart, cholesterol and metabolism can all be fine and you can still be screwing your future over by carrying too much extra weight like I unfortunately did. Now pain is a part of my life and it actually wakes me up in the morning before my cat does.
posted by srboisvert at 9:23 AM on December 6, 2013 [14 favorites]


The reason why I think the "fat-shaming" trope is a red herring in this case is because now that I am in my early 40's I *am* experiencing health effects of obesity and metabolic syndrome. I have high blood pressure, for one thing. Sleep apnea. Other problems.

I am also not morbidly obese, either.

Health problems *will* manifest themselves if obesity is not addressed. These health problems are not caused by societal pressure and advertisements in glossy magazines or whatever.
posted by KokuRyu at 9:24 AM on December 6, 2013 [13 favorites]


For me, using the BMI alone sortof undercuts all the rest of the findings.

Yeah, those stupid scientists. Next they'll be saying the earth is getting warmer....
posted by Pogo_Fuzzybutt at 9:27 AM on December 6, 2013 [5 favorites]


If more people had more muscle mass, they might easily weigh more and have greater BMIs, and so might the population as a whole. Wouldn't make them less healthy.

That would be true if that happened, but there is not much evidence that it has. In fact, if one actually looks at body fat percentages, things are much worse than studies based on BMI alone would seem to indicate.
posted by jedicus at 9:32 AM on December 6, 2013 [3 favorites]


Wasn't an FPP just deleted in the past couple of days on this? Perhaps I'm misremembering.

Nope, you are not. Can't say if you're from a different timeline, but I have my suspicions.
posted by Brandon Blatcher at 9:34 AM on December 6, 2013 [3 favorites]


We do not know for certain that being fat is even related to having Coronary Heart Disease,

Setting the bar at certainty is unusually high for a public health problem.
posted by MisantropicPainforest at 9:36 AM on December 6, 2013 [2 favorites]


Nope, you are not. Can't say if you're from a different timeline, but I have my suspicions.

Ah, thank you!

It'd be nice to have a secret "deleted posts" MeFi. Maybe called "DeFi" and with a black background.
posted by Celsius1414 at 9:38 AM on December 6, 2013 [2 favorites]


"I know this has been said before, but I really wish we could move beyond BMI as the be-all-and-end-all of obesity measurement. Honestly, I am very close to "obese" according to my BMI, and I'm in better shape than I have been in years, and I don't think anyone I know IRL would consider me to actually be "obese" with a straight face.

For me, using the BMI alone sortof undercuts all the rest of the findings.
"
Those damn experts!

People have been hating on the BMI since it was developed in Belgium as the Quetelet index 160 fucking years ago. It has always been seriously flawed particularly when looking at individuals, which is why it is almost never used where alternatives are available, but the BMI does have an incredibly important place in research and public health. It's inaccuracy is very powerfully statistically definable and it is so trivially easy measure that it can be applied to huge populations for those statistics to be done on. So long as you aren't asking questions of the data that would be affected by the tiny population of Schwarzeneggers and 'skinny fat' folks who defeat the usefulness of the test it can provide incredibly valuable answers on a population level.
posted by Blasdelb at 9:38 AM on December 6, 2013 [25 favorites]


It'd be nice to have a secret "deleted posts" MeFi. Maybe called "DeFi" and with a black background.

There's a Firefox extension you can use. Don't have the link...
posted by sweetkid at 9:40 AM on December 6, 2013 [1 favorite]


Does bariatric surgery and the weight loss that occurs afterwards bring people back in line statistically with people who were thin or only very slightly overweight all their life? I know surgical complications can be major, but wonder if there has been a tipping point established.
posted by PussKillian at 9:42 AM on December 6, 2013


I have the post by looking on the MetaFilter Deleted Posts blog.
posted by Brandon Blatcher at 9:43 AM on December 6, 2013 [6 favorites]


Even if all of this is true, it doesn't mean anyone has the right to lecture me on what I should put into my body out of a sense of "concern".
posted by inturnaround at 9:46 AM on December 6, 2013 [2 favorites]


From: What is Epidemiology?

Emphasis mine.


I know what Epidemiology is thanks, and your quote says nothing about certainty, which again, is an usually high bar for social science, let alone a public health campaign.
posted by MisantropicPainforest at 9:47 AM on December 6, 2013 [1 favorite]


We do not know for certain that being fat is even related to having Coronary Heart Disease, Cardiovascular Disease, joint problems, Diabetes or other disorders.

What? In what sense? What level of proof are you looking for here?

Is this one of those devils' advocate, "Sure, most of the time but not always" things?
posted by hobo gitano de queretaro at 9:51 AM on December 6, 2013 [2 favorites]


Being healthy and obese is a myth, researchers say

Define healthy.

This isn't snark, but a serious question. Is there a particular clinical definition this study is working with. And with that definition, how far do the obese tend to differ from that definition.
posted by Brandon Blatcher at 9:52 AM on December 6, 2013


Lucky there's little chance obesity causes global warming.
posted by Spanner Nic at 9:53 AM on December 6, 2013 [1 favorite]


This movement completely ignores the huge issue of joint health.

I don't think that's true. I think HAES argues that even fat people who are at a higher risk of osteoarthritis in the knee can take steps to prevent or relieve arthritis, if it is affecting their quality of life, like moderate exercise, potentially joint-strengthening foods, etc. HAES does not mandate that no one try to lose weight to improve their health. It argues that even if you can't lose weight, you can do things to improve your quality of life.

This isn't snark, but a serious question. Is there a particular clinical definition this study is working with

They talk about their criteria in the paper summary
Included studies evaluated all-cause mortality or cardiovascular events (or both) and clinical characteristics of 6 patient groups defined by BMI category (normal weight/overweight/obesity) and metabolic status (healthy/unhealthy), as defined by the presence or absence of components of the metabolic syndrome by Adult Treatment Panel III or International Diabetes Federation criteria.
Basically healthy in their study means normal levels of cholesterol and no elevated fasting blood sugar or other diagnostic markers for diabetes.

Lucky there's little chance obesity causes global warming.

Oh yeah? There is literally nothing we can't blame on obesity.
posted by muddgirl at 9:58 AM on December 6, 2013 [8 favorites]


Oh come on, obviously increased consumption and demand for food is related, at least in some way (not necessarily meaningful) to obesity and global warming.
posted by MisantropicPainforest at 10:01 AM on December 6, 2013 [1 favorite]


Wonderful, someone else telling me how I'm going to die this week.

Look, I'm a great big fatass poopypants visual offense. I know that; I get told it on a daily--nay, hourly--basis by media and headline scarebait like this. (No, I did not RTFA, because I've read it a thousand times in every other possible permutation.) I will never, ever be thin. Ever. Believe me, I have tried. I'm female and unfortunate enough to be built like an NFL linebacker. My hands are huge, my feet are bricks, my shoulders are broad--even my head is enormous. I have a ridiculously large body; even at my very thinnest I was still far more than overweight by medical standards. Basically, I'm a fucking orc.

My husband just spent a ridiculous amount of money on exercise equipment for me, so I can keep up my fitness without having to go out into subzero temperatures. According to shit like this, what's the point? I'm just going to die prematurely anyway, right? I can exercise like a fiend, I can eat perfectly, I might even lose 50 or 60 pounds, but none of it will make any difference. I still won't be thin, not even by the loosest medical standards.

Nah, just go ahead and die, fatty. That's what you're telling me, science?
posted by timetoevolve at 10:02 AM on December 6, 2013 [4 favorites]


This is one of those terribly uncomfortable situations where people feel hurt because their identity is under attack by all elements of society, so when scientific fact arises that shows an element of that identity to be unhealthy, it adds to the feeling of being under attack.

The same thing happens when people suggest that transpeople on hormones are at higher risk for cancer and illness associated with taking high levels of hormones.

I empathize with those feelings, they must really suck. I also think it's important to recognize scientific evidence and fact to be what they are: empirical evidence and fact.

Obesity is unhealthy. It just is. It shortens people's life expectancy. It is something that can most people are physically capable of changing about their bodies, though on an emotional/psychological level it can be very difficult. It's also a personal choice that I don't want to judge when it's being made by an adult who's not responsible for anyone other than themself. But when adults let their kids become obese and do nothing to stop it, that's not OK with me.

I'm glad we have more science to back up the idea that it's healthy and good to try and work one's way out of obesity. I realize that it hurts people's feelings to hear it, and I empathize, but I also think it's better to tell people the truth and get hurt feelings than to let them lie to themselves and end up with serious health risks.

Fat shaming and health consciousness are not the same thing.
posted by MeanwhileBackAtTheRanch at 10:02 AM on December 6, 2013 [34 favorites]


sigh. our society as a whole is just so caught up in judging people for everything, it's like our whole damned culture is one MMORPG of Moral High Ground with no obvious endgame.

and yea, it'd be so awesome if our media wasn't such a pack of lemmings invested in selling eyeballs at any cost.

I'm not sure what to tell folks who really don't like movement / activity that would even help. I've had a lot of friends who just do not like to exercise. For myself the best advice I can give is start slow and find a training partner. I'm currently getting my ass kicked around by a 22 year old grad student, and it is SO GOOD FOR ME, but I'm also a collegiate cycling coach. It's awesome but dealing with college kids as a middle-aged introvert surely is not for everyone.

Try everything. Gyms suck IMO, and I refuse to do "normal" shit like riding the indoor trainer or running on a treadmill. Natural movement (urban hikes / parkour / trail running / dance / just derping around in the woods or around town on a bike) is more my speed. Just being outside even in shitty weather makes me feel better and more prone to continue moving, but I get that I've also got the right gear and the right background experience and skills to fully utilize and appreciate it, too.

Honestly these days just getting up from the cubicle crouch and walking around every 20-30 minutes keeps me from rusting into a U shape, because despite all the activity I do, I am still getting old and that does take its toll if I'm not diligent about maintenance (stretching, massage, yoga, etc...)

