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News & ArtsTuesday, February 15, 2011
Health / Science Hello, Fatness Is a Poor Way to Measure Unhealthiness
Posted by Jonathan Golob on Tue, Feb 15, 2011 at 2:03 PM
At the risk of stepping into the middle of a fight… I must suggest that anyone interested in the relationship between fatness, fitness, and health read a fantastic, complete, and highly accessible scientific review on this subject written by Vojtech Hainer, Hermann Toplak, MD, PHD, and Vladimír Stich, MD, PHD. For the TL;DR crowd:
1. It is inarguable that being fat and sedentary is terrible for your health.
2. Quite a few recent, large, and well-crafted studies have dug into figuring out which is more important for preserving health: being normal weight or being active. Almost all—and particularly the better crafted studies that have used independent and scientifically rigorous measures of fitness rather than surveys—show being active is the more important factor, even if the activity does not succeed in causing one to lose weight.
- The relative risk of dying per year, by fitness and fatness.
The numbers in this figure represent the relative risk of dying in a given year, broken down by fitness and fatness; lower numbers are better. The healthiest group in this study were the (moderately) fat, fit group.
A prospective JAMA study from 1995 showed nicely that becoming fit had a significant effect on both all-cause mortality and cardiovascular mortality. The effect size wasn't small. For every minute one could last longer on a treadmill, the relative risk of death in a given year was reduced by 7.9 percent.
3. Therefore, just because someone is fat (or looks fat) doesn't mean they're unhealthy. Additionally, even if exercise didn't work for you (i.e., it didn't make you thin), you are still deriving a massive benefit from exercising even if you remain fat. The amount of exercise needed is quite small, 20 minutes of moderate exercise (enough to get your breathing rate up, not to drive you into a drenching sweat and gasps for air), three times a week is enough.
Updated:
Here is data for women, around the same question. This study isn't quite as clean as the one for men I cited above.
In this study—the Lipid Research Clinics Study—both fatness and fitness were relevant predictors for health. A more ethnically diverse population of subjects was involved in this study. The results from slightly overweight and massively overweight individuals were combined, perhaps clouding the relationship in the other (men-only) study was able to demonstrate.
3
There are a few similar studies in women, but unfortunately not as well done as this one in men--either lacking a rigorous measure of fitness (instead relying upon surveys, etc) or not enough power.
The results are similar, but a bit more muddled. I'll throw one together for you, and add it to the post.
The results are similar, but a bit more muddled. I'll throw one together for you, and add it to the post.
5
Thank you.
Fitness is (duh?) way more important to health than what you look like. It's no more healthy to be skinnyfat (you know - a little under "ideal weight", no muscles, no cardiovascular capacity, omentum full of fat) than it is to be fattyfat.
It's also true that losing weight can be extra hard because of the way fat functions as an endocrine organ. It's not just sitting there; it's doing things that potentially alter your metabolism.
All of that said, in my experience of helping obese and sedentary pets regain their fitness, caloric restriction while meeting nutrient requirements + increased activity results in weight loss in all but a tiny fraction of individuals. And humans are not really that different from other mammals.
When humans tell me about "failures" dieting, I wonder if part of the problem is that they're eating an unbalanced diet. I know I used to. With dogs and cats, we have an easy time because there are experimentally-proven diets that you can just feed less of, and they can't get extra food. For humans, it's harder to resist the temptation to switch to eating entirely different foods, convincing your body that it's starving and making it simultaneously conserve resources and make the brain intensely crave food.
The recommended way to get fit is to do moderate exercise reasonably often, and to modify the diet to a more healthful one slowly, and to maintain this change over the course of months or years. This will help a person become fit; but it's not going to result in rapidly-perceptible weight loss, which is going to make people feel frustrated and give up.
Fitness is (duh?) way more important to health than what you look like. It's no more healthy to be skinnyfat (you know - a little under "ideal weight", no muscles, no cardiovascular capacity, omentum full of fat) than it is to be fattyfat.
It's also true that losing weight can be extra hard because of the way fat functions as an endocrine organ. It's not just sitting there; it's doing things that potentially alter your metabolism.
All of that said, in my experience of helping obese and sedentary pets regain their fitness, caloric restriction while meeting nutrient requirements + increased activity results in weight loss in all but a tiny fraction of individuals. And humans are not really that different from other mammals.
When humans tell me about "failures" dieting, I wonder if part of the problem is that they're eating an unbalanced diet. I know I used to. With dogs and cats, we have an easy time because there are experimentally-proven diets that you can just feed less of, and they can't get extra food. For humans, it's harder to resist the temptation to switch to eating entirely different foods, convincing your body that it's starving and making it simultaneously conserve resources and make the brain intensely crave food.
The recommended way to get fit is to do moderate exercise reasonably often, and to modify the diet to a more healthful one slowly, and to maintain this change over the course of months or years. This will help a person become fit; but it's not going to result in rapidly-perceptible weight loss, which is going to make people feel frustrated and give up.
6
Jonathan, I commiserate in advance that calm science-based discussions will draw only a tiny fraction of the comments (or views) of impassioned relating of anecdotes, claiming of butthurt, sanctimonious denials, or vindictive finger-pointing.
7
I don't think Lindy's central point was that Dan believed that fat people can't be relatively fit, I believe that Dan did make that allowance. Her point was that Dan shouldn't have any opinion about fat people AT ALL, unless that opinion was that they were fabulous, attractive and should never change one thing, and should always feel good about themselves and here's a pony, otherwise he's shaming them into eating a cheesecake and it's his fault they're fat.
Some people find overweight people unattractive. Apparently they just can't ever say so.
Some people find overweight people unattractive. Apparently they just can't ever say so.
8
The highest power in statistical studies on women which have BMI (body mass index) are the UK Wellcome Trust and the US heart study (which i've spaced for the moment.
In terms of longitudinal fitness and scientific rigor. All the rest lack sufficient power.
In terms of longitudinal fitness and scientific rigor. All the rest lack sufficient power.
9
Golob, this is, by far, the best interjection into this discussion so far. It's this study that convinced me to keep taking my 30 minute walk every day, no matter what the results might appear to be.
10
Hooray science!
I found it interesting that in both fit and non-fit cohorts, moderately fat folk had the lowest risk.
I found it interesting that in both fit and non-fit cohorts, moderately fat folk had the lowest risk.
12
Thanks, Jonathan!
@8 Why do you cite references when no one who reads comments trusts you in regards to anything, Will? Do you just enjoy preying on newbies that much?
@8 Why do you cite references when no one who reads comments trusts you in regards to anything, Will? Do you just enjoy preying on newbies that much?
13
This is a great post. Thank you for saving me the trouble of finding and reading that study. I am now more informed about a subject that draws many uninformed comments.
14
"Fat" is not a little misleading in your diagram for "BMI". Big difference between muscle and fat. No? Hard to have a fit heart if you're really fat.
15
I think half of your conclusion is correct. that if exercise "doesn't work" to reduce your weight, it's still providing a massive benefit.
I look at the numbers for the 'fat' and still see them as fundamentally more unhealthy than the 'sorta fat' rating for the active & inactive.
And is anyone really surprised that an inactive thin person is as likely to die as the average inactive "a lot fat" person?
Final note: might be nice to go with thin / average / fat, rather than thin/little fat/lots of fat.
The real key from this is not "being fat doesn't mean you're unhealthy". The real key is "activity is a central key to health no matter what weight you are, so don't think because you're skinny you can get out of being active."
Which is a vastly different final answer than "fat doesn't mean you're unhealthy".
And that study doesn't address things like quality of life, strain on knees/ankles/back, or the other things that carrying around a lot of extra weight can do to you. Think extra weight isn't a big deal? put on a backpack and carry around an extra 50lb of weight for a few days and see what you think.
I look at the numbers for the 'fat' and still see them as fundamentally more unhealthy than the 'sorta fat' rating for the active & inactive.
And is anyone really surprised that an inactive thin person is as likely to die as the average inactive "a lot fat" person?
Final note: might be nice to go with thin / average / fat, rather than thin/little fat/lots of fat.
The real key from this is not "being fat doesn't mean you're unhealthy". The real key is "activity is a central key to health no matter what weight you are, so don't think because you're skinny you can get out of being active."
Which is a vastly different final answer than "fat doesn't mean you're unhealthy".
And that study doesn't address things like quality of life, strain on knees/ankles/back, or the other things that carrying around a lot of extra weight can do to you. Think extra weight isn't a big deal? put on a backpack and carry around an extra 50lb of weight for a few days and see what you think.
20
'At the risk of stepping into the middle of a fight…'
No apparent risk of that, Jonathan; seems like Lindy put her post up late Friday afternoon, then promptly went on vacation. Not a peep from her since. What's up Lindy?
No apparent risk of that, Jonathan; seems like Lindy put her post up late Friday afternoon, then promptly went on vacation. Not a peep from her since. What's up Lindy?
21
YAY for SCIENCE! It works, bitches. Ditto @9: best interjection so far.
Jonathan, I want you to know that for years I had fantasies of the Stranger having a science column (and of me writing it - this was fantasy, mind you). I can't tell you how glad I am that the Stranger read my mind (and got YOU instead).
Jonathan, I want you to know that for years I had fantasies of the Stranger having a science column (and of me writing it - this was fantasy, mind you). I can't tell you how glad I am that the Stranger read my mind (and got YOU instead).
22
Being a 'little bit" fat for health means around 14% body fat or less. In today's society most people consider that skinny or in shape.
Also BMI is the worlds worst measurement of fatness. Anyone who works out and has muscle will throw off their BMI quite a bit, muscular men have it the worst. Also some sedentary women who starve themselves will have a "healthy" BMI but actually be quite high as far as body fat %.
Also BMI is the worlds worst measurement of fatness. Anyone who works out and has muscle will throw off their BMI quite a bit, muscular men have it the worst. Also some sedentary women who starve themselves will have a "healthy" BMI but actually be quite high as far as body fat %.
24
One fun exercise to try, based on these studies, is attempting to calculate how many fewer fatal heart attacks and strokes there would be in the United States (in a given year) if the front few rows of parking at every Wal*Mart were blocked off.
