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Being mildly overweight/underweight is good/bad for you
November 7, 2007 4:21 AM   Subscribe

In this week’s medical research update, being mildly overweight might not be so bad for you. According to one summary, “overweight people have a lower death rate because they are much less likely to die from a grab bag of diseases that includes Alzheimer’s and Parkinson’s, infections and lung disease. And that lower risk is not counteracted by increased risks of dying from any other disease, including cancer, diabetes or heart disease.” And so what is meant by “overweight” needs to be reconsidered. But last week’s bulletin, discussed here, suggested that longer life spans are associated with lower weights, and the primary recommendation was to “Be as lean as possible without becoming underweight.” Allright: Epidemiological studies are hard to interpret and some people question the science. Newspapers are oriented to breaking news and treat medical reports as such, relying on he said/she said quotes from experts instead of providing integrative analysis. So who exactly is going to put together the pieces? What about NIH, your tax dollar at work? Or some blogs?
posted by cogneuro (52 comments total) 4 users marked this as a favorite

 
So is eating an entire bag of Milano cookies at one sitting "mildly overweight?" Just curious, you understand.
posted by maxwelton at 4:25 AM on November 7, 2007


So, it's a mildly overweight world after all?
posted by flapjax at midnite at 4:37 AM on November 7, 2007 [2 favorites]


So where is the line drawn between "mildly overweight" and "cancer causing overweight" again?
posted by CitrusFreak12 at 4:52 AM on November 7, 2007


You're considered obese when you are more than 15% over your target weight, I believe, but that always seemed like a low bar to me. A woman who is supposed to weigh 100 will be obese at 115?

I don't think there are hard and fast rules for this kind of thing. It's best to work out your personal weight parameters with your doctor.
posted by orange swan at 4:59 AM on November 7, 2007


The problem with the word "overweight" is that in general speech it means fat, but in BMI terms it just means you are over the ideal wieght for the population of people that has the same height as you, and are likely not to be considered "fat." They need to rename the BMI terms. "Normal" should be renamed "least risk," "Overweight" should be something like, "Slight risk, overweight," "Obese" should be "high risk, overweight" and "underweight" should be "high risk, underweight".
posted by afu at 5:08 AM on November 7, 2007


afu: except according to the new studies "overweight" should be "least risk" and "normal" should be "normal, slight risk"

I actually made this claim in a thread a while back and someone asked me for a "cite", so I had to dig up references.

One of the arguments made is that the people who claim skinny is best work at Harvard, and are sort of at the top of their profession. They lambasted the work saying overweight people were healthier, saying it was crap and a lot of people thought they were just biased and wanted to protect their work.

The Harvard people had done studies of people in the medical community and they determined that for nurses being thin was best. But this person did studies of the general population, and found that those people had a slightly elevated risk.

Now personally, I think many of those thing people were thin because they smoked, or maybe worked too hard and didn't eat enough (or they could be anorexic) or something like that.

I bet that if you expanded the field from nurses to all people who consider themselves health conscious, don't smoke, etc you'd find that thin people are healthier, but that's just a guess. Or if you just looked at upper middle class people, maybe.

In other words, for people who actually care about these studies, being thin would probably be better.

But who knows.
posted by delmoi at 5:24 AM on November 7, 2007


On "putting together the pieces" - I have long given up on the popular press to put together pieces from science that is generally so fragmented that the scientists doing the work can't put together the pieces. Nearly all research is modular and this is no exception.

There is no coherent picture available that is not being reported in the popular press and there are certainly no health recommendations here about becoming mildly overweight if you are not.
posted by bluesky43 at 6:00 AM on November 7, 2007


Overweight people should be less likely to die in sporting accidents.
posted by StickyCarpet at 6:18 AM on November 7, 2007


Weight IMO is moral - the world is operating at over-capacity, we need something like 2.5 earths to sustain the current worlds needs. Most of the resources are being used by individuals in countries like America. If you live your life in a sustainable manner weight will take care of itself. It forces you to be more active and eat higher quality and less amounts. It doesn't mean starve just to be skinny so you don't feel guilty, all that does is lead to more gluttony.
posted by stbalbach at 6:22 AM on November 7, 2007


The main criticism of using BMI as a health indicator is that it fails to take into account above average muscle mass. Could mildly overweight just mean people who work out?
posted by ShadowCrash at 6:24 AM on November 7, 2007


Rubens - good.
Botero - bad.
posted by dances_with_sneetches at 6:34 AM on November 7, 2007 [2 favorites]


ShadowCrash: "The main criticism of using BMI as a health indicator is that it fails to take into account above average muscle mass. Could mildly overweight just mean people who work out?"