All this shit in the news is just your typical shallow sensationalist pullquote crap that passes for "journalism" these days. And this may sound nihilistic, but one of the things that keeps me from going into batshit anxiety mode about the ZOMG ____ IS GONNA KILL YOU!!!111 headlines is that, ok, fine, guess what? There are no guarantees, and no one gets out of this game alive. So it's up to me to figure out how to best maintain or improve the quality of my life for whatever quantity I'm signed up for, whether it's 5 more days or 5 more decades.
posted by lonefrontranger at 10:02 AM on December 6, 2013 [2 favorites]


Its kind of strange how many different reactions this pretty narrow, previously up in the air, and important scientific finding in public health has caused, almost none of which are on the topic of the finding. Not so much a derail to reign in as a giant herd of cats to sigh at and then start pouring a little more generously. We've got everything from ARE THEY CALLING ME FAT? to IDEOLOGICAL STANCE! to DON'T JUDGE ME! to THIS CONFIRMS MY BIASES!. Someone who hadn't read the paper could almost be forgiven for thinking that the authors were trying to do experimental morality, attempting to empirically determine who is worthy of respect.
posted by Blasdelb at 10:03 AM on December 6, 2013 [16 favorites]


This is not a problem about social stigma per se, this is a public health issue, and a personal issue.

It's a quality-of-life issue. Being yelled at when out walking, or people giving you crap in a gym when you're trying to improve your condition and health, causes a negative effect on your quality of life. If that factor is worse than 'I don't like being obese' as a factor, well, you're going to stop it rather than take the abuse.

So getting someone slowing down in their car when I'm out walking, rolling down the window, and yelling "WHAT THE FUCK IS WRONG WITH YOU FAT FUCKER", then laughing as they drive away, makes me not want to go out and walk. Not enough, yet, to make me stop, but enough to make me uncomfortable about it.

I suppose fat-shaming exists. I suppose I am the recipient of fat-shaming. I don't really care all that much though. I care more about trying to figure out how to get in shape in order to live longer!

Good for you; when I get crap at the gym, the muscle-heads pointing and laughing at me, and basically pulling back to high-school level stuff, it gets shoved in my face and I begin to slip in my resolve to not be arrested for criminal assault and battery.

Yes, there's all sorts of biological reasons, and health reasons, but until it's no longer shameful to be fat in public due to a large number of people finding fat people the last group to be openly prejudicial about, fat people are going to avoid trying to do something because fuck it, we don't want to be doubly miserable for a) doing something we don't enjoy to lose weight and b) getting emotional abuse doing it.
posted by mephron at 10:04 AM on December 6, 2013 [14 favorites]


I don't care what study it is, if that word is not plural it does not mean what the "science" journalism it will appear in will claim.

Which does not mean it's 100% wrong, either, but it doesn't warrant any crowing about how HAES is wrong unless it really means that you are being seriously imperiled right now by your body proportions and nothing else and they are completely sure of that. Because you know, there are a lot of us who weren't obese until the world insisted that a BMI of 27 is just as "unhealthy" as twice that and decided that we were ugly and lazy and horrible just for wearing double digit pant sizes.

I'm metabolically healthy by most measures but evidently blood sugar and thyroid are the few things not falling apart. I'm in terrible health by most other measures--partly due to the ED I'm mostly over and the mental health issues I never will be--and I'm not meant to be the weight I am, and better habits on my part is slowly reducing that. But I'm not you. Things that have some meaning about the population--i.e., no, this HFCS sugar rush is gonna have to go eventually--do not mean things about individuals in terms of who is or is not going to be healthy and how they should or should not care for their bodies. I'm not meant to be 220, but I'm not meant to be 120, either. If you aren't my doctor, it is really not your business. But, of course, the media thinks this one study means that with 100% certainty you, fatty, yes you, you are just as gross as they always thought you were. And that disgusts me. I caught this on NBC the other night and the framing of it was just revolting.
posted by Sequence at 10:05 AM on December 6, 2013 [4 favorites]


I hate to break it to you but our lack of progress on metabolic studies like the Minnesota one I linked above seems to indicate that at least in some cases, caloric intake is not predictably linked to body weight.

The article is a meta-study about BMI, nothing at all about the link between caloric intake and weight.
posted by MisantropicPainforest at 10:08 AM on December 6, 2013 [3 favorites]


There was this interesting chart years ago showing that "overweight" had the best survival rates, followed by "proper" weight, then "skinny" then "obese"...

This, maybe?

I just barely fall into the 0.94 section for white men... it seems strange to me that according to this chart, losing ~5 lbs will put me in the "normal" category and statistically be a bad thing...
posted by Huck500 at 10:09 AM on December 6, 2013 [1 favorite]


previously up in the air

I'm blase about this study because I don't think the findings are novel at all, nor do they say anything that was "up in the air" before. I think the fact that it's acceptable journalistic practice to take a confirmational metastudy and proclaim that it "proves fat and fit is a myth" despite the fact that it doesn't really say that at all is more troubling than anything in the study itself.
posted by muddgirl at 10:11 AM on December 6, 2013 [3 favorites]


Yeah, and at the population level an increase in caloric intake will increase obesity, ceretis paribus,
posted by MisantropicPainforest at 10:13 AM on December 6, 2013


People who are obese and have normal blood pressure, cholesterol and blood-sugar readings will still be unhealthy and die sooner compared with people who have a normal body weight, according to researchers.

This study talks about statistics, not facts regarding individuals. I see words like this in a lot of posts about studies. The proper way to say it is "are more likely" to die sooner.

As for still being "unhealthy" I don't know what that means exactly.
posted by Ironmouth at 10:14 AM on December 6, 2013


Also, one of the things I do really have to watch is my joints, because arthritis runs bad in my family even among the skinny people, and so I have realized that I need to be really careful about that, because my inactivity and the extra weight is going to exaggerate that. But, again, that's me. That's something that doesn't likely apply if your grandparents were all off climbing mountains at 85 instead of getting joints replaced at 60. But there are also people who run towards ED who I guarantee will be healthier fat than skinny. There are people who should definitely not run marathons because of heart problems, there are people who really need to move for their mental health. We're all individuals, here. On average, if we all practice better self-care in whatever way is actually best for us and were actually supportive of one another, I suspect that would have a way better practical impact just on average BMI than if we all make a concerted effort to lose weight because somebody on TV said being fat is dangerous.
posted by Sequence at 10:15 AM on December 6, 2013 [1 favorite]


"I don't care what study it is, if that word is not plural it does not mean what the "science" journalism it will appear in will claim."

I share your contempt for and suspicion of science journalism, but science does not come in units of rightness measured by number of studies. There is exactly no substitute for judgment, contextual knowledge, and time consuming effort when evaluating scientific evidence. Larger studies will generally mean a hell of a lot more than smaller studies, well designed studies can tease a lot out of very little, poorly designed studies can tease out absolutely nothing of value out of a hell of a lot, and the value a question has to begin with is incredibly dependent on all sorts of shit that is really fucking non-intuitive.
posted by Blasdelb at 10:15 AM on December 6, 2013 [3 favorites]


Can we also acknowledge that BMI is not that useful of an indicator? My BMI is in the healthy range. My younger brother shows up as overweight. But I've got a higher body fat percentage than he does. I'm about average build, 5'10 and 172, and he is a personal trainer who's 5'11" and 195 pounds of almost pure muscle, so he's 'overweight'. Kind of ridiculous.
posted by MeanwhileBackAtTheRanch at 10:16 AM on December 6, 2013 [1 favorite]


Can we also acknowledge that BMI is not that useful of an indicator? My BMI is in the healthy range. My younger brother shows up as overweight. But I've got a higher body fat percentage than he does. I'm about average build, 5'10 and 172, and he is a personal trainer who's 5'11" and 195 pounds of almost pure muscle, so he's 'overweight'. Kind of ridiculous.

BMI's fairly useful for almost everyone... not as useful as body fat percentage, but much easier. Very few people are overweight because of muscle, and those who are don't really need BMI...
posted by Huck500 at 10:21 AM on December 6, 2013 [6 favorites]


But we do not have proof

Proof is not necessary. Evidence is, and we have that.
posted by MisantropicPainforest at 10:23 AM on December 6, 2013 [3 favorites]


"Can we also acknowledge that BMI is not that useful of an indicator?"

No, your sample size of two with half of your genetic information double counted, does not invalidate 160 years of careful statistical analysis based on public health data taken from 10s to 100s of millions of people. While the information that the BMI can give to individuals is limited by a bunch of confounding variables, and that limitation is trivially addressable with 2 minutes worth of education, it is incredibly useful for studying populations of people for whom those confounding variables can be addressed mathematically.
posted by Blasdelb at 10:24 AM on December 6, 2013 [30 favorites]


I saw this reported on two different television networks. On both, the not-obese newscaster shrugged, admitted that they themselves do not have the best of health habits, and...chuckled. Because, you know, they could.

To this obese person who is trying like hell to be healthy, that's a lot more disturbing than yet_another_study_01.
posted by gnomeloaf at 10:25 AM on December 6, 2013 [1 favorite]


Can we also acknowledge that BMI is not that useful of an indicator? My BMI is in the healthy range. My younger brother shows up as overweight. But I've got a higher body fat percentage than he does. I'm about average build, 5'10 and 172, and he is a personal trainer who's 5'11" and 195 pounds of almost pure muscle, so he's 'overweight'. Kind of ridiculous.
posted by MeanwhileBackAtTheRanch at 10:16 AM on December 6 [+] [!]


There are also smokers who do not get cancer. Individuals vary. But on average the point to people in the fit-and-fat camp is that they are probably not the exception and that in fact what they are claiming is simply not supported by evidence.
posted by rr at 10:25 AM on December 6, 2013 [1 favorite]


...the muscle-heads pointing and laughing at me...

Very obviously ymmv (everyone's does, right?), and I'm very sorry to hear that anyone has been pointed-at-and-laughed-at (this should never ever happen, obvs). But in my (lucky?) experience, "muscle-heads" are more often-than-not supportive of people who are making an honest effort to improve their fitness. I mean, they also have non-normative bodies and are subject to hegemonic discourse about how "unhealthy" their lifestyles are, and how their bodies must reflect some psychological failing (narcissistic neanderthal with subnormal IQ etc).

