The stupid explodes: obesity now a disability

[casebro]

So, 'more likely' in this context means an average BMI of 28 for the 'exercise' cohort, versus average BMI of 25 for the 'calorie reduction' cohort.

Both 25 and 28 are well within the healthy range of 17-34, as shown by a study done by Kaiser Permanante Canada. When obesity starts at 35? how about looking at the mental gymnastics of subjects below 30 vs above 35?

Why didn't they poll a group of obese? Couldn't they find any?

Reminds me of Statin drug studies done on patients in their 50s, when most heart attacks occur in our 70s.

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Waitwaitwait- the two groups probably have a gausian bell curve of weight, with averages of 25 vs 28. There is probably an 80% overlap in the middle of the curve- many heavy people think diet is key, and as many skinny subjects think exercise is the key. But the averages is a difference of 3 BMI, when the overall range is from 15-50? 3? Meaningful?

And what was the avg BMI of the combo theory group? 26, or 23? When combo therapy is supposed to be best, why isn't it mentioned in the abstract?

Sounds like a study that had to be datamined for anything substantial.

 

[blutoski]

Both 25 and 28 are well within the healthy range of 17-34, as shown by a study done by Kaiser Permanante Canada. When obesity starts at 35? how about looking at the mental gymnastics of subjects below 30 vs above 35?

Why didn't they poll a group of obese? Couldn't they find any?

Reminds me of Statin drug studies done on patients in their 50s, when most heart attacks occur in our 70s.

The question wasn't about obese people specifically - it was about whether a model of how weight is accumulated can influence a person's actual accumulated weight.

Waitwaitwait- the two groups probably have a gausian bell curve of weight, with averages of 25 vs 28. There is probably an 80% overlap in the middle of the curve- many heavy people think diet is key, and as many skinny subjects think exercise is the key. But the averages is a difference of 3 BMI, when the overall range is from 15-50? 3? Meaningful?

Yep. For large populations, a 3 BMI is medically significant.

And what was the avg BMI of the combo theory group? 26, or 23? When combo therapy is supposed to be best, why isn't it mentioned in the abstract?

It was not included in all the surveys and tests, so hard to describe its effect.

Not sure what you mean by 'supposed to be the best' ? My point is that it's not considered the best by professionals who study the topic. In the surveys and tests where there was combo arm, they were in the middle (lower BMI than 'exercise' arm but higher BMI than 'calories' arm / fewer chocolates than 'exercise' arm but more chocolates than 'calories' arm.

This is consistent with other studies that show exercise frustrates weight management rather than supports it, and should probably be eliminated from the lists of valid strategies.

Sounds like a study that had to be datamined for anything substantial.

I disagree - it was preregistered with their endpoints clearly defined. That's the opposite of data mining.

 

[Skeptical Greg]

This is consistent with other studies that show exercise frustrates weight management rather than supports it, and should probably be eliminated from the lists of valid strategies.

What does that leave besides food intake ?


What this list of valid strategies you speak of?

 

[Modified]

The question wasn't about obese people specifically - it was about whether a model of how weight is accumulated can influence a person's actual accumulated weight.

They used BMI though. It seems possible that people who believe that exercise is the best way to lose weight exercise more than the others and therefore tend to have more muscle mass.

 

[casebro]

They used BMI though. It seems possible that people who believe that exercise is the best way to lose weight exercise more than the others and therefore tend to have more muscle mass.

Yeah, that too. I lost 60 pounds, had abs. Doc was not happy, I was still obese- by one pound. An electronic scale gave me a lean body mass of 216, total wt 235. Less than 10% body fat.

Link to the study I've quoted so often: http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.191/full

And I'm sure that I've stated up-thread that the lines of the BMI recommendation were taken form the Met Life tables, which work out to:

Men, 5' tall, 125# plus 5# per additional inch
Women, 5' tall, 100 pounds, plus 5# per inch.

Dunno where Met Life got their data, but that seems a little tooo pat.

Whereas that study of 11,326 people over 12 years say the class I obese live as long as "ideal weight". Overweight has an RR of only .83.

So, that important difference between BMI 25 and BMI 28 is meaningless from a longevity point of view. And what better way to quantify "health" than longevity?

 

[blutoski]

What does that leave besides food intake ?


What this list of valid strategies you speak of?

Do you mean the 'popular' list, or the 'scientifically validated' list?

Because the popular list is huge: the list of 'possible' strategies is infinite, although they can be categorized into buckets. For example, elimination diets are a strategy category ("don't eat anything that starts with the letters A through M on even numbered days, don't eat anything that starts with the letters N through Z on odd numbered days," and "Wednesday I can eat all the potatoes I want, but nothing else."). Macronutrient ratios are another category ("low carb"). Fasting days is another catgory. "Exercise More" is another category, with subtypes involving advice on how much, and whether strength training or aerobic exercise is better &c. None of these move the needle on a population's body fat percentage.

What does seem to work is firstly, environmental shaping. For example, sugar taxes have a measureable impact on a population's body fat percentage. Food advertisement to children restrictions have an impact on children's body fat percentage and future lifetime habits. And secondly, education about how to evaluate a proper portion size and reducing caloric intake has measