Overweight people live longer

My observations:

1) there is a difference between "old fat" and "young fat"--even if older people have a low BMI, they often have less muscle mass and more fat as a proportion, also they tend to have lower bone density

2) I think a distinction needs to be made between men and women, I think that women can carry more fat into old age than can men, and that generally "fatter", but not "obese", older women live productively longer lives

3) BMI is complete bullcrap

4) I don't care AT ALL about my BMI or how "fat" or "thin" I am--I do what I do because I enjoy doing it, and doing it has landed me in great shape as a byproduct.

A big problem with these studies is the fact that it is difficult to control for other things that may influence BMI. A big one is cancer-- one of the first things that can occur is weight loss. As a physician, nothing sets off red flags more than a patient telling me he's lost 15 pounds without really trying. That screams serious illness, the only question is which one.

The real question, which is harder to answer, is: for a person without a serious underlying illness, is it better to try to maintain a BMI in the 20-25 range, or in the 25-30 range? The definitive study would be to enroll healthy people and randomly assign them to the different strategies-- but even then, there is the question of is it the things done to get to the weight, or the end wight itself that is driving any mortality effect.

Ultimately, for health, staying active, eating a varied diet, and not being obsessive about anything is probably best. But if athletic performance is important, then obviously that changes.

Link to the full JAMA article: http://jama.jamanetwork.com/article.aspx?articleid=1555137&atab=7#RESULTS

Yourpoint? wrote:

I'll still take my 155 lbs over 255 lbs any day. The fact that fat people could live longer simply means they'll smell gross longer and look like a slob longer. I fail to see any benefit to that.

This is an amazingly stupid perspective. 255lbs at most heights is obese, not overweight. You're manufacturing a false dichotomy: you at 155lbs may be healthier than you at 255lbs, but I would bet that you at 155lbs is *not* healthier than you at 200lbs.

Moreover, you wouldn't have the build of a prepubescent girl.

The study did show a very significant increase in morbitity for people who were very obese. So, there is definitely a point where too much weight becomes a killer.

What this study has really shown is that modern medicine has become very good at treating the health problems associated with obesity. So, the risk of death may not be there, but that doesn't mean that it is ok to pack on the pounds and run the risk for diabetes, heart disease, stroke, etc. just because doctors will be able to keep you alive.

dd--

"The real question, which is harder to answer, is: for a person without a serious underlying illness, is it better to try to maintain a BMI in the 20-25 range, or in the 25-30 range?"

I'm wondering why you believe that should be "the question".

What is "the issue", or "the interest" that is at stake here?

You can see by how your question is formulated that it is unanswerable, even with gold-standard double-blind randomized trials. "Better" according to what standard? You are of course aware of the many dimensions of "health", including emotional and spiritual, in addition to "physical".

And even with regard to "physical" health, what should that mean, since every human is physiologically distinct?

This all begs the basic question, "What is the goal"?

To reduce human life to a quality that is correlated to any single variable is IMHO a pathetic reductionist fallacy--all the more so when that variable is bogus, like BMI.

I do understand that public health policies need to be guided by some underlying "rationality", but the exigencies of public policy have little to no import to the consideration of the individual and his or her life. Public policy today is about the allocation of resources, and incorporates many different interests, including private commercial interests.

"The real issue" is the nature and extent of the interaction of the state with the individual--to what extent should individuals be free to do as they please, to what extent should the state support their efforts, and to what extent should the state proscribe their efforts?

The ONLY health care I have ever consumed since early childhood was a cast on a cracked ankle from HS sports, and an ACL reconstruction as an adult. I have never, ever gone for anything else, including all the injuries that come with hard athletic training. Should the state pay for my gym/track membership under the guise of preventive care? Should the state then pay for any injuries I sustain as a result? Is that "healthy", according to the state?

What is the basic goal of public health policy? I hate to say it, but in this rudderless era, the basic goal is to manage the public health accounts in such a manner that is favorable to the gaining or maintenance of political power, for its own sake. Any other effects on the public are only incidental.

Sure there are people at various levels who "care" about something other than political power, but these are people who work within the envelope of the articulated policy, with its shifting allegiances. Dairy is great for you, now it is bad for you, now it is good again, now it is bad again.

WTF does all that bullcrap add up to?

It means that you have to live your life as you see fit, and that hopefully you are sufficiently well-acculturated that you at least unconsciously consider the concerns of a larger society in which you live, in making your decisions.

I disagree that staying active, eating a varied diet, and not being obsessive are "best for health". Look at Chaim Soutine--a complete nutjob. Out of shape, poor nutrition, disease-ridden, and totally obsessive, creates fantastic art that contributes to the health of western civilization, not just in his own time, but down through history.

Glenn Gould. Healthy? Who cares? Did he live a life worth living? In my opinion, absolutely. I am in his debt.

I could go on ad infinitum.

Synopsis: BMI is bullcrap.

Um..... wrote:

This is an amazingly stupid perspective. 255lbs at most heights is obese, not overweight. You're manufacturing a false dichotomy: you at 155lbs may be healthier than you at 255lbs, but I would bet that you at 155lbs is *not* healthier than you at 200lbs.