Sigh. People need to be good to each other.
posted by erlking at 10:27 AM on December 6, 2013 [15 favorites]


Blasdelb, I didn't mean to imply that more=better, always. Just that replication matters, to some degree, but more than that, it's that the media will just seize on whatever it is and make a giant big deal out of it regardless of what the study actually says. And that means that they never have context; they just care about momentary big headlines. So when the media says, "Study says waffles cause cancer!" it is very unlikely to mean that you should stop eating waffles right now. Once they're actually paying enough attention to start looking deeper, they're usually referring to more than one study. Critical thinking necessary in any case, but more so when the evening news announces for the ninety-seventh time this month that no, really, THIS is the one study that has changed the face of the world as we know it.

It might say some really significant and useful things from a public health perspective, but the media's take on it is pretty much always sensationalist trash.

rr: I'm not going to be surprised if some exist, but I have never met a HAES proponent who thinks we all ought to be fat. The idea is usually that judging on bodies is pointless and you should do what you can to be healthy. I've never been shamed in that crowd for losing weight.
posted by Sequence at 10:32 AM on December 6, 2013 [1 favorite]


wotsac: "When I see the word meta-analysis, I think of Dr Crislip (I never Meta Analysis I Really Like)"

That's a great article, and I'm a big fan of science-based medicine. Thanks. I will point out, however, that the scientific view of meta-analyses remains nuanced. In that article, for instance, Dr Crilsip says:

"I still like the meta-analysis and systemic reviews as a nice overview of a clinical topic, but, for reasons we will see, I am hesitant to draw any therapeutic conclusions from any meta-analysis."

There's a subtle distinction there, one worth paying attention to. Meta-analysis remains terrible for therapeutic conclusions. "This meta-analysis says this drug is safe, so we're going to prescribe it" = bad. "This meta-analysis says behavior A leads to obesity, so you personally should do X" = bad. But "this meta-analysis says obesity is not conducive to healthier outcomes, so we should look a bit closer and think about taking moderate steps to deal with this issue carefully on a population-wide level, by using education and other tools" is probably a fair way to go.

As far as I can tell from what I've heard and read in this and other articles, the best way to put it is: meta-analysis is a blunt instrument; it's not great for precision work, so we should probably not use it when determining things like the immediate efficacy or safety of a particular treatment, but it can be handy (if used carefully) when we want a bird's-eye view of a population or even of society as a whole so we can start thinking about what directions seem to be good ones for public policy.
posted by koeselitz at 10:35 AM on December 6, 2013 [3 favorites]


While the information that the BMI can give to individuals is limited by a bunch of confounding variables, and that limitation is trivially addressable with 2 minutes worth of education, it is incredibly useful for studying populations of people for whom those confounding variables can be addressed mathematically.

It seems like it would be pretty easy to make a three-point body fat pinch-test a standard part of a checkup.
posted by MeanwhileBackAtTheRanch at 10:38 AM on December 6, 2013


Reissuing the comment I made in the deleted thread the first time this was posted:

Based on the risk ratios reported in the abstract, a better summary would be "obese people with metabolic markers in the normal range have a slightly higher mortality and risk of cardiovascular events than lower-weight people with normal metabolic markers, but they have a massively lower mortality and cardiovascular risk than people of any weight with bad metabolic markers." In other words, metabolic health seems to be much more determinative of mortality than BMI is.
posted by escabeche at 10:39 AM on December 6, 2013 [19 favorites]


The article is a meta-study about BMI, nothing at all about the link between caloric intake and weight.

You are right that this is a derail.

Yeah, and at the population level an increase in caloric intake will increase obesity, ceretis paribus.

YOU ARE RIGHT THAT THIS IS A DERAIL.
posted by BrotherCaine at 10:39 AM on December 6, 2013 [1 favorite]


While the information that the BMI can give to individuals is limited by a bunch of confounding variables, and that limitation is trivially addressable with 2 minutes worth of education, it is incredibly useful for studying populations of people for whom those confounding variables can be addressed mathematically.

All the substitute metrics for BMI have problems too. Either they are difficult, time consuming or expensive to assess, or they are inaccurate for some subgroup. Body Adiposity Index seems somewhat promising.
posted by BrotherCaine at 10:45 AM on December 6, 2013 [1 favorite]


I really wish people could get away from this idea that "Healthy at Every Size" is some smokescreen we fatties came up with to hide behind while we do nothing but scarf cheeseburgers in front of the TV. If it helps, imagine some extra words in there: [Everyone should practice, to the best of their ability,] Healthy [habits] at Every Size. If your concern is genuinely about health, you should be all over HAES and focusing on getting us to a place where everyone, regardless of current or future shape, can eat nourishing, delicious food and participate in physical activities that make them feel good. Body shaming, and making everything about some distant end-goal, does more harm than good. HAES gives us all a way to take care of ourselves and each other.
posted by atropos at 10:46 AM on December 6, 2013 [31 favorites]


If we've gotten to the point where people are seriously on a "you're either fat or against us" trip, there's a bigger societal problem here.

The micro-identity clique politics that's been emerging over the past 20 years is a huge problem for everybody. And it belies a society so full of insecure people that we've come to a point where we create our identities and self-esteem based on incredibly narrow and self-limiting definitions. I wonder if anybody's done any solid writing on that topic.
posted by MeanwhileBackAtTheRanch at 10:48 AM on December 6, 2013 [4 favorites]


Thanks atropos, that was extremely apropos not just to the adipose. Sorry, it's like a compulsion.
posted by BrotherCaine at 10:48 AM on December 6, 2013 [9 favorites]


Honest question: can an overweight person stay overweight if they actually reduce their caloric intake to normal levels? Can a person become overweight without intaking abnormal numbers of calories? If the answer is yes, how common or uncommon is it for this to happen?
posted by MeanwhileBackAtTheRanch at 10:50 AM on December 6, 2013


Being yelled at when out walking, or people giving you crap in a gym when you're trying to improve your condition and health, causes a negative effect on your quality of life.

I want to make sure I'm very careful about this because people are generally quite horrible and I'm sure things like this happen. That said - is this really the norm? I've been upwards of 50-70lbs overweight - probably borderline obese - and I lost it by going to the gym and eating right.

Not once - literally, not once - did I experience anyone yelling at me when running or giving me crap in a gym. I remember some vaguely patronizing platitudes from the very fit - stuff like, "you're an inspiration" or whatever - but I took it at face value, because shit, what I did was pretty fuckin inspirational.

I have worn many hats in life. I've been in bands. I've worked in every class of occupation, from fast food to construction to high-prestige consulting. I've attended two universities, one shit, the other world-renowned. And nowhere in my proverbial travels have I ever met people as supportive, generous, and kind as in the fitness community. None.

I'm really sorry you've had bad experiences, and I don't think anyone is under the slightest obligation to lose any weight they don't want to. But I do think anyone who looks for - and finds - that community in their area will be forever thankful they did.
posted by downing street memo at 10:50 AM on December 6, 2013 [6 favorites]


And it belies a society so full of insecure people that we've come to a point where we create our identities and self-esteem based on incredibly narrow and self-limiting definitions. I wonder if anybody's done any solid writing on that topic.

Yeah, his name was Jesus.
posted by phaedon at 10:51 AM on December 6, 2013 [3 favorites]


What metric are we using for "normal"? It varies so widely by activity level and overall height/frame. I can get away with 1200 net calories a day and not be hungry. If I eat 2,000 I'll gain weight.
posted by sweetkid at 10:55 AM on December 6, 2013 [1 favorite]


Yeah, his name was Jesus.

Well, he might well have been illiterate. But he had quite a fan fiction club.
posted by Celsius1414 at 10:56 AM on December 6, 2013 [7 favorites]


Honest question: can an overweight person stay overweight if they actually reduce their caloric intake to normal levels? Can a person become overweight without intaking abnormal numbers of calories? If the answer is yes, how common or uncommon is it for this to happen?

There's some evidence that NEAT goes up and down to deal with excess calories more efficiently in some individuals than others. Anecdotally I have much fatter friends who always ate less than me, and I know I used to be able to eat several thousand surplus calories a day with my weight pegged at 165 pounds. I don't know how common it is for our genetics to determine more about our weight than our choices though. It wouldn't surprise me to learn our choices give us more control over our height than our weight.
posted by BrotherCaine at 10:57 AM on December 6, 2013 [1 favorite]


Meanwhile: If you've already been significantly overweight, then yes. It changes your metabolism. If you go from 300 pounds to 150, you have to eat markedly fewer calories or burn markedly more than someone who was always 150 to stay 150. I'm not sure if it ever balances out again. This has been sort of an ongoing thing with interviews with former Biggest Loser people--they're usually not nearly as slim as they were and yet a lot of them are total health nuts, seems like. I've been a decade since my worst ED phase and I still gain weight at the drop of a hat--that changes it, too. Cruel joke.
posted by Sequence at 10:59 AM on December 6, 2013 [2 favorites]


Detailed analysis of this study and the various reactions to it, from the fierce freethinking fatties blog.

There *are* a few questionable assumptions in the study that may vitiate the conclusions the researchers try to draw from it.
posted by edheil at 11:08 AM on December 6, 2013 [3 favorites]


Nah, just go ahead and die, fatty. That's what you're telling me, science?

Science is telling you to lose weight by reducing caloric and become more active.

However, purchasing exercise equipment or getting a gym membership is not going to directly help. My wife, who experienced PCOS, was told by her endocrinologist that it would take working in a coal mine to burn off calories and lose weight by exercising (obesity and body-fat percentage, even in a mild case like my wife's, is linked to PCOS).

The endocrinologist said that the easiest way to "lose weight" is to watch what you eat, while exercise has the ability to adjust the body's metabolism. That's why sitting at a desk all day can result in "metabolic syndrome."

The message here is that in order to improve longevity and quality of life when you get older (and "getting older" can mean your late 40's) focus on exercise and diet.