I tried my hand at it, and ended up at a pretty impressive number.
I tried my hand at it, and ended up at a pretty impressive number.
25
agree that @9 is doing the best thing.
mild to moderate exercise is the key, with a varied diet (yes, don't eat diets with one food type) high in veggies and fruits.
most of the rest of the advice has fairly low returns for women. other than getting enough sleep and reducing stress.
for men, though, alcohol with food is good, especially with meals. still not sure how much of that is stress reduction and socialization, mind you. alcohol has a mix of bad and good effects for women, so just do what you were doing.
mild to moderate exercise is the key, with a varied diet (yes, don't eat diets with one food type) high in veggies and fruits.
most of the rest of the advice has fairly low returns for women. other than getting enough sleep and reducing stress.
for men, though, alcohol with food is good, especially with meals. still not sure how much of that is stress reduction and socialization, mind you. alcohol has a mix of bad and good effects for women, so just do what you were doing.
26
I want to see the data on how many lives are saved every time Savage announces on his blog that fat people they don't feel bad enough about themselves. My understanding is that the healthier industrialized counties with longer life expectancies are far ahead of the US in daily production of snarky, nasty (but hi-LAR-ious!) blog posts about fat people.
27
Reminds me of this cartoon about global warming:
http://i.imgur.com/jVt9p.jpg
What if it's a big hoax and fat people get healthier for nothing?
http://i.imgur.com/jVt9p.jpg
What if it's a big hoax and fat people get healthier for nothing?
28
@22 - for the purposes of this study "a little fat" meant 25 - 27.8 BMI. And, uh, 14% is "a little fat"!? That is insane... at least for women. For men, 14% is right smack dab in the middle of the "recommended" range (whatever "recommended" means).
Also, BMI is not a perfect measure of "fatness", by any means. But, it's a reasonably good shortcut for most of the population. Particularly at the extremes (in other words, if your BMI is in the obese range, and you are not an elite athlete, then it's probably a reasonable estimate of "fatness"). What this study shows is that BMI (i.e., weight) is not necessarily a good indicator of health.
Also, BMI is not a perfect measure of "fatness", by any means. But, it's a reasonably good shortcut for most of the population. Particularly at the extremes (in other words, if your BMI is in the obese range, and you are not an elite athlete, then it's probably a reasonable estimate of "fatness"). What this study shows is that BMI (i.e., weight) is not necessarily a good indicator of health.
29
As an obese dude that plays rugby and runs regularly, I'm relatively fit. What isn't measured in this study though is the likelihood that you will exercise if you are fat vs if you are skinny. When my weight goes up (and it goes up because I love food and eat lots of it) my desire to exercise goes down, and vice versa. Lindy postulates that this is because Dan hates the fat me and that makes me sad. Given my almost psychotic levels of self esteem, I doubt it. What really causes it is the greater level of physical assertion it takes to get started. It's really, really hard to get in those 20 minutes when I'm at my highest weight, and much easier when I'm lower on the scale. That's why, after lazy time when I'm trying to get back in shape for rugby season, I have to ramp up the exercise while cutting the calories. I can't just do one or the other.
Obesity makes me way less likely to get those 20 minutes of exercise, and makes me sedentary, which is deadly. I doubt I'm the only one.
Obesity makes me way less likely to get those 20 minutes of exercise, and makes me sedentary, which is deadly. I doubt I'm the only one.
31
I'd love to see where Dan's announced that fat people don't feel bad enough about themselves, Wretched Harmony. I'd also love a pony.
Thanks for bringing science to this debate, Jonathan!
Thanks for bringing science to this debate, Jonathan!
34
I have a question that I hope is legitimate - let's say a larger person seems to be able to stand on their feet at work all day fairly well. Or could walk a decent distance, but seems to have difficulty tying their shoes (reaching them over bulk).
It seems to me that having difficulty with something as simple as that would indicate a problem? Am I totally wrong?
It seems to me that having difficulty with something as simple as that would indicate a problem? Am I totally wrong?
35
@Bella,
There is, of course, a difference between functional and overweight and disabled from being morbidly obese.
Both the nutritionists and endocrinologists loathe the scooters-for-the-obese-unable-to-walk, for example, as a harbinger of death.
There is, of course, a difference between functional and overweight and disabled from being morbidly obese.
Both the nutritionists and endocrinologists loathe the scooters-for-the-obese-unable-to-walk, for example, as a harbinger of death.
36
Hi, Jonathan,
Thanks for very interesting post.
Since I'm too lazy to read the papers, could you give us your take on this question: I've heard from several sources the idea that being "a little fat" correlates with lower mortality -- it seems to be true. What I can't figure out is whether that means it is (slightly) dangerous to try to drop those last 15 pounds and (slightly) beneficial for a skinny person to try to plump up a little. Or, is it that the correlation arises from the fact that several diseases that might cause us to die soon (cancer, anorexia, tobacco and certain other drug addictions) tend to make us skinny, first. In the latter explanation, the ranks of the very thin would include a disproportionate number of people who are basically on their way out, and perhaps don't even know it yet. Do you have a take on which, if either, is true?