"I'm not (mildly) overweight, I just work out."

It seems to me that the ultimate goal would be sensible moderation, healthy eating, etc... If you're a few pounds over or under, it's not going to hurt you. I think our "target weights" are a bit ridiculous. I've been of the mind that a little extra weight won't hurt (and like this seems to indicate, may help), but just don't go overboard. That said, I'm obese, so what do I know?
posted by symbioid at 6:39 AM on November 7, 2007


Eating to make weight sure beats the reverse of jogging in a sauna suit to make weight.
posted by caddis at 6:45 AM on November 7, 2007


Ruben sammich -- good.

Monte Cristo sammich -- good, too.
posted by ericb at 6:48 AM on November 7, 2007


i was surprised when an actuarial chart showed i would have a longer life if i weighed more. but a lot of people are thin because they are sick which is going to skew the average.
posted by bhnyc at 7:04 AM on November 7, 2007


Monte Cristo sammich -- good, too.

Am I the only one who read this as "Monte Crisco"?
posted by Blazecock Pileon at 7:08 AM on November 7, 2007 [1 favorite]


Weightloss precedes age-related dementia/Alzheimer's by about ten years because people lose their sense of smell as the disease develops and don't want to eat. I just heard this this A.M. on "Health in a Heartbeat." So the disease causes the weightloss not the other way around. Being skinny is probably correlated with being about to die because the conditions that kill people also reduce people's appetites or make it hard for them to get/prepare/digest food. Probably being gigantic is correlated with being about to die for the same reason: the flab is an offshoot of the disorder that is killing the person. Being skinny does not cause death, being fat does not cause death, diseases cause death. Diseases cause skinniness, fatness and death.
posted by Don Pepino at 7:14 AM on November 7, 2007 [1 favorite]


Where the skinny dead people always skinny, or did they lose weight as part of their illness (or as a side effect of their treatment)? As bhynyc points out, that's an extremely important question. Lots of chemo patients suffer from a loss of appetite and energy levels, so if they lose the battle, they're more likely to be considered underweight. That doesn't mean being underweight had anything to do with them dying.

A 6' tall man weighing 185 would be considered slightly overweight, but he could also just be in really great shape from working out. It wouldn't surprise me if this category had the lowest risk, because it's a mix of slightly overweight and extremely healthy individuals.

Unless the above scenarios are accounted for, the study can't be used to determine if being overweight due to higher body fat is beneficial, or if being underweight is actually detrimental.
posted by ShadowCrash at 7:18 AM on November 7, 2007


Doh... Were, not Where. Or what Don Pepino alluded to.
posted by ShadowCrash at 7:20 AM on November 7, 2007


I was wondering when we could pick up the debate again.
posted by docpops at 7:34 AM on November 7, 2007


Being 'overweight' isn't bad. Being fat is bad. If your stomach is fat that makes you less healthy. Having a few extra pounds is almost always bad because you don't refer to the pounds that make your legs powerful or the pounds that make your arms strong as extra. What makes pounds extra is that they are pounds of fat. Seek to be lean and well muscled. Or better yet seek to be active and to eat mostly fresh vegetables.
posted by I Foody at 7:36 AM on November 7, 2007


> The main criticism of using BMI as a health indicator is that it fails to take into account above average muscle mass. Could mildly overweight just mean people who work out?

Muscle mass and low fat percentage doesn't necessarily equate health either. I recall a discussion on a bike mailing list pointing out that former elite pro cyclists tend to have shorter lifespans than former domestic racers. The hypothesis is that sustained extreme exertion wears out your body faster, even if you don't suffer the consequences for a couple decades.
posted by ardgedee at 7:36 AM on November 7, 2007


My BMI is on the cusp of "normal" and "overweight". I have finally located some moist, delicious cake. (Don't ask me what I went through to get it.) Do I eat the cake?
posted by maudlin at 7:43 AM on November 7, 2007


I'm just going to stop eating altogether until we figure this out for good.