Once again, it's longevity and preserving quality of life.

It has nothing to do with aesthetics (although it might when you are in your 20's and early 30's, when your 40's seem a long way away).
posted by KokuRyu at 11:09 AM on December 6, 2013 [7 favorites]


"My anecdotal experience is one reason that I think we need to do some basic work on figuring out how metabolism works."
Just because it takes 5-10 years of post secondary schooling to gain a really meaningful understanding of it, doesn't mean we aren't doing it.
posted by Blasdelb at 11:09 AM on December 6, 2013 [8 favorites]


I guess people really are desperate to get OMG BUT TEH SCIENCE OF EVIL FAT back onboard the bandwagon of anti-fat-people prejudice and hatred, after work had been done to kick it off.

Kinda like that Bell Curve shit that was supposed to show that black people were stupid after all, so everybody's old prejudices and the old "science" they were based on were right.

"No, really, our hatred is science! REALLY!"
posted by edheil at 11:11 AM on December 6, 2013


"According to shit like this, what's the point? I'm just going to die prematurely anyway, right? I can exercise like a fiend, I can eat perfectly, I might even lose 50 or 60 pounds, but none of it will make any difference. I still won't be thin, not even by the loosest medical standards.

Nah, just go ahead and die, fatty. That's what you're telling me, science?
"
This is not at all what the research is saying, like not even close.
posted by Blasdelb at 11:12 AM on December 6, 2013 [8 favorites]


Define healthy.

interesting.

I'm fifty-four. In the past five or so years, four guys that I graduated high school with have died of heart attacks, at least three of whom were described as "... in very good health" (I haven't heard details on the fourth yet). So, yeah. There's the looks good, gets their exercise, eats well, has-a-spring-their-step (but might drop dead at any second due to stress issues and/or genetic time tomb) unhealthy, and there's the smoking, drinking, bleary-eyed etc (but will live well into their 80s) healthy.

We need more studies, it seems.
posted by philip-random at 11:12 AM on December 6, 2013 [1 favorite]


fyi,

You have to scroll quite a bit down in edheil's link to get to the part where they discuss the study in the FPP.
posted by MisantropicPainforest at 11:15 AM on December 6, 2013


We need more studies, it seems.

I would argue that it seems that we need more required statistical education, as a nation.
posted by hobo gitano de queretaro at 11:15 AM on December 6, 2013 [16 favorites]


MeanwhileBackAtTheRanch: "Honest question: can an overweight person stay overweight if they actually reduce their caloric intake to normal levels? Can a person become overweight without intaking abnormal numbers of calories? If the answer is yes, how common or uncommon is it for this to happen?"

My caloric intake stays relatively constant at somewhere between 2300-3000 calories. For someone my height and build, this is a normal caloric intake. (3000 is a bit on the high side. I'm supposed to keep it between 2200 and 2600.) I don't drink alcohol. Yet I have slowly been gaining weight for the last 10 years thanks to an (until recently) undiagnosed hormone imbalance. (I'm hypothyroid.)

I do lose some weight when I exercise regularly, and eat foods that are high in fiber. But raising and lowering my caloric intake generally doesn't put a dent in my weight. And the hormone imbalance has made it very difficult to lose, even with exercise.
posted by zarq at 11:18 AM on December 6, 2013 [1 favorite]


Study may bust myth of 'fat and fit' healthy obesity.

Right.

Hey doc, get back to me when you change the words "may bust" to "absolutely disproves".

Seriously, I am sure there are points to be made with the findings. However as long as researchers continue to throw out doomsday medical predictions with phrases such as "may bust" preceding the cause of death du jour, I am going to look at it with a jaundiced eye.
posted by lampshade at 11:22 AM on December 6, 2013


MB@TR: Lustig on calories in calories out vs weight gain (watch video for a couple minutes).
posted by BrotherCaine at 11:22 AM on December 6, 2013 [1 favorite]


ok, can I reiterate escabeche's point upthread? The increase in risk is 24%. Not total risk. That is significant, but really not a huge effect. As escabeche also points out, having a good cardiovascular panel remains a much better predictor of longevity than being thin. If you are a normal weight but metabolically unhealthy, the same article estimates that your risk is increased 214%. Also, as muddgirl points out, the same effect was not seen for people who are overweight but not obese. These details are not very prevalent in the reporting for some reason, e.g.:

The Times has reported that the idea you can be ‘fat and fit’ is “a big fat myth”.

♫ if you are a science reporter, sometimes it's fun to look at the actual aaaarticle ♪
posted by en forme de poire at 11:33 AM on December 6, 2013 [11 favorites]


Thanks researchers I'm already aware that some people are physically superior to others because of their genes that's why I'm eating mayonnaise sandwiches in the first place.
posted by Potomac Avenue at 11:46 AM on December 6, 2013 [3 favorites]


Being yelled at when out walking, or people giving you crap in a gym when you're trying to improve your condition and health, causes a negative effect on your quality of life.

Fat-hate is a very puzzling phenomenon.

We live in an extremely competitive society-- for jobs, mates, school admissions, housing, etc.; in games, contests, and recreational activities of all kinds-- and the presence of people fatter than us in any milieu should therefore be very welcome to us because it would tend to push us up in the hierarchy.

But that's not how people behave.
posted by jamjam at 11:51 AM on December 6, 2013 [3 favorites]


It's relative risk. You can't have an absolute risk of >100%. To convert to absolute risk you would multiply the baseline absolute risk by (e.g.) 1.24 (24%) or 3.14 (214%). Baseline absolute risk depends very heavily on a lot of things, like age and gender, so you have to take that into account as well - obviously older people are more likely to get CVD in general, irrespective of their weight or lipid profiles. The 10-year-risk for cardiovascular disease in a 30-year-old male of normal weight is around 1% based on the Framingham Heart Study; they have a calculator so you can play around with different values.
posted by en forme de poire at 11:51 AM on December 6, 2013 [2 favorites]


I ask again, is that 24% or 214% a change in relative risk or absolute risk?

Relative, and (glancing) they seem to report incidences in one of their tables.
posted by ROU_Xenophobe at 11:57 AM on December 6, 2013


I meant to write "If fat is so bad, fat-hate is a very puzzling phenomenon."
posted by jamjam at 12:00 PM on December 6, 2013 [1 favorite]


We live in an extremely competitive society-- for jobs, mates, school admissions, housing, etc.; in games, contests, and recreational activities of all kinds-- and the presence of people fatter than us in any milieu should therefore be very welcome to us because it would tend to push us up in the hierarchy.

I suspect that some people feel defensive when they see others exercise. It reminds them of the healthy steps they've thought about taking but never gotten around to. They surely feel even worse if they perceive themselves as more able-bodied than the person who is showing them up by jogging uphill or performing other feats of badassery.
posted by tofu_crouton at 12:11 PM on December 6, 2013 [1 favorite]


So, I've seen several people in my family die as a result of their obesity (heart failure, mostly, diabetes-related gangrene in one, excessive injury in a car accident due to girth in another). I'm not trying to fat-shame people, but I don't understand where the idea of "healthy at any size" originates from the beginning. Is there any evidence, anywhere, that being obese (as opposed to "normal" or even slightly overweight) leads to better outcomes in any measure?

Most of the times when I was inching up towards "fatness," so to speak, were when I was beset by depression and stress. Losing weight was one of the first actions I took in those instances, and it helped me feel better and get out of the funk. I worry that HAES is a sort of self-justification, the denial that a correctable aspect of health can negatively impact life experience in order to avoid taking action. I certainly took that path myself with regard to "social anxiety," which I was convinced I had for quite a while (years) until I managed to pull myself out of a cycle of depression and "right the ship" so to speak.
posted by sonic meat machine at 12:14 PM on December 6, 2013 [6 favorites]


And still, people who are obese and try to address it - walking, exercise, et cetera - will get abuse for the terrible, horrible crime of being fat in public around the sanctimonious.

Maybe it's just me, but anytime I see an overweight person out running in my neighborhood, I'm weirdly proud of and hope only the best for them, no matter how uncomfortable or awkward they look. As a naturally slim person who benefits from pretty good genes, I try to put myself in their place and imagine how difficult it would be—both physically and psychologically—to do what they're doing. I can't imagine I'm the only one.
posted by echocollate at 12:15 PM on December 6, 2013 [7 favorites]


sonic meat machine: Is there any evidence, anywhere, that being obese (as opposed to "normal" or even slightly overweight) leads to better outcomes in any measure?

I could be mistaken, but I thought "healthy at any/every size" was not the thought that obesity is better than something else or leads to better outcomes in some measures, but that being obese was not terrible, and if one made decent health decisions but was obese, they were still going to be OK in the long run.
posted by filthy light thief at 12:23 PM on December 6, 2013 [6 favorites]


kalessin, it's actually more complicated than that in this case, because they're using a statistical framework to adjust for other confounding variables like age and gender and smoking status. Only reporting absolute risk could also be misleading in this case because it would necessarily average over categories that are really, really different (like the ones I just mentioned).

But anyway, RR is defined as the "risk ratio," which should always be Pr(event given risk) / Pr(event given no risk). The "control" state should always be the denominator. If you are talking about an "increase" in risk, then that means RR - 1 (and this wouldn't make sense for RR < 1 because that would mean that the risk decreased). In your example, if the normal state is 4% and the risk state is 5%, then RR = 1.25 and the increase in risk would be 25%. None of the other ways of calculating it would be accepted as valid (again, assuming that the 4% risk was for the "not exposed" condition).
posted by en forme de poire at 12:23 PM on December 6, 2013 [3 favorites]


I wish people wouldn't keep repeating the "being overweight gives you an average longer lifespan than being normal weight" thing. I know it gives people a feeling of satisfaction to post it and be all like "HAHA SO THERE 'NORMAL' WEIGHTIES!" but it doesn't mean what you're implying it means.