Thanks for very interesting post.
Since I'm too lazy to read the papers, could you give us your take on this question: I've heard from several sources the idea that being "a little fat" correlates with lower mortality -- it seems to be true. What I can't figure out is whether that means it is (slightly) dangerous to try to drop those last 15 pounds and (slightly) beneficial for a skinny person to try to plump up a little. Or, is it that the correlation arises from the fact that several diseases that might cause us to die soon (cancer, anorexia, tobacco and certain other drug addictions) tend to make us skinny, first. In the latter explanation, the ranks of the very thin would include a disproportionate number of people who are basically on their way out, and perhaps don't even know it yet. Do you have a take on which, if either, is true?
37
This is the argument I feel Dan is usually making when he brings up obesity, and not being all squeamish about body fat the way he is about vaginas.
38
Ahhh, thank you science!!
Some time for the future please: the irrelevance of personal anecdote in denying population level data.
Some time for the future please: the irrelevance of personal anecdote in denying population level data.
40
@31
Hi, Canadian Nurse. What is the point of this? It was a horrible tragedy and Savage wants to exploit it do serve his agenda. It's obvious Savage believes obesity isn't taken seriously enough. He believes obese people don't say to themselves often enough, "I need to lose weight." That's the only reason I can think of: to make fat people feel worse. Either that or to laugh at the death of a child caused by somebody's obesity.
When you read posts like this and compare that with what Jonothan Golob just posted above, you can see how unqualified Dan Savage is to fact check any fat acceptance activists. Savage doesn't get science. He can't do math. He doesn't know statistics and he can't interpret scientific studies. What Savage knows how to do is cull the most sensationalistic stories from his Google Alerts and post them to try to raise, uh, "awareness" if you want to call it that. Hysteria might be a better word. His fundamental goal is blame: blame soda, blame fast food, and especially blame fat people for eating too much and for lack of exercise (in spite of what Golob just posted) and for being unhealthy (in spite of what Golob just posted).
Sure, sometimes he acknowledges that it's a free country and you can kill yourself with your indulgent habits, but his number one mission is to make sure each and every overweight reader knows that they are to blame. Dan Savage can't enlighten anyone about what causes obesity or give useful advice about what to do about it because he's woefully unqualified.
In simple terms, Dan Savage's only role is to make fat people feel bad. And give his fans a little chuckle at somebody else's expense.
More...
Hi, Canadian Nurse. What is the point of this? It was a horrible tragedy and Savage wants to exploit it do serve his agenda. It's obvious Savage believes obesity isn't taken seriously enough. He believes obese people don't say to themselves often enough, "I need to lose weight." That's the only reason I can think of: to make fat people feel worse. Either that or to laugh at the death of a child caused by somebody's obesity.
When you read posts like this and compare that with what Jonothan Golob just posted above, you can see how unqualified Dan Savage is to fact check any fat acceptance activists. Savage doesn't get science. He can't do math. He doesn't know statistics and he can't interpret scientific studies. What Savage knows how to do is cull the most sensationalistic stories from his Google Alerts and post them to try to raise, uh, "awareness" if you want to call it that. Hysteria might be a better word. His fundamental goal is blame: blame soda, blame fast food, and especially blame fat people for eating too much and for lack of exercise (in spite of what Golob just posted) and for being unhealthy (in spite of what Golob just posted).
Sure, sometimes he acknowledges that it's a free country and you can kill yourself with your indulgent habits, but his number one mission is to make sure each and every overweight reader knows that they are to blame. Dan Savage can't enlighten anyone about what causes obesity or give useful advice about what to do about it because he's woefully unqualified.
In simple terms, Dan Savage's only role is to make fat people feel bad. And give his fans a little chuckle at somebody else's expense.
41
So the big piece of information that's missing here if we're trying to answer the question "how much can we tell about peoples' health by their BMI" is how many people actually fit into each of these categories.
43
the measure here is death. i'd still like to see similar data but with different aspects of health as measure. quality of life is important too.
but i like the focus on fitness. there has been too much focus in this discussion on eating habits. one can diet like crazy but still be unhealthy if you're just sittin there on the couch.
but i like the focus on fitness. there has been too much focus in this discussion on eating habits. one can diet like crazy but still be unhealthy if you're just sittin there on the couch.
44
Thank you for this. I knew that such a graph existed, but gave up on finding it to drop into the sea of comments on the previous installations.
Regarding @36's comment about the benefits of being a bit overweight: Aside from severe underweight being a sign of undiagnosed illness, I've usually seen estimates of the benefit of extra body mass among elderly people, where higher body mass can act as a buffer for recovery following serious illness and the baseline risk of mortality is much higher.
Regarding @36's comment about the benefits of being a bit overweight: Aside from severe underweight being a sign of undiagnosed illness, I've usually seen estimates of the benefit of extra body mass among elderly people, where higher body mass can act as a buffer for recovery following serious illness and the baseline risk of mortality is much higher.