Moreover, you wouldn't have the build of a prepubescent girl.

I'm thin but reasonably muscular at 5'10", 150. At 200 pounds, there's no way I wouldn't be a fatass. I know this because my dad, who's about the same height, is fat at 180.

A good rule for everyone to follow is that if a study does not pass the common sense smell test, it probably is not true. This study is a joke, and somebody just wasted a lot of the taxpayers money on this farce.

Wow, that's quite a screed.

Taking things a bit out of order, and perhaps missing a few of the more baffling parts of your post:

First, the "goal" of this study is not BMI-- and there are certainly problems with BMI, since body composition isn't taken into account, but for research purposes a marker that can be readily obtained from records has advantages. But in this case the outcome ("goal", if you will) was mortality; BMI was a variable that was assessed for associations with mortality.

Second-- most public health people are not trying "to manage the public health accounts in such a manner that is favorable to the gaining or maintenance of political power, for its own sake" (feeling a little paranoid, are we?) They're for the most part good people, studying issues they care about, and reporting things in a far more transparent way than any other area of public life. You have a quibble with their study? Read their protocol, decide what errors they've made, write a letter to the editor at JAMA, or contact them directly. The corresponding author has their email on the paper. I don't publish in this area, but my research is public-health related, and I can tell you I have no political power to maintain, so the goal of my research can't really be what you claim it is.

As to your remarkable virtue for having largely avoided the health care system-- good for you, but don't get too smug. You didn't do all of that through your remarkable prowess or wisdom-- you were lucky to not have been born with any number of diseases that are completely unrelated to lifestyle choices, and you've also managed to avoid the bad luck of getting hit by a car, shot, been assaulted, etc. Not to mention having been born in an era where the diseases that used to decimate children are largely preventable by vaccines, sanitation, and all the other evils of public health. The fact that one person can be healthy without a great deal of medical intervention is hardly a valid argument that public health policy is an unnecessary thing.

So WTF does all that bullcrap add up to-- it adds up to people surviving diseases that used to be fatal. It adds up to a better, but still far from perfect, understanding about how various things influence health-- however defined, and most good studies do define what they're studying, so you can decide if you think it's worth the effort. It adds up to you being able to have your ACL being reconstructed with a minimal chance of serious complications.

As for the guy who is terrible unhealthy but creates fantastic art (no idea who he is, I guess I'm too uncultured); I'm not sure how that's relevant. I never said that staying active and leading a varied diet was the recipe for the perfect life; I said it's probably best for health. And health is largely defined as living long, not needing medical intervention, and being physically able to do what you want. Not by the impact of one's art.

Same comment for Glenn Gould-- I wasn't saying this is what people should do to have "a life worth living", I was commenting on the relationship between activity, diet, and physical health-- Is that so hard to understand?

@ dd

i, for one, understand you perfectly well

your post is well-written and accurate

not sure why Sprintgeezer is so tee-ed off

Ghrelin wrote:

Um..... wrote:

This is an amazingly stupid perspective. 255lbs at most heights is obese, not overweight. You're manufacturing a false dichotomy: you at 155lbs may be healthier than you at 255lbs, but I would bet that you at 155lbs is *not* healthier than you at 200lbs.

Moreover, you wouldn't have the build of a prepubescent girl.

I'm thin but reasonably muscular at 5'10", 150. At 200 pounds, there's no way I wouldn't be a fatass. I know this because my dad, who's about the same height, is fat at 180.

You're not reasonably muscular at 5'10" 150lbs. If your body type is anything like your dad's, it's more telling that you're not reasonably muscular if your dad is fat at 180lbs.

My father was overweight and lived to 80. The people who died younger (50's, 60's) that I knew were long term smokers.

Or sometimes it was just a throw of the dice. Cancer....

Penis length is approximately one inch shorter for every 30 pounds overweight.

Are you sure the doctor didn't tell your mom to increase your calorie intake because you were close to underweight?

dd--

You have entirely missed the point, probably because of my rambling post.

I am unconcerned with the immediate goal of the instant study--I was referring to the goal of life.

I was using myself as an example of what society supports and what it doesn't. Public policy does absolutely nothing to affirmatively support anything that has helped me maintain my health. It doesn't subsidize my good food, it doesn't subsidize my wife to stay home and cook, it doesn't subsidize my exercise, or my sleep. Should it subsidize my small injuries, for which I could EASILY have sought medical care and associated subsidy, like most other people do? Physio? Drugs? Surgery? I could have sought all the above, for any variety of conditions--achilles tendonitis/tendinosis, PF, torn adductor, torn quad, torn ab, strained MCL, compromised cartilage, olecranon bursitis, I could go on forever.

The point is that public health subsidy was not required in order for me to survive these conditions. Did I spend time injured? Yes. Did it make my life worse, overall? Certainly not. It is an integral part of life, as much as anything else. Would my life have been better, overall, with medical intervention? I see no reason to believe that would be the case, and it is I who am best-positioned to judge.