What it means, primarily, is that smokers tend to weigh less and they tend to die early.
posted by Justinian at 12:36 PM on December 6, 2013 [1 favorite]


>Is there any evidence, anywhere, that being obese (as opposed to "normal" or even slightly overweight) leads to better outcomes in any measure?

There's no good, solid, scientifically and statistically sound evidence that supports any conclusion but anecdotal conclusions

Are you saying that there is no scientific evidence that obesity causes health issues?
posted by Bort at 12:39 PM on December 6, 2013 [1 favorite]


Well, there's a difference between noise and a small, reproducible effect. 24% is a small effect size, but given the sample size they have I don't doubt that it's statistically significant. And of course, to defend this type of study a little, these researchers are mostly concerned with populations: 24% might be pretty small for any given person, but that doesn't mean you couldn't still make a lot of people healthier by eliminating that risk.

However, I do agree with others that if improving blood work is easier than losing weight, that's pretty win-win because improving blood work appears to be very much more effective.

(Justinian, that's not correct: the overweight-longevity thing is still true even if you correct for smoking. Underweight people are more likely to be sick than normal weight people, but that doesn't change the relationship seen between longevities of normal and overweight people. We don't totally understand what causes this relationship yet.)
posted by en forme de poire at 12:43 PM on December 6, 2013 [1 favorite]


Articles like this are not actually helpful. You can't make individual decisions based on this. Say you are one of the metabolically healthy obese people mentioned. You are probably already eating healthy and exercising. That's why you're metabolically healthy.
How is this study going to help you? It's just going to make you feel like the good you were doing is for naught.
I used to think "Oh, I'll never be a model, but at least I've lowered my blood pressure and cholesterol."
Would it have killed them to focus instead on the mortality gap between the "healthy obese" and the "unhealthy obese" instead?
posted by domo at 12:44 PM on December 6, 2013


Underweight people are more likely to be sick than normal weight people

...though I'd guess the causal arrow is mostly the other way?
posted by ROU_Xenophobe at 12:47 PM on December 6, 2013


It's worth noting that it's health at every size, not healthy at every size, and that is a notable distinction. One can address their health at any size, even if they can be demonstrated to not necessarily be entirely healthy in the overall picture, and that's what the whole HAES thing is about. The mythos that we are in some sort of denial because we say "You know what? I'm fat. I need to start where I am right now," which is a distinct thing from losing weight. Losing weight is a part of health, if one is carrying too much weight. It is not, however, the whole of health.
posted by sonascope at 12:49 PM on December 6, 2013 [12 favorites]


I asked you earlier in the day, kalessin, what you felt was an acceptable level of proof. As you have not replied to that yet, for my own sanity I'm going to pretend this has all been an elaborate exercise in trolling.
posted by hobo gitano de queretaro at 12:50 PM on December 6, 2013 [1 favorite]


Beyond that, I'm done here. Obviously you're not going to change your mind.

There's some serious unintentional irony going on here.
posted by aspo at 12:50 PM on December 6, 2013 [3 favorites]


Articles like this are not actually helpful. You can't make individual decisions based on this.

I don't think the primary goal of the study was to help people, it was to find out the truth.
posted by MisantropicPainforest at 12:51 PM on December 6, 2013 [4 favorites]


On the other hand, you may elect to shoot the moon by claiming that causation is in fact, not a subset of correlation.
posted by hobo gitano de queretaro at 12:51 PM on December 6, 2013 [1 favorite]


Would it have killed them to focus instead on the mortality gap between the "healthy obese" and the "unhealthy obese" instead?

Also, in grad school we were taught when reviewing books that the number one thing to not do was to review a book the author didn't write.
posted by MisantropicPainforest at 12:51 PM on December 6, 2013 [2 favorites]


Yeah, sorry, ROU_X, I wasn't trying to make a statement about causality there - I think you're right, it's almost certainly more like "some third variable, like an underlying disease, causes both underweight and increased mortality."
posted by en forme de poire at 12:52 PM on December 6, 2013


500-2000%? Are you kidding?
posted by Justinian at 12:55 PM on December 6, 2013 [4 favorites]


I am not aware of any causal arrow in any understanding of whole-being Terran metabolics

But if we wanted to understand whether it was more that underweight people get sick more, or more that sick people become underweight, all we'd need to get a decent first guess is a big-enough TSCS.
posted by ROU_Xenophobe at 12:56 PM on December 6, 2013 [1 favorite]


Yeah, sorry, ROU_X, I wasn't trying to make a statement about causality there

I didn't think you were making any particular claim, I was just thinking "aloud."
posted by ROU_Xenophobe at 12:57 PM on December 6, 2013 [1 favorite]


That's on par with the causality between smoking and lung cancer. There can be a very real causative effect which isn't as strong as the link between smoking and lung cancer.
posted by Justinian at 12:58 PM on December 6, 2013


That high a bar would basically cripple any public health campaign.
posted by MisantropicPainforest at 1:02 PM on December 6, 2013 [1 favorite]


This where we can all fall into the trap of talking about people as opposed to talking to them. I'm sensitive to this, I mean, we can pontificate all damn day long about the article, but at the end the day there are many people here on mefi this article is describing and we should keep it in our minds that they are a part of our audience as we comment. Let's not objectify them, please?
posted by Annika Cicada at 1:03 PM on December 6, 2013


The more I consider these results, the more I consider doubling down on the position that it will be inefficient and ineffective for public health interventions seeking change on the level of the individual adult to emphasize individually-driven weight loss. We know that maintaining significant weight loss is very hard for the typical person, if nothing else than due to the impressive biological challenges many peoples' bodies mount in the wake of weight loss. The data really do show that many people who lose weight go into "starvation mode" with concomitant radical changes in their hormonal profiles and neurobiological responsiveness, and that a formerly 300 pound person who drops to 200 pounds will need to eat far fewer calories to maintain 200 pounds than someone who has been 200 pounds for the past 10 years. I just went to a talk from a leading medical weight loss center indicating that the only empirically supported treatment for weight loss proven to reliably drop weight for the majority of individuals has been weight loss surgery, which also alters metabolism in many cases. The assertion was that NO well-designed diet plan—alone or even paired with heavy support and/or psychiatric intervention for appropriate cases—has shown reliable efficaciousness in promoting weight loss for most individuals. And we have to imagine individuals in a behavioral weight loss trial are among the most motivated psychologically to lose weight! It increasingly seems like a lost cause from a public health perspective for attempts to promote individual weight loss to focus on individual-level rather than societal-level changes. It really does. (For many people—some people do show that they can diet and change their weight, and for sure resources should be provided to them!).

Conversely, there is apparently huge improvement in mortality risk based on both the target meta-analysis and the fitness/BMI meta-analysis from improving your metabolic health and increasing your physical fitness. If we are all gawking over the 25% risk increase from being metabolically healthy but obese compared to a non-obese person, just look at the 150-200% increases in risk going from being metabolically healthy to metabolically unhealthy. And there's a comparable 100-150% risk increase seen in the fitness meta-analysis going from fit to unfit across the BMI levels. That's a major difference in effect compared to simply going from obese to "normal" (25% vs. 100+%). Put another way: based on this data, if I were an obese, unfit person and you gave me a choice to become either normal weight or physically fit, I would chose becoming physically fit as fitness seems to be much more strongly related to mortality than my BMI. Plausibly, these two factors—metabolic health and fitness—are what are driving the majority of the mortality risk for overweight/obese people. (Though strictly speaking no one to my knowledge has analyzed the three-way interaction: BMI x Metabolic Health x Physical Fitness). I have to imagine it would be comparatively much easier to help individuals increase their fitness and possibly some markers of their metabolic health (which will probably induce some degree of weight loss; many markers of metabolic health admittedly track weight, but further research should be done to see which ones do not and can be independently altered apart from big weight shifts). Such a refocus could give realistically achievable goals for fitness and health to the average overweight/obese person who really may never be a "normal" size, ever; it reorients the goal from the body and all the shame and stigma that rides along with the body, and makes it about things many people can do right now to change their health for the better.
posted by Keter at 1:07 PM on December 6, 2013 [22 favorites]


That high a bar would basically cripple any public health campaign.

Just out of curiosity, have there been any studies about the efficacy of public health campaigns in general? We're all delighted for the successes (vaccinations for example), but is there a cost in terms of health campaigns that didn't understand the science well?
posted by BrotherCaine at 1:09 PM on December 6, 2013 [1 favorite]


I'm primarily talking about the Calvin Cycle

Fucking Calvinists....
posted by mikelieman at 1:11 PM on December 6, 2013 [2 favorites]


kalessin, I see what you're saying re: large effect sizes, but I think you're ignoring the relationship between the effect size and what it would cost to reduce or eliminate the risk. If a particular risk factor only has an RR of 1.25 (and in this case it does appear to be repeatable - that's the whole point of a meta-analysis) it could still be worth it to eliminate that risk factor if you can do so cheaply and effectively. The problem is that based on our previous attempts at treating obesity, a cheap and effective cure (at the population level, not the individual level) does not exactly appear to be around the corner. If a risk is in the 5-20 range instead, then maybe that's something in the "any means necessary" category.
posted by en forme de poire at 1:13 PM on December 6, 2013 [2 favorites]


I'm looking for a relative risk of approx 500% - 2000% to show authoritative proof.

If something about my lifestyle doubles my risk of something pretty bad happening, that is something I absolutely want to know about. Setting the "proof" bar as high as 5-20x increased risk means accepting a lot of possibly preventable illnesses, especially for something as common as cardiovascular problems. We're talking about millions of people here.
posted by randomnity at 1:13 PM on December 6, 2013 [1 favorite]


kalessin, can you provide citations for those BMJ papers? I have the feeling you might be misinterpreting or otherwise not correctly parsing their conclusions, as earlier you'd made a statement along the lines of 500-2000% RR being only those RRs that are indeed statistically significant. But there's actually no relation between the magnitude of RR and whether it's statistically significant -- whether a given RR is stat sig depends on the design of your study and the variance of the effect in your population of interest, among other things. However, I could see the case being made that, at the sample sizes we're running these studies at, to derive any conclusions with meaningful public health implications -- that is, information about these huge effects of doing or not doing X, information that would be of use to the average person -- that'd indeed be the range of RR that we'd want to have in hand before proclaiming anything. But I'm skeptical.
posted by un petit cadeau at 1:19 PM on December 6, 2013 [3 favorites]


Also, if your doubled absolute risk goes from 1% to 2%, then do you give a shit?