45
Glad someone pointed this out. As someone who gets a lot of exercise and is very active, it often surprises people to learn that, although I am 5'6" I weigh upwards of 180 lbs. I forget what I "supposed" to weigh; I grade myself on how much bicycling I can get in, rather than what clothes I can fit into.
46
I'm a 44 year-old woman with a BMI of 36, but my cholesterol is good and my blood pressure averages 120's over upper 60's. During my physical in October, my doctor, knowing my adult history with weight gain (and loss, and gain), was empathetic. She was aware of life events over the last year that gave me little time to get regular exercise. But, she framed it this way: I'm currently in good health, but given my family history of type 2 diabetes, I stand a chance of developing health problems within the next 10 years. Be sensible about food choices, do try to get regular exercise. No guilt or shame, just sensible advice.
Jonathan, your contribution to this discussion is reassuring, not only because you bring scientific data, but that you also point out:
"(J)ust because someone is fat (or looks fat) doesn't mean they're unhealthy. Additionally, even if exercise didn't work for you (i.e., it didn't make you thin), you are still deriving a massive benefit from exercising even if you remain fat."
Good take-away advice: Being active, no matter one's size, is beneficial to health. From the debate here on SLOG these recent days, I've read unsolicited advice from self-appointed "experts", who would, on first glance of me or someone my size, declare what I should eat and how much I must exercise to ease their moral disgust with "fatties."
Thank you.
Jonathan, your contribution to this discussion is reassuring, not only because you bring scientific data, but that you also point out:
"(J)ust because someone is fat (or looks fat) doesn't mean they're unhealthy. Additionally, even if exercise didn't work for you (i.e., it didn't make you thin), you are still deriving a massive benefit from exercising even if you remain fat."
Good take-away advice: Being active, no matter one's size, is beneficial to health. From the debate here on SLOG these recent days, I've read unsolicited advice from self-appointed "experts", who would, on first glance of me or someone my size, declare what I should eat and how much I must exercise to ease their moral disgust with "fatties."
Thank you.
47
@44: Yes, I've heard the "a little extra weight as buffer" idea too, and it sounds reasonable, as does "a possible reason you don't have a little extra weight is tht you have undiagnosed illness." To my non-expert ear, both sound like entirely likely scenarios. I'm really wondering though if there exists data that allow one to say which hypothesis (or what factional combination of both) is correct. Most of the SLOG uproar of the last four days has concerned genuine obesity, not 20 extra pounds. But there are also a hell of a lot of people who are relatively active and healthy, and carrying 20 extra pounds, who are wondering just how much it matters if they lose those 20 extra pounds. Depending on which of the two scenarios is correct, it could be actually harmful (although not very) to lose the 20 extra pounds. Food for thought, not to mention, potentially, food to indulge in! Thus my question to Jonathan. As someone who only by the narrowest of margins once survived a life-threatening illness, I intuitively like the idea of having a "reserve". In my case a reserve would be a question of putting on a little weight (God knows, not hard to do) rather than not taking it off, but one way or the other, it's a relevant question to many people.
48
Here's a something I found interesting: a comparison of two groups of overweight people, one that was put on a regular diet/exercise plan, and another that was put on a plan that emphasized improving health (which included improving self-esteem) over losing weight.
The second group, whose strategy was called Health at Every Size, came out on top:
The conclusion is pretty clear. Encouraging people to lose weight is less effective than promoting overall health, including healthy self-esteem.
http://www.ars.usda.gov/is/AR/archive/ma…
More...
The second group, whose strategy was called Health at Every Size, came out on top:
Every Size volunteers had kept their weight stable, neither gaining nor losing a significant number of pounds. In contrast, the dieters had lost weight by the sixth month, but regained it by the 2-year checkpoint. Their beginning weights and their weights 2 years later weren’t significantly different.
At the start and end of the study, total cholesterol and systolic blood pressure were in the normal range for all the women. Within this range, however, the Every Size women lowered their total cholesterol and their systolic blood pressure and were able to maintain those reductions for the entire course of the study.
In contrast, the dieters didn’t lower their total cholesterol at any point in the study. And they weren’t able to maintain the healthful decrease in systolic blood pressure that they’d achieved just after the 6-month reducing-diet phase
What about physical activity?
At the 2-year point, Every Size team members had nearly quadrupled the amount of time they spent in moderate, hard, or very hard physical activity, compared to what they had reported at the study’s outset.
The dieters didn’t fare as well. At the 1-year point, they were exercising more than at the start, but they didn’t sustain their improved level to the 2-year checkpoint.
Although all the dieters made a lasting improvement in at least one of the food-related habits called “eating behaviors,” the Every Size volunteers improved in more of the categories.
The researchers also monitored depression, a common problem among large-sized women whose low self-esteem may be related to their body image. Both groups made significant strides in lessening depression, but only the Every Size women were able to preserve a more optimistic outlook.
The conclusion is pretty clear. Encouraging people to lose weight is less effective than promoting overall health, including healthy self-esteem.
http://www.ars.usda.gov/is/AR/archive/ma…
49
Thanks for the peer-reviewed goodness, Dr. Golob. Like @9, this made me walk today, too -- the kick in the pants I needed to start back up.