Somebody drop me a line when that happens, OK?
posted by krinklyfig at 7:43 AM on November 7, 2007


Somebody wake me when we have discovered the ideal dirt/fat ratio for healthy living.
posted by kuujjuarapik at 7:50 AM on November 7, 2007


Here's the hint:
The media likes to run fattie stories because it increases readership (everyone likes to read stories about either schaudenfreude (against scientists or fatties) or that affirms aspects of life stuff in their favor). At this point, we cannot trust the journalists to do their homework (i.e. do sufficient fact checking).

My advice: Do your own homework if you absolutely must know what's going on with this "newest study"/"newest findings". This means tracking down the actual study and learning to read medical studies not only for what they say but what their baseline assumptions are, whether they seem biased, and who funded them and what their funding sources' biases/agendas are.

If you don't have time to do all that work and research, go find someone you can trust to do the same kind of analysis sanely. There are folks in the blogosphere/media who are trustworthy. I've already said that Junkfood Science is one I rely on, but don't take my word for it. At least do that much homework and find an analyst/advisor you think you can trust to be ethical in a way that's compatible with your system of ethics.
posted by kalessin at 7:55 AM on November 7, 2007 [1 favorite]


The main criticism of using BMI as a health indicator is that it fails to take into account above average muscle mass

Give me a break. For 95% of people who are classified as obese, especially in America, their BMI is not high from being too muscular. This argument is generally used as a cop-out from overweight people who don't want to admit that they're fat.

If you really have great muscle mass, and you work out a lot, then common sense tells you that you don't have to worry about obesity.
posted by chrisamiller at 7:56 AM on November 7, 2007


I always run across these new studies on the BBC news site. I think if somebody will take the time to delve into the mystery, we will eventually find that they all come from the same tireless and gifted researcher: Sybil Fawlty from Torquay, special subject the bleeding obvious. Sybil has a lot to tell us about body weight and health:
* People who've always been rail thin or big boned and who have always been otherwise healthy and who are still healthy are healthy.
*People who've always been ill and skinny or fat and who are still ill are ill.
*People who suddenly balloon up or shrink to a nubbin must either be taking in more/fewer calories than they were or burning more/fewer off. Their change in weight might be for a reason unrelated to their health or it might be because they've been well and gotten sick or because they've been sick and gotten well.
posted by Don Pepino at 7:57 AM on November 7, 2007


I thought the release of these two contradictory "big" studies in within a short time frame was so classic, and brought home the problem with how this kind of research is presented (by the researchers) and reported. Maybe there's no coherent picture to be had yet, and certainly newspapers aren't going to sift the pieces. The researchers have their own axes to grind, so I ask, what are the forums for doing the critical analysis and integration, and who is motivated to pursue them?
posted by cogneuro at 7:58 AM on November 7, 2007


Despite the intent of this picture, what I thought was, "The unicorn's sexier."
posted by Wolfdog at 8:17 AM on November 7, 2007


Real conversation with an actual physician:

L. Mustachio: I'm overweight. (BMI 26.5)
Actual Physician: Pffft. *rolls eyes*


I'll take that as being the consensus of the entire medical community until I get a better answer.
posted by louche mustachio at 8:26 AM on November 7, 2007


I think HURF that this is a DURF contentious issue that BUDDER probably isn't best discussed on EATER metafilter.
posted by koeselitz at 8:57 AM on November 7, 2007


Also, does anybody else hear the snarling voice of Johnny Rotten whenever they read about "BMI"?
posted by koeselitz at 8:58 AM on November 7, 2007 [2 favorites]


This just in: Intelligentsia Scorn Crystal Ball, Believe in Bathroom Scale
posted by zennie at 9:21 AM on November 7, 2007


Since when is my weight a moral issue? If I have a potbelly, it might be unflattering, or unhealthy, but is it immoral? For that information, I'm 5'7", 195 lbs, I run a decent mile and half and still work out regularly. I'm barrel chested, but I also look stocky. I am stocky. And it's okay, as I look forward to being 45, with a great beard and a great rotundity while I hold a mug of bear and a mutton leg as I laugh a full-bodied laughter. I look forward to that you know.