Yes. I do. And more importantly, I don't want someone to take away my ability to give a shit by hiding the information from me. Put the facts out there accurately and people can decide for themselves whether a 1% higher absolute chance of dropping dead (or worse) is something they give a shit about.
posted by randomnity at 1:24 PM on December 6, 2013


Wonders to himself how long it will take before someone who hasn't read the article pops in to defensively attack it.... but somehow is still surprised to see it only took one comment.
posted by IAmBroom at 1:29 PM on December 6, 2013


kalessin, it sure seems like you've gone from "there is no evidence for this!" to "This hasn't been absolutely proven!" to "The relative risk isn't high enough to matter (to me)!". Is your position that there isn't good evidence that being overweight causes health problems or is it that the increase in number of health problems isn't enough to matter or what?
posted by Justinian at 1:36 PM on December 6, 2013 [1 favorite]


Is the evidence for a causal link between weight and health better or worse, in your opinion, than the evidence for climate change?
posted by Justinian at 1:43 PM on December 6, 2013


Studies on obesity are probably most useful for the people who are at risk or on their way and who can still get in front of it, i.e. obesity. Usually people still young enough to turn things around. Without surgery, obesity can almost never be corrected unfortunately, for any length of time. Whether mortality is elevated or otherwise, caring for people who are obese presents its own set of major problems.

I think it is important to be able to tell an active obese person who is trying to eat right and is otherwise healthy in terms of measurable metrics that worrying unnecessarily isn't helpful, because it won't help them lose weight. But those folks are fairly uncommon. The majority of overweight or obese patients we see eat and drink too much. Not too much as in "gluttony", just no where close to the insanely low amounts an average adult should really consume if they want to stay the weight they should, which, frankly, isn't much more than what it was in your twenties. If you talk to people in their forties and older who maintain a normal body weight, the tricks of mind and body, the eating rituals and degrees of avoidance and daily discipline they utilize to stay that way would shock a typical person who is trying to understand how to lose weight. And yet when people do lose weight, the first thing they say is something to the effect of not having had any idea how little they needed to eat to get to goal.
posted by docpops at 1:44 PM on December 6, 2013 [1 favorite]


Yeah, when I'm eating an amount of food which would cause me to lose weight very slowly I am hungry a lot. It's not very much food.
posted by Justinian at 1:46 PM on December 6, 2013


Is the evidence for a causal link between weight and health better or worse, in your opinion, than the evidence for climate change?

I compare the science of obesity research to cancer research when describing it to patients. That is, for every new insight we feel confident in, we introduce or reaffirm the vastness of how little we actually know or can agree on.
posted by docpops at 1:49 PM on December 6, 2013 [4 favorites]


I've been saying that we do not have sufficient scientific evidence to claim that we know causality and that I'm not really okay with making public policy about it.

I think if you'd said that to start, you might not be getting the push back you are. But you didn't. Your first mention of causality was:

We still have no causal evidence of obesity and health issues commonly associated ... with it.

And later:

I'm saying that there are plenty of scientific hypotheses that obesity and health issues are linked but there exists no scientifically/statistically sound evidence that back the hypotheses.

Which is quite a bit different, and why I asked the question to start with. No scientifically sound evidence is a far cry from not sufficient to establish causality.
posted by Bort at 1:56 PM on December 6, 2013 [1 favorite]


Yeah, when I'm eating an amount of food which would cause me to lose weight very slowly I am hungry a lot. It's not very much food.

It depends on what food you're eating. If you're eating a lot of grains, that actually stimulates your hunger. If you eat protein and fat, you will be sated much more quickly.
posted by sonic meat machine at 2:02 PM on December 6, 2013


So getting someone slowing down in their car when I'm out walking, rolling down the window, and yelling "WHAT THE FUCK IS WRONG WITH YOU FAT FUCKER", then laughing as they drive away, makes me not want to go out and walk. Not enough, yet, to make me stop, but enough to make me uncomfortable about it.

When I got fitter it simply changed to people rolling down the window and calling me a fag. Which is to say the people in the car yelling at people on the street are versatile hateful assholes who will yell at you no matter what. If that helps you out at all....
posted by srboisvert at 2:03 PM on December 6, 2013 [14 favorites]


kalessin: "BMI would be more reliable if it were established by scientific organizations and also if the standards didn't keep changing to make the numbers again, more reportable."

I was unable to find any variation in the definition of BMI in this google search. As for it not being established by scientific organizations... who do you imagine is setting the standards? Girl scouts?
posted by IAmBroom at 2:07 PM on December 6, 2013


people in the car yelling at people on the street are versatile hateful assholes

In other words, for what it's worth, don't feel bad for your personal plight as a human, it's the whole fucking miserable human condition we should be weeping for.
posted by The 10th Regiment of Foot at 2:08 PM on December 6, 2013 [1 favorite]


Brandon Blatcher: "Being healthy and obese is a myth, researchers say

Define healthy.

This isn't snark, but a serious question. Is there a particular clinical definition this study is working with. And with that definition, how far do the obese tend to differ from that definition.
"

You are allowed to read the articles we're commenting on, you know.
posted by IAmBroom at 2:15 PM on December 6, 2013 [4 favorites]


Justinian: "Is the evidence for a causal link between weight and health better or worse, in your opinion, than the evidence for climate change?"

That's an odd comparison - of course it's worse, right? Medicine is not like environmental science. Medicine is trying to say something about what is best for individual organisms. Environmental science is content talking about general benchmarks of health for the entire environment; science must try to drill down and talk about what is best for the individual. So obviously environmental science does its work mostly through studies that are as broad as possible with as large a sample size as possible, so long as certain things are controlled for. In medicine, there are so many difficult parameters to control for - every possible permutation of human life possible - and the individual outcome is so specific that it's much more difficult to render a certain judgment.

That's one reason why I think people are misunderstanding the criticism here. I said above that meta-analysis can be useful for public policy, but I think it's a good idea to remain a bit skeptical on that point. This study certainly isn't enough, for example, to tell individual people "you need to work to lose weight in order to be healthy." Let that sink in for a moment: we don't have any basis here for telling overweight or even obese people that losing weight would be healthy for them individually. Can you see why people are therefore skeptical about the benefit or knowledge conferred by studies like this? It really would be much preferable to have a targeted study that wasn't a meta-analysis.
posted by koeselitz at 2:17 PM on December 6, 2013 [2 favorites]


What I mean is: medicine necessarily has higher standards it has to meet before prescribing behavior in order to solve problems, for a number of reasons. This study doesn't meet those standards; it's interesting, and maybe useful for pointing a direction for research, but it doesn't really even allow us to say definitively that people ought to act in a certain way when they're overweight or obese. Doesn't it make a lot of sense to demand that the actual accepted medical threshold be met before we go prescribing a bunch if stuff and (yes) telling people what's good for them?
posted by koeselitz at 2:20 PM on December 6, 2013 [1 favorite]


I think there's a significant difference between saying this study proves you should lose weight to get healthier and telling people they should probably refrain from pushing the "healthy at any weight" mantra. We may not have enough evidence, yet, for the former but the data suggests we should stop with the latter.
posted by Justinian at 2:24 PM on December 6, 2013 [1 favorite]


The data suggests that you don't understand what "health at any size" actually means. It's aspirational, not polemical. It means "you should start working to be healthy, no matter what size you are." This thread seems to be full of people who love to speak whereof they do not know.
posted by koeselitz at 2:27 PM on December 6, 2013 [13 favorites]


(Honestly, I didn't realize that myself until a few minutes ago. But since at least two people have pointed it out in this thread so far, maybe we could listen to them?)
posted by koeselitz at 2:35 PM on December 6, 2013


I compare the science of obesity research to cancer research when describing it to patients.

That's pretty insightful, however I would mention that 'obesity research' is often compounded by potential underlying emotional and psychological aspects which -- once addressed -- could render the tasks of sustainable weight management a whole lot easier.

I guess whatever point there is -- is that cancer doesn't give a shit whether you get over your hang-ups.

And that makes me consider another question, "What are the best ways to help people get over their emotional/psychological issues which preclude effective weight management?"

For me it took over a decade of stress-reduction and relaxation work.
posted by mikelieman at 2:36 PM on December 6, 2013 [1 favorite]


koeselitz: People claiming that's not what health at any size means are being disingenuous. It may be what it is supposed to mean. It may be what some people mean. But, for example, from a Health At Any Size community website:
Health at Every Size is the new peace movement.

Very simply, it acknowledges that good health can best be realized independent from considerations of size.
So the data also suggests people are being a bit misleading about what HAAS means and how it is actually used.
posted by Justinian at 3:15 PM on December 6, 2013 [3 favorites]


To put it another way: It's kind of like BMI. The way it is used and the way it is supposed to be used are different.
posted by Justinian at 3:17 PM on December 6, 2013 [1 favorite]


Very simply, it acknowledges that good health can best be realized independent from considerations of size.

In fact, that is one of the conclusions of this study. If improving your bloodwork is ~3 times as effective as losing weight and significantly easier for most people to accomplish, then it makes perfect sense that good health may best be achieved independent of considerations of size.

Beyond that, the question is really what the cutoff should be to call someone in "good health." Again, a 25% increase in risk is pretty small. For comparison, around 50% of men will develop coronary heart disease after the age of 40, compared to 33% of women; that's around a 50% increase in risk for men vs. women. Yet I'd imagine that most people would still say that men can be in "good health."
posted by en forme de poire at 3:50 PM on December 6, 2013 [8 favorites]


People claiming that's not what health at any size means are being disingenuous.