Do you begin to see the picture? You suggested that health included "being physically able to do what you want." See how amorphous that is? I always "want" to run, but sometimes I can't, for good physical reasons, like injury. Should we subsidize roids for everybody so that they can run 9.9 like they "want", or be huge, like they "want" to be? Is it beneficial for "health" in the aggregate that we subsidize testosterone for middle-aged males, based on nothing other than their chronological age?

Regarding "needing medical intervention", that is also very amorphous. Obviously it is a sliding scale--who is to determine "need"? I determined it myself for my various conditions--if I had used public health criteria, the determinations would have been decidedly different. Is function any less than some mythical 100% demanding of intervention? Is that not the very definition of an individual, who is an entirely unique set of circumstances, any of which could be judged inadequate simply by characterizing the ideal state as something other than what they happen to embody?

The other point is that I'm doing everything right, from a public policy perspective, and am supported for absolutely NONE of it.

Public health policy is nowhere near as philosophically cut-and-dried as you would make it out to be. Even your "agreed-upon" metrics such as long life, need for intervention, and doing what you want are absurdly amorphous, and of course subject to interpretation and manipulation, suitable for the achievement of particular goals.

And in public health, ultimately those goals are political. I'm not talking at the actual level of research, I'm talking at the level to which research is subservient.

I was right in the middle of medical research for years, all the way from epi studies to surgical techniques to clinical trials. I saw it from all perspectives, actually designing studies, doing the research, sourcing funding, writing proposals, administering grants, publishing, IRB review, writing and administering contracts, and so on.

Medical research lives off funding, be it from private foundations, public resources, or industry. It is the available funding that drives the direction of research. Industry has a profitability motive that decides the direction, the other sources have their various motives. Private foundation funding is most often issue-specific, and can be the most valuable type of funding in the treatment and prevention of specific disease states. In such situations, there is often a clearly defined goal, but sometimes not--the BRCA situation comes immediately to mind.

Treatments are valuable, but when you consider that the cost of treatment is, in industrialized nations, largely borne by the public through either public or private insurance schemes, it can be seen that the public policies that shape the structure of cost reimbursement reflect the concerns of the policy-makers.

I have been, and continue to be involved with, policy-making. I know where the power lies, and I will tell you plainly and simply: it lies with Pharma and their lobbying activities. It resonates right through DHHS and all the NIH and related programs, and right through to the health programs of other nations. It is political concerns that, at the highest levels, are shaping the contours of acceptable research.

I must impress upon you that without funding, no research happens.

The relationship in the USA between money, political power, and public health policy is critically damaging to the public accounts, and it will only get worse. Not only that, but the explosion of so-called "health care" costs as a fraction of total social costs is staggering.

Wait, WTF am I doing? Discussing with some anonymous poster the finer points of public health policy, because the b.s. variable of BMI was used in a correlative association that scientifically demonstrated nothing about causality?

Hopefully you will move on in your career in public health.

It is easy to be "reasonably muscular" at 5'10" 150lbs. I weigh 5 lbs less than that when I am at race weight (153 lbs just now when I checked) and all women drool when they see me shirtless. I am guessing that you are just some tubby cross-fitter or something.

Fat people should live longer. They need more time in their life to accomplish things because they are too fat to anything at a reasonable pace. Walk to your car? Slower. Taking longer to eater food? Slower. Sex?...well lets be real, that doesn't happen to begin with.

Skinny people don't need as long to live a fulfilling life. Fat people need more time to struggle.

I suppose I'm "teed-off" because I've been involved in this area so long that, seeing the ultimate characterization of issues up-close, I've come to the realization that it bores me, and that perturbs me, because I want a better world in the aggregate at the same time as maximizing individual value, and it is abundantly clear that many, including many in positions of significant power, do not at all agree with my aims.

There is so much in public health policy that is a smokescreen for the underlying agendas that it boggles the mind. I know, I was responsible for some of it.

I have almost reached the point where I feel like if you're sick but happy, are not living unduly off the avails of others, and have taken the needs of others close to you in consideration in choosing how to conduct yourself, then so be it.

This is directly relevant to the USA, which is loaded full of morbidly obese people. By a medical definition, they are ALL "sick". And you know what? Most of them are sick by choice. Public health policy tries to make people into something they are not, which is a monumental task. Think of how long healthy-eating campaigns have been around, and how much penetration they have had in schools. Has there been a measurable improvement in the diets of 20-somethings versus 20-somethings in the 1980's?

The stated goals are often about education, but education always has an aim. Consider the other goals of education, like self-esteem, which can be competitive goals with "physical health". Clearly, looking at a consistently fatter, more malnourished, "sicker" population, public health policy education has been confounding, at best.

The drag is that we allocate so many social resources to unclear ends. We have bankrupted the country in an attempt to approach ill-defined and contradictory goals, and this trend shows absolutely no slowing.

In a huge fit of irony, public health policy could be responsible for the downfall of the civilization that invented it.

All those vaccines and disease-prevention strategies have led to over-population, competition for finite resources, political suppression, and overcrowded refugee camps. Have you seen them? Is that "improved health"?

Of course, certain "health"-related expenditures are valuable and worthy, the question is which ones, and when.

Using the variable BMI in an epi-study in a correlative capacity does nothing to improve "health", except perhaps the "health" of the researchers and administrators.