I can take the ugly and (sometimes) the unhealthy, but immoral?
posted by Lord Chancellor at 9:47 AM on November 7, 2007


chrisamiller,
My point wasn't about being obese. The study in the fpp could be interpreted that being slightly overweight is the healthiest lifestyle choice. I was trying to point out that this finding might be skewed b/c of how bmi fails for the extremely fit. Being above your 'ideal' weight b/c of extra muscle mass is completely different than being above your 'ideal' weight due to flab.

ardgedee,
It could be your theory, or maybe the high rate of drop use/blood doping is the problem.
posted by ShadowCrash at 9:49 AM on November 7, 2007


I hate stories like this. Not only is it not trustworthy, but I find it very hard to believe that many people think of themselves as "obese." "I'm carrying a few extra pounds." "I'm a little bit overweight," and the like, are much more likely. So everyone places themselves in the safe zone and ignores it.
posted by agregoli at 10:09 AM on November 7, 2007


If you live to 80 THEN pack on the weight.
posted by tkchrist at 10:15 AM on November 7, 2007


I thought in the last post people decided to ignore the science and just use common sense.
posted by salvia at 10:23 AM on November 7, 2007


While I agree with the bulk of kallesin's comment, it's worth noting that 1) Sandy Szwarc @ that blog appears to overstate her conclusions at times, writing beyond her expertise about some pretty serious issues, and 2) she's at least associated (and perhaps paid) by an industry-funded "consumer choice" group.
posted by OmieWise at 10:34 AM on November 7, 2007


I'm not fat, I'm just deviated from the mean.
posted by blue_beetle at 10:41 AM on November 7, 2007


OmieWise,

That's why in the bulk of my comments, I said that you should find your own advisors that you think you can trust.
posted by kalessin at 11:27 AM on November 7, 2007


And that's why I agreed with that bulk. ;)
posted by OmieWise at 11:55 AM on November 7, 2007


Well, according to this calculator, I can be a moral person who is not abusing the planet (and a unicorn!) if I eat 1288 calories a day (plus or minus 100 calories or so, to account for daily activity). Of course, as I age, my BMR will decrease, so by the time I'm in my 70's I'll need to consume 1,000 calories a day.

Or, I can be a wastful, gluttonous slob who is doomed to die a lonely, sad death -- not to mention a rhino! -- if I eat 1483 calories a day.
posted by jrochest at 3:41 PM on November 7, 2007


I completely agree that you need to read these journal papers yourself and not rely on the interpretations of others. I also want to echo a note of caution with regards to the "Junkfood Science" blog, in that it appears (at leas to my eye) to be a bit angled towards a particular bias.

In one article: adults today are more active, etc., she claims that we are more active today than before, and that this is causing an increase in joint damage. She then goes on to discuss total knee and hip replacement and osteoarthritis.

It is by no means clear that running and osteoarthritis are clearly linked. (Studies have gone one way or the other, with most of them leaning towards no link for moderate exercise.) In fact, as far as I recall, one of the main factors which is correlated with osteoarthritis is obesity. The other big one is previous knee injury.

Hence, while it is possible that exercising to excess will cause osteoarthritis (questionable) or knee injury leading to osteoarthritis (more likely), it is, perhaps, far more likely that obesity will also lead to osteoarthritis. Given the recent increase in obesity rates, it seems a little odd to try to place to recent blame for osteoarthritis rates squarely on the shoulders of 'everybody is exercising too hard'
posted by Comrade_robot at 3:59 PM on November 7, 2007


Oh yeah, and in keeping with the check it out yourself, don't take my word for it, do a pubmed search or something.
posted by Comrade_robot at 3:59 PM on November 7, 2007


great news!

goes to lay head down on a pillow of suzi-q's
posted by CitizenD at 10:47 PM on November 7, 2007


In fact, as far as I recall, one of the main factors which is correlated with osteoarthritis is obesity.

Which is interesting, because from the physics perspective, being fat increases your weight-bearing activities' improvement of your changes against osteoporosis (another bone-related disorder). Assuming you do enough activities for the difference to be noticed, which is silly unless you have a clone anyway, who shares your overall lifestyle.

I think the important thing to remember is that most ethical scientists, unless they can demonstrate causality through some actual biological/biochemical/genetic/phenotypical (i.e. via the well-characterized, well understood - what there is of it - machinery that makes up our bodies), try to stay away from asserting causality based on correlation observed via statistical analysis.

Generally if you find assertions of causality based on statistical analysis, you've entered into the realm of the freely-reinterpreted press release, and have left the hallowed halls of careful scientific research.