The trouble with the quote you use from the HAES website is that you've only quoted half of it, and the other half pretty much supports the way that HAES principles are generally understood and practiced by those who believe in the philosophy:

Very simply, it acknowledges that good health can best be realized independent from considerations of size. It supports people—of all sizes—in addressing health directly by adopting healthy behaviors.

That's not remotely the same as an apologist's approach. It's a plain declaration that HAES is about taking action on health, but holistically, rather than taking a simplistic approach in which weight is the sole factor. People advocating for HAES very rarely take the position that one should never lose weight (and when they do, they are straying from the principles of the movement), and self-acceptance is not the same as imagining yourself to be a perfected being—it's just saying "I am a human being worthy of love, respect, and a satisfying life," which is a sentiment at the core of any reasoned attempt to improve one's health.
posted by sonascope at 4:45 PM on December 6, 2013 [13 favorites]


And still, people who are obese and try to address it - walking, exercise, et cetera - will get abuse for the terrible, horrible crime of being fat in public around the sanctimonious.

(As a fat guy, the comments I get walking around from people driving by should, really, send me to the sniper-rifle-and-clock-tower level of rage.)


and

Yes, there's all sorts of biological reasons, and health reasons, but until it's no longer shameful to be fat in public due to a large number of people finding fat people the last group to be openly prejudicial about, fat people are going to avoid trying to do something because fuck it, we don't want to be doubly miserable for a) doing something we don't enjoy to lose weight and b) getting emotional abuse doing it.

Sing it, mah brothah.

I'm short. AND fat. AND suffer from an autoimmune disorder (RA) AND "metabolic syndrome" AND MDD. And yet...my cholesterol is great, we're starting to get the "metabolic syndrome" out the door thanks to use of supplements, the MDD is being treated with medication that is working really well. I eat fresh foods, practice "everything in moderation", bellydance an hour a day, and when the weather is warm, I train for distance bike rides. But I'm still fat. That's probably not going to change a whole lot, and I've made my peace with that.

The general public, though? Jesus Havelock Christ. Last summer, when I was training for my second event of the summer - the first being a 50 mile trek for the MS Society that was great fun and very exhilarating! - there was an afternoon where I couldn't get out to my favorite bike trail to train, so I rode in the streets around my neighborhood. Some dude thought it would be fantastically encouraging to scream from his front porch "Why don't you get some fucking exercise, you fat whore!"

Let me repeat that a little: He called me a fat whore and demanded I get some exercise. While I was training for a 65 mile bike ride, after having just completed a 50 mile bike ride 3 weeks before. Not just fat, but a whore besides, because I had the audacity to be fat on a bike in public.

Him, I challenged to get on his bike and keep up with my fat ass. (Of course he didn't take me up on it!) But I don't generally have the presence of mind to do so when someone hassles me for existing while fat. I feel like the breathless reporting done on articles like these do nothing to promote any sort of knowledge, and only contributes to the notion that it's OK to abuse people for not meeting your aesthetic standards, under the guise of "concern for [your] health". The only people who are privvy to whether J. Random Fat Person is healthy or not are J. Random Fat Person and his/her doctor. Everyone else needs to STFU and mind their own fucking business instead of parroting the latest "but studies show...!".
posted by MissySedai at 5:22 PM on December 6, 2013 [23 favorites]


Does bariatric surgery and the weight loss that occurs afterwards bring people back in line statistically with people who were thin or only very slightly overweight all their life? I

That's a very interesting question. I would be surprised if it did, not only because of the huge number of complications and bad health outcomes associated with the surgery but a) because of figures I've seen showing that a surprisingly large number of people still manage to put most of their weight back on and b) the number of chronic health conditions associated with the kind of obesity bariatric surgery is recommended for often never resolve/take a long time to resolve.

Would be interested to see some more informed opinion about that one, though.
posted by smoke at 6:30 PM on December 6, 2013 [1 favorite]


When we were smokers, everythnig wrong with us was due to our smoking. Then we quit smoking and got fat and now everything is due to our obesity. Five thousand studies come out condemning fat in every form as a prime case of early mortality, then one study comes out that claims obesity isn't absolutely deadly after all and all hell breaks loose. Of course it does - sinners die young, you know, whether from smoking or eating to much or taking too many pain pills or smoking marijuana - only alcohol is free from the sinner's penalty.

Throw your stones, you sanctimonius fruitcakes - you need to spend some actual time in the care of the dying before you pass such judgements.

A wonderful man died today. He was SO thin, a skeleton with skin and big, blue eyes - and a gentle, kind manner. Up until a few months ago when they realized he was very ill, he was SO proud of his low cholesterol, so proud of the fact that he ate healthy and took care of himself. He's dead now, but he didn't die without suffering horrible open sores on his body where his bones came through his skin because there wasn't any meat or fat to prevent it. He was 54; is that "premature" mortality? Oh, and in anticipation of the inevitable - no he never smoked. He did, however, end up addicted to pain pills.

It's below zero outdoors this evening. The skinny people in my building are unable to walk, with a coat, from the front door to the mailbox on the street without turning into shivering, shaking bodies, but those of us with blubber find the cold "bracing" and chilly, but not frightening.

As for the word "healthy" - what does that term even mean? How about mental health - does that count at all? If I had to guess, I'd have to say I'd find the overweight Mama flying through Wal-Mart looking for Christmas presents, laughing with her kids and husband, as more mentally healthy than the skinny person who's glaring at the fat lady, picturing money coming out of her own pocketbook to support the health care of that horrible, obese woman.

Health is a stupid word that means nothing. My paleo granddaughter thinks bacon is healthier than whole-grain bread, my store is warning about possible Salmonella contamination in packages of (healthy) lettuce and cantaloupe, and my son still smokes. My goddaughter has colon cancer and she's getting thinner and my friend with metastasized ovarian cancer is still heavy but has lost the brightness in her eyes and the joy in her heart.

Healthiest of all, I think, would be for the judging to stop and the caring begin.
posted by aryma at 6:32 PM on December 6, 2013 [10 favorites]


I heard about this on an NPR program and - when pressed - the researcher said that they found that although everyone in the study was in the normal range for blood pressure, cholesterol, etc, the obese subject had higher average numbers than the normal weight people. So, those with higher blood pressure / cholesterol had more heart disease than those with lower numbers, though everyone was in the normal range.

I'd love to see what happens to the data if they controlled for that. Does an obese group with EQUAL numbers to a normal weight group still have a higher risk of death? Or is it just that the obese group had worse numbers, and worse number that are still normal lead to higher rates of death?

My guess is that if you controlled for numbers, so averages between the normal weight and obese populations were equal, you wouldn't find differences in mortality rates.
posted by insectosaurus at 7:09 PM on December 6, 2013 [1 favorite]


So getting someone slowing down in their car when I'm out walking, rolling down the window, and yelling "WHAT THE FUCK IS WRONG WITH YOU FAT FUCKER"...

When I got fitter it simply changed to people rolling down the window and calling me a fag….

Let me repeat that a little: He called me a fat whore and demanded I get some exercise...


Wow, that sucks. You people need to think about moving.

There’s a local park where lots of people exercise, hundreds, climbing and walking. At any given time your going to be with incredibly fit super humans, lots of average people, and many obese, even very obese people, working their asses off. I’m always going to see at least half a dozen people over 300 lbs kicking ass, sweating and wheezing, climbing the hill (which is fucking Hard At Every Size).

There’s a good amount of joking and encouragement among strangers, but I’ve never heard anyone say anything even slightly negative to anyone. I can’t even imagine it happening.
posted by bongo_x at 8:08 PM on December 6, 2013 [3 favorites]


Science is science. Experiments are designed and run and results are reported. Unless it is about the quality of the experiment itself, there is nothing to blame science for. Don't scientists have absolute freedom to do good science and report their findings to the academia and public, simply and honestly, even if the findings are things like there is a higher crime rate among black people (in this particular study), male homosexuals are at the highest risk of contracting HIV (in this particular study), or there are health risks with being obese (in this particular study)? There is nothing wrong with asking questions, endeavoring to find answers, and sharing the results in a truthful, unbiased, or, scientific, manner.

And it really is perfectly fine to leave a fact as a fact. There is no requirement to take it and start forming all sorts of bias, opinion, judgments, and inference without a good reason and supporting materials to do so. A group of researchers did an experiment, and they got certain results. That's it. There really isn't anything to say on being "right" or "wrong" or "better" or "worse" on that..
posted by eisenl at 8:08 PM on December 6, 2013 [3 favorites]


I came in to make the same point as escabeche - the numbers from this study tell a very different story from what the reporting says. Look at the odds ratios. They find a large increase in the likelihood of an adverse event - meaning a factor of 2-3 - among people categorized as metabolically unhealthy, no matter what they weigh. On the other hand, being obese but metabolically healthy was associated with a modest increase in the likelihood of an adverse event, around 1.25. In other words, if you believe the study, it's much, much worse to be thin and metabolically unhealthy than to be obese and metabolically healthy.

I interpret this as giving strong support to the ideas behind healthy at every size. Focusing on metabolic health rather than weight should give much more bang for the buck. If the results are correct then weight loss also has some benefit for obese people, but the effect of improved metabolic health is vastly larger. This would suggest that a public health focus on metabolic health would have more benefit than a focus on weight.
posted by medusa at 9:42 PM on December 6, 2013 [11 favorites]


The data really do show that many people who lose weight go into "starvation mode" with concomitant radical changes in their hormonal profiles and neurobiological responsiveness, and that a formerly 300 pound person who drops to 200 pounds will need to eat far fewer calories to maintain 200 pounds than someone who has been 200 pounds for the past 10 years.

Indeed. And this is what should lead to a massive focus on anti-obesity childhood campaigns, so that people don't end up at the 300lb stage to begin with (hell, 200lbs is high for any non-athlete). But even anti-obesity campaigns for children get subject to intense criticism by some people.

Fat shouldn't be seen as a moral failing by an individual, but on a national level, especially in countries with universal health care, it is a public issue that requires addresing, for the same reason that smoking is. As an aside, i am dismayed by the drift in this thread towards rejecting scientific evidence the moment in conflates with your own prejudices and beliefs, and I lump those who have done it here in with the climate change deniers who do the same. Yes, you might have an anecdote of your obese friend who lived to 90, just as there are smokers who do the same (and anecdotes of very cold days in places otherwise subject to global warming).