50
BTW, the data for the "not fat" folks are a little skewed because people who are seriously underweight have elevated death rates. If you filter those out there is little difference in death rates over the range of BMI from 18.5 to 27.5 or so, but it goes up outside of that range. See the wiki on Obesity for some nice graphs.
52
Golob - The Lee study data you cite was from a cohort of 95% caucasian with 80% of them being college graduates. That raises a few questions about how applicable the results would be to the rest of the population. Seems the other studies showed a less dramatic impact.
The Blair study clearly indicates that it is critically important to maintain a constant level of fitness throughout life. Even those that started out unfit and became fit over the 5 year period had over 50% higher mortality than the fit-fit group.
Interesting data, but lots of moving parts with the CRF portion of the study based on genetics it seems. So good genes do count, still, for cardiac health.
The Blair study clearly indicates that it is critically important to maintain a constant level of fitness throughout life. Even those that started out unfit and became fit over the 5 year period had over 50% higher mortality than the fit-fit group.
Interesting data, but lots of moving parts with the CRF portion of the study based on genetics it seems. So good genes do count, still, for cardiac health.
53
@50: Thanks for that tip. Interesting graphs, and I see how they support your point. After a longish and unpleasant* stay in an ICU, I once down around BMI 17.5, which the plots suggest is unhealthily gaunt.
*Not to sound ungrateful re the miracle of modern critical care. My time in the ICU was way better than the alternative I was facing! I love you, ICU people!
*Not to sound ungrateful re the miracle of modern critical care. My time in the ICU was way better than the alternative I was facing! I love you, ICU people!
54
@52: I agree on all of your points. The Lee study, I still maintain, was well done--with the major questions being ones of generalizabilty.
It's clear you dug into the full (and freely available) review article that I linked to at the start. In my summary, I chose the clearest and cleanest data. It's always a struggle when the vast majority of people won't even make it through my post, let alone a 4000+ word scientific review article, to get the across without simplifying too much.
It's clear you dug into the full (and freely available) review article that I linked to at the start. In my summary, I chose the clearest and cleanest data. It's always a struggle when the vast majority of people won't even make it through my post, let alone a 4000+ word scientific review article, to get the across without simplifying too much.
56
I'm a slightly chubby woman who can run 10+ miles any given day. This study will keep me running despite my physique completely betraying my physical ability:)
57
Another major factor besides fitness, possibly more important for women at least:
Women and overall mortality -
Lowest beef and pork consumption: 1.00
Median beef and pork consumption: 1.24
Highest beef and pork consumption: 1.63
Men and overall mortality -
Lowest beef and pork consumption: 1.00
Median beef and pork consumption: 1.17
Highest beef and pork consumption: 1.48
Of course, "lowest" beef and pork consumpion is just the 20% quintile, which is still a lot of beef and pork for America. Other studies suggest zero consumption reduces cancer and heart disease risk even more.
http://archinte.ama-assn.org/cgi/content…
Women and overall mortality -
Lowest beef and pork consumption: 1.00
Median beef and pork consumption: 1.24
Highest beef and pork consumption: 1.63
Men and overall mortality -
Lowest beef and pork consumption: 1.00
Median beef and pork consumption: 1.17
Highest beef and pork consumption: 1.48
Of course, "lowest" beef and pork consumpion is just the 20% quintile, which is still a lot of beef and pork for America. Other studies suggest zero consumption reduces cancer and heart disease risk even more.
http://archinte.ama-assn.org/cgi/content…
58
@54 Thanks for the response.
The data on the importance of long term fitness was interesting to me. I've seen so many other types of studies about smoking, etc. that indicate that risk fades quickly to baseline levels that this really stands out.
The Lee results are somewhat shocking to me that they could produce such a huge spread in mortality outcome. I would love to read the entire thing and look at the data - for better and worse, those results hit directly home with me: college educated white male.
Definitely a kick in the ass to stay off the couch at all costs, and maintain a good relationship with my GP. Thanks for posting this.
The data on the importance of long term fitness was interesting to me. I've seen so many other types of studies about smoking, etc. that indicate that risk fades quickly to baseline levels that this really stands out.
The Lee results are somewhat shocking to me that they could produce such a huge spread in mortality outcome. I would love to read the entire thing and look at the data - for better and worse, those results hit directly home with me: college educated white male.
Definitely a kick in the ass to stay off the couch at all costs, and maintain a good relationship with my GP. Thanks for posting this.
59
@28 Sure, but....:
However, the recent meta-analysis of studies on the relationship between physical activity and abdominal fat using imaging techniques revealed that reductions in visceral and total abdominal fat may occur in the absence of changes in BMI and waist circumference (41).
Thus, insensitivity of anthropometric indexes to reflect actual amounts of visceral fat may contribute to overestimating the role of fitness in relation to fatness in their effect on cardiometabolic risks.
60
The good thing about science is that it's true whether or not you believe in it."
— Neil deGrasse Tyson
— Neil deGrasse Tyson
61
@54: Interesting, understandable, simple, comprehensive, accurate, brief: one can't be all those at once. But I think your posts consistently find a good balance. One of these days you should do a post telling us about your day job, now that you're all MDd and residented and what have you.