I think that the amount of statistical analysis that paints itself as "real science" that is about the interrelated topics of body size, health, fitness, eating and various methods of gaining fitness (and which many people, myself not included, tie directly to losing weight - and which is probably one of the reasons I don't find Szwarc's obvious biases bothersome) in this day and age is quite, quite telling. There are many would-be expertswho justify their "expertise" with statistics when I would expect them to be doing so with demonstrable causalities instead.
posted by kalessin at 7:57 AM on November 8, 2007


Welll...

While being fat no doubt may increase your bone density (bone responds to loading by remodeling -- increasing its density), fat is by no means the only way of doing this. If I recall correctly, for example, bone density increases were also found in a study in which children jumped from a box, and in studies of female athletes who preformed high impact activities. As another example, years ago, Dennis Carter, at Stanford, patented a machine for increasing the strength of bone through repeated impact loading.

I would actually disagree that ethical scientists need to stay away from statistical analysis. Just to take osteoarthritis again -- osteoarthritis is a poorly understood disease. We know what happens (normally, your knee cartilage holds on to a bunch of water, which your body weight rests on. In OA, it doesn't hold on to it as well, which leads to degradation of the cartilage, which eventually leads to a lot of pain), but we do not know why it happens. Part of the reason for this is that it is a disease with a slow progression and an unclear beginning point -- by the time you go into the doctor's office complaining about knee pain, you have already had it for quite some time.

What information do we have, then? Well, we know that people who have suffered previous knee injury tend to later develop osteoarthritis. We know that obese people tend to develop osteoarthritis. These are facts which aren't really pointed at body size and fitness (I have seen older studies which also claim correlation between jackhammer use and osteoarthritis, and between long distance truck driving and osteoarthritis). Some people say that it's due to running, but most people find no clear link. There may be a genetic component. Asian people seem to get less OA. You can make knockout mice which develop OA.

This is certainly valuable information, and might help us understand why osteoarthritis occurs. Given the role of articular cartilage, it is not unreasonable to hypothesize that loading plays a role in OA. Given that forces through the knee are proportional to body weight (generally, forces in the knee, even in walking, are many times body weight), it is not unreasonable that obesity might result in increased knee loading which might lead to higher incidences of OA. We can then investigate this, and look for a pathway. But that's not easy.
posted by Comrade_robot at 10:49 AM on November 8, 2007


Related Links:
The Case Against Weight-Loss Dieting - second graph shows optimum BMI is 30-35 in studied group.
4-year Mortality Risk Calculation - which shows increased risk of mortality if BMI<25, and showed no increase for extreme values of BMI that were not accounted for by other variables (p.802)
posted by mediaddict at 2:38 PM on November 8, 2007


Statistics have their place in science, please don't mistake me for saying they don't, Comrade_robot.

I don't think that place is in synthesizing new results from studies involving cherry-picked results and from asserting causality where none can be applied, which is what I see happening a lot lately, especially about topics such as fatness, fitness, risks for certain kinds and classes of mortality, and the like.

It's worse when the survey study scientists clearly have agendas of their own that actually override the study results when talking with press, which also appears to be happening these days. Perhaps it has something to do with the prevalence of the diet and fitness industries as sources of funding for these survey studies?
posted by kalessin at 9:19 AM on November 9, 2007


While I agree that the popular media tends to take results from a scientific study and run wild with them, I think you over-exaggerate a 'bias' on the part of scientists. Most scientific studies of this nature, to my knowledge, are funded through the NSF or NIH, not the 'diet and fitness' industry.

Certainly I would not take the position that Junkfood Science's bias is just balancing out any bias on the side of the scientists. While many of the topics covered there are not my field of research, those that I am familiar with are covered in a very skewed manner. (The OA article is particularly disturbing.)

If we know OA is correlated with obesity and knee injury, and we say that people of today are getting more replacement knees (generally people get replacement knees because the cartilage inside has become 'worn out' due to OA), the logical conclusion is not that people of today are exercising too much, especially given that we know that people of today are weighing more and more. The linked article, in fact, mentions:

People who are obese or overweight make up the largest portion of patients requiring joint replacement. In 2004-05, according to the national report, nine out of every 10 knee-replacement patients were either overweight or obese, compared to nearly eight out of 10 hip-replacement patients.

Certainly my health insurance company, which has motivation to spend as little money on my health as possible is constantly encouraging me to exercise.
posted by Comrade_robot at 5:20 PM on November 10, 2007


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