I will try and teach my kids to eat healthy and exercise regularly for the same reasons that I will try and teach them not to smoke. Maybe I will fail, but i would be remiss if I didn't even try. And that effort and desire for them to stay slim and to stay a non-smoker is not a moral judgment on my friends who are overweight or who smoke, but it is a recognition of the very real health risks that accompany those decisions to start smoking or to make unhealthy eating/exercise choices at a young age.
posted by modernnomad at 1:54 AM on December 7, 2013 [3 favorites]


I don't think anyone is denying that health risks are associated with various BMI categories. But there are critical questions to be asked about those risks - What is the magnitude of risk? What is the distribution of the risk (for instance, does risk increase linearly with increasing body weight?) What are the underlying causes of the risk? Are there social and cultural factors, such as stigma affecting socioeconomic status and access to appropriate health care, in addition to the physiological and biochemical ones? And, finally, what can we practically do about the risk? Does weight loss change a person from high-risk to low-risk status for the long-term? Those are questions worth asking.
posted by Ouisch at 11:37 AM on December 7, 2013 [2 favorites]


Seriously, fuck everything. You cannot ever win.

My doctor says my RD is wrong because she wants me to eat more frequently. (I have a terrible habit of forgetting to eat. I typically eat fewer calories in a day than I should. Naturally he hasn't studied my scrupulously honest food diaries the way she has).

My doctor says my new trainer (who I specifically hired to help me lift way heavier than before) is wrong, and his workout routines are inadequate. Only cardio! Do nothing but cardio! (Never mind I can do 20+ miles on my 50+ lb military bike three speed, no problem...but I like lifting, and if it gets me into the gym all winter long, so be it).

My doctor doesn't think my wacky bloodwork is "that bad" despite my tracking a pattern of the oddities getting worse. I'm just fat. That's all I am. I should note he's actually one of the better doctors I've ever had so you can imagine the others...

I can make all the effort in the world to eat better, to work out, to do what I'm "supposed" to and I will still never be good enough. Even at my thinnest, as a competitive athlete in high school, I was overweight by BMI standards. This is the shit that keeps overweight people from even wanting to TRY. None of the professionals you ask for help will ever agree about anything. And meanwhile, here I am just slogging through trying to do SOMETHING and getting chewed out for it. It's fucking depressing.

I really need to stop reading these threads because they make me crazy.
posted by bitter-girl.com at 1:03 PM on December 8, 2013 [1 favorite]


This is the shit that keeps overweight people from even wanting to TRY.

The cynic would suggest, "the system is working exactly as designed."
posted by mikelieman at 1:58 PM on December 8, 2013 [2 favorites]


I'm going to pick on your comments, modernnomad, and it's nothing against you personally but they illustrate for me this strange dynamic.

But even anti-obesity campaigns for children get subject to intense criticism by some people.

Fat shouldn't be seen as a moral failing by an individual, but on a national level, especially in countries with universal health care, it is a public issue that requires addresing...


So I go to take a look at the "intense criticism" link to see what sorts of delusional monsters oppose attempts to discourage obesity in children and this is the sort of thing I read:

But they also have outraged parents, activists and academics who feel the result is more stigma for an already beleaguered group of children.

"Stigma is not an effective motivator," said Rebecca Puhl, a Yale University psychologist who is an expert on weight discrimination. "Whether children or adults, if they are teased or stigmatized, they're much more likely to engage in unhealthy eating and avoidance of physical activity."

Linda Bacon, a nutrition professor at City College of San Francisco... said the focus by "Let's Move" on BMI was of dubious medical value and posed potential problems for kids at all weight levels.


What I'm reading in that article are people objecting not to efforts to curb childhood obesity but rationally discussing the effectiveness of specific methods in specific campaigns. One of the key objections is the point that you yourself highlight: the issue of stigmatizing obesity as a moral failing. Because that is what a giant billboard of a sad fat kid that basically says "look at this pathetic fat kid. Look at what you did" is doing.

I guess I feel like critics of fat acceptance often throw out disclaimers about not denigrating or shaming fat people as a sort of aside, yes of course we don't want to just shit on people because they're fat BUT (and it's always about the but) OBVIOUSLY they choose to be this way and they're sunk in denial because they're pretending it's okay.

But I think many people - especially people who don't personally really struggle with weight - largely dismiss how harmful and most of all how counter-productive stigmatization, denigration and outright mockery are for fat people. That it is a serious, prevalent, substantial part of the overall problem of obesity. So, you know, hell yes if your anti-child-obesity campaign is shading into "behavior modification through shaming" territory you should expect some "intense criticism".

Again, criticizing a focus on tracking individuals' BMI as a component of preventing obesity is a perfectly reasonable thing to do. You can certainly rationally argue well yes it is helpful or not it isn't in this or that context without it being painted as some effort to derail the fight against childhood obesity.

Likewise: i am dismayed by the drift in this thread towards rejecting scientific evidence the moment in conflates with your own prejudices and beliefs

I would like to know what exactly you're pointing the finger at here, because by far what I'm reading in this thread are people offering rationally argued objections to the idea that the basic conclusions of the cited research are best and most usefully and completely summarized as "being healthy and obese is a myth".

Questioning why this assertion is the universal journalistic take-home point of research that equally asserts that metabolic disease is the more substantial risk factor for cardiac events and overall mortality across all weight groups is not denying science.

Arguing that there is may be more to be gained in trying to motivate people to seek more positive health outcomes by whatever means rather than focusing on loss of weight a the primary (and often sole) goal is not denying science, and in fact the conclusions of this study are completely in line with this argument. The fact that a relatively skinny person who eats like shit and has terrible cholesterol numbers is very much not off the hook for increased mortality is every bit as much a reasonable take-home conclusion from this research and yet you will not see this point highlighted in any of the copious media presentations of this research. The universal headline is "healthy obesity is a myth".

An assertion that seems to have some serious research back-up that it is extremely rare for obese individuals to succeed in attaining sustained weight loss through modifying their diet and lifestyles. I don't know if there is really much good evidence that it is easier to prevent obesity in susceptible individuals than it is to correct it after the fact, as people (including yourself and docpops above) commonly assert in these discussions: I'd like to see it if there is because I haven't personally encountered it.

When you see obesity on the rise worldwide and see it rising more prominently in specific nations it seems to me pretty obvious to me that the likely explanation is that you're seeing a societal phenomenon that requires a societal solution if it's going to find any solution at all. The issue of whether trying to rhetorically motivate people to make different personal diet and lifestyle decisions is going to be an effective societal solution for obesity is an issue we absolutely should be debating and arguing about because as far as I can see it is almost exclusively where resources are being placed in this issue and there doesn't seem to be any particular evidence in support of it. I think it is very worth questioning whether the primary motivation for preferencing these sorts of "solutions" is that they are cheap, do not obstruct commerce in any significant way and ultimately lay all the blame flatly on the doorstep of the obese.

While they are certainly not perfect and dodgy science comprehension is endemic at all levels of the popular discourse, the value I see in fat acceptance and health at any size type communities is that they are often the only people in the discussion attempting to pragmatically engage the very large, murky gray areas of these thorny questions at all. They are saying "personally motivated weight-loss strategies don't seem to work very well at all, we need to focus on improving health by whatever means necessary, and we need to attack stigmatizing and shaming because they are harmful and have no benefit". These are valid arguments and they deserve better than to be hand-waved off as science denial.
posted by nanojath at 10:12 AM on December 9, 2013 [4 favorites]


but I’ve never heard anyone say anything even slightly negative to anyone. I can’t even imagine it happening.

That's the beautiful part. You don't have to imagine it! Somebody else experienced it and is here to report it to you!!!

It's great that you've never experienced this. It's great that (I'm guessing) you've never done this to anyone else. Thank you, and thank you for continuing this course of action.
posted by disconnect at 1:44 PM on December 9, 2013 [3 favorites]


It's great that you've never experienced this.

You really should work on your reading comprehension.
posted by bongo_x at 10:13 PM on December 9, 2013 [2 favorites]


It's really not helpful to tell people to move when they discuss harassment.
posted by sweetkid at 6:04 AM on December 10, 2013 [2 favorites]


It's really not helpful to tell people to move when they discuss harassment.

Why not? The only time I have ever been harassed for walking on the side of the road is in Kamloops BC (I was working on a project there for a short time in the 90's).

Because of that I would never consider living in Kamloops (I've been back many times since then, and it's not a bad place, but still...)

As some internet sage once said, “Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes.”
posted by KokuRyu at 2:33 PM on December 11, 2013 [1 favorite]



It's really not helpful to tell people to move when they discuss harassment

Why not?



Because not everyone CAN move, and because talking about harassment is a common and important way to process it. Usually when people say "just move" it's because they haven't had experience with harassment themselves either ever or recently, but for people who are harassed they know it's a common enough experience that "just moving" isn't going to do anything.

Overweight people are harassed often and in many places. It's nice that one person lives near a park where people don't say anything, but plenty of people in this thread are reporting counter experiences, and it's not helpful to just say it's their fault for living in a "bad place."
posted by sweetkid at 3:11 PM on December 11, 2013 [2 favorites]


I don't think anyone is saying "it's their fault" for living in the wrong place (or anyone is seriously suggesting the answer to obesity is moving).

In regards to fat shaming, what is the solution in the short term?

I lived in a society for about a decade where having a BMI of from 25 to 30 (ie, thinner than most people in North America) was considered "fat", and people would let you know it, either through remarks or even grabbing you!
posted by KokuRyu at 4:36 PM on December 11, 2013 [1 favorite]


Because it comes off as dismissive, and casually places the onus of dealing with the problem (even hypothetically) on the person experiencing harassment, instead of on the people causing the problem. It's insensitive.
posted by Ouisch at 1:25 PM on December 14, 2013 [1 favorite]


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