62
ah.
"Science"....
Dr Golob;
could you comment on the CDC declaration that the best way to prevent STDs is abstinence until in a long term relationship and monogamy thereafter?
also please compare and contrast the objective science based advice from the CDC with the degenerate behavior Danny advocates.
"Science"....
Dr Golob;
could you comment on the CDC declaration that the best way to prevent STDs is abstinence until in a long term relationship and monogamy thereafter?
also please compare and contrast the objective science based advice from the CDC with the degenerate behavior Danny advocates.
63
Let's be 100% clear - the definition of "fat" in this study is not actually fat. You have a technical definition and a common definition, and you're using the former to make a point related to the latter. I assume that this slipped your attention, but you should know better. We should all know better.
The technical definition of "fat" in the study you cite is a BMI between 25 and 28 (for comparison, at my height (6-2), that's between 195 lbs and 218 lbs.) The common definition - as when Lindy and many sloggers say that they're fat - is somewhat larger than that.
The paper that the same group published in Obesity Research is available full-text, so let's sum their lessons up up. Both fitness and BMI are significant predictors of excess mortality (an imperfect proxy for health, but the best we have). Fitness has a stronger effect than BMI, so you should take both into account.
It's really hard to be fit if you're overweight. Look at fig 3 of the Obesity Research paper. Low fitness (the very bottom quintile) is not evenly distributed. Nearly everyone with BMI < 27 will not have low fitness. Nearly everyone with BMI > 35 will have low fitness.
In other words, fitness is not available on a sliding scale. Health is not available on a sliding scale. If you want to be as healthy as someone who's lighter, AND your BMI is over 27, you have to be fitter. Not fitter relative to people your size/BMI range. You have to be able to run longer and run harder than them - you have to be just plain fitter.
The technical definition of "fat" in the study you cite is a BMI between 25 and 28 (for comparison, at my height (6-2), that's between 195 lbs and 218 lbs.) The common definition - as when Lindy and many sloggers say that they're fat - is somewhat larger than that.
The paper that the same group published in Obesity Research is available full-text, so let's sum their lessons up up. Both fitness and BMI are significant predictors of excess mortality (an imperfect proxy for health, but the best we have). Fitness has a stronger effect than BMI, so you should take both into account.
It's really hard to be fit if you're overweight. Look at fig 3 of the Obesity Research paper. Low fitness (the very bottom quintile) is not evenly distributed. Nearly everyone with BMI < 27 will not have low fitness. Nearly everyone with BMI > 35 will have low fitness.
In other words, fitness is not available on a sliding scale. Health is not available on a sliding scale. If you want to be as healthy as someone who's lighter, AND your BMI is over 27, you have to be fitter. Not fitter relative to people your size/BMI range. You have to be able to run longer and run harder than them - you have to be just plain fitter.
64
Damn, I was reading Lee et al (1998) rather than Hainer (2009). Hainer covers more ground,
The article in Obesity Research is Farrell et al, The Relation of Body Mass Index, Cardiorespiratory Fitness, and All-Cause Mortality in Women, Obesity Research (2002) 10, 417–423
The points still stand, though - obesity is bad, and fitness is good. I do wonder what the limits of the relevant work are, because we're looking at smaller and smaller populations who are both obese (class II or class III) and even moderately fit.
The article in Obesity Research is Farrell et al, The Relation of Body Mass Index, Cardiorespiratory Fitness, and All-Cause Mortality in Women, Obesity Research (2002) 10, 417–423
The points still stand, though - obesity is bad, and fitness is good. I do wonder what the limits of the relevant work are, because we're looking at smaller and smaller populations who are both obese (class II or class III) and even moderately fit.
65
I actually brought this up in that Lindy post, but someone misread my reply as support for Lindy (it was not) and then flamed me so I just dropped it. I think @63 makes a solid point, but there's still an interesting theoretical point that merits more research in this study. Namely, what are the limits on the BMI level? Is there a point where even good fitness cannot help your life expectancy? At any rate, it's a good study, but people are going to abuse it. Most... no, biologically speaking, ALL people get fat and stay fat from varying ratio of sedentary lifestyle and overeating (as determined by their level of activity and to a lesser extent genetics). If you stay fit and still stay overweight you would have to be consuming so many goddam calories I almost question who it would ever apply to.
66
Oop, lost the main point for that reply. Your title says "fatness is a poor way to measure unhealthiness" but that's not really true. No measure is sensitive enough to capture all irregularities, as this study points out, but it's still a very valid and reliable measure for outcomes associated with bad health.
67
Dr. Golob, I love you. And I love science. But science only answers the questions it asks. So has anyone asked (that you know of) the question posed by @29? Is there a correlation between being overweight - however that may be technically defined - and being fit? And does that change as we age?
I know I had a long term weight problem, and only after I turned 41 did my cholesterol and blood sugar become a concern. Reading the comments on Lindy's and Dan's posts, I see a lot of 20 and 30-somethings saying "I"m overweight and my numbers are great" but I wonder if that will last. Seeing my step-father battling the end stages of Type II diabetes and all that involves was a well-timed wake up call for me, and an awful way to die for him.
I know I had a long term weight problem, and only after I turned 41 did my cholesterol and blood sugar become a concern. Reading the comments on Lindy's and Dan's posts, I see a lot of 20 and 30-somethings saying "I"m overweight and my numbers are great" but I wonder if that will last. Seeing my step-father battling the end stages of Type II diabetes and all that involves was a well-timed wake up call for me, and an awful way to die for him.
68
@65 I think that there's more than one.limit, take this hedging for what it's worth
First, certainly there's a limit where you're sufficiently big and heavy that you can no longer be high cardio fitness (top 2 quintiles), same for moderate fitness (3rd and 4th quintile), even with maximum effort.
Second, there's certainly a point out there where the additional mortality cannot be made up for by exercise - we can't get there from here. That's the latter limit, and it's probably closer to us now than the former.
First, certainly there's a limit where you're sufficiently big and heavy that you can no longer be high cardio fitness (top 2 quintiles), same for moderate fitness (3rd and 4th quintile), even with maximum effort.
Second, there's certainly a point out there where the additional mortality cannot be made up for by exercise - we can't get there from here. That's the latter limit, and it's probably closer to us now than the former.
71
From Rob's link @70
Federal guidelines call for 150 minutes of moderate to vigorous physical activity every week, including two days of full-body strengthening.
(snip)
...it may be time to consider more drastic measures, from employer-mandated exercise breaks for office workers to auto-free zones that encourage more walking.
72
"the data for the "not fat" folks are a little skewed because people who are seriously underweight have elevated death rates."
"Elevated death rates" Yeah, dying people "skewer" results for everybody, I hope they're pleased with themselves.
"Elevated death rates" Yeah, dying people "skewer" results for everybody, I hope they're pleased with themselves.
73
Thank you, Dr. Golob! I agree with gnossos @38, and would also like one on how correlation does NOT equal causation!
74
Obesity alone raises risk of fatal heart attack, study finds
http://yourlife.usatoday.com/health/medi…
http://yourlife.usatoday.com/health/medi…
77
I'll join the other inspired people. I'm getting up and walking to the vegetable market (1.4 miles one way) now. It beats my normal health plan, which is walk home from the bar.
78
I don't think anyone is saying that being overweight is unhealthy...it's being very obese that is unhealthy. Active people with a little extra weight on them rock, I don't think anyone is criticizing those people. It's the people who struggle to walk that everyone is worried about and there are sooo many of them.
79
BMI is not "fatness", especially not for fit (muscular) men.
That's why this study shows that fit men with a higher than average BMI
(due to muscle more than fat for most of them ...) had the lowest mortality.
That's also why the data is different for women than men.
In short the study is good, but the analysis of it given here is just crap.
BMI is not "fatness", especially not for fit (muscular) men.
That's why this study shows that fit men with a higher than average BMI
(due to muscle more than fat for most of them ...) had the lowest mortality.
That's also why the data is different for women than men.
In short the study is good, but the analysis of it given here is just crap.
80
The study is only measuring mortality. Fat leads to loss of quality of life, diabetes, joint problems, but why do we keep arguing this? Everyone has to agree that being moderate in all things is best. That's what the science really shows. You can be 20lbs overweight and be fine, but if you are 80lbs overweight, it's a mistake to say that's okay.
81
One of the things I’m surprised no one ever mentions is how different BMI standards are for women versus men… at least compared to what society calls “fat.” Put it this way, as a woman who is 5’3”, I have to be over 145 pounds to make it into the overweight category. From society’s standpoint, that is a pretty generous range. If you asked most people on the street what the idea weight for a woman of that height is, what sort of numbers would you get? 110? 120?
On the other hand, for a 6’ man to be overweight, he has to be over 185 pounds. That seems on the slender slide. The bottom range of normal for a man at that height is an anorexic 135. How many of you know men who top 200 pounds at six feet tall and just look muscular?
On the other hand, for a 6’ man to be overweight, he has to be over 185 pounds. That seems on the slender slide. The bottom range of normal for a man at that height is an anorexic 135. How many of you know men who top 200 pounds at six feet tall and just look muscular?
82
Great example - of how diagrams mean science to most people, and how "statistical" charts can be incredibly misleading.
If you look at this another way, the fat people, taken together, have a 5.96 risk of mortality. The not fat have a 3.25 risk. Not fat = less than HALF the risk. So, does this still say what you think it says?
The first thing you learn in a stats class is that you can present the numbers however you want. You can make a chart with data that totally disproves your theory, and make it look like you're correct. Takeaway: statistics need to be correctly interpreted to have ANY real meaning. Don't believe everything you see on tv, kids.
If you look at this another way, the fat people, taken together, have a 5.96 risk of mortality. The not fat have a 3.25 risk. Not fat = less than HALF the risk. So, does this still say what you think it says?
The first thing you learn in a stats class is that you can present the numbers however you want. You can make a chart with data that totally disproves your theory, and make it look like you're correct. Takeaway: statistics need to be correctly interpreted to have ANY real meaning. Don't believe everything you see on tv, kids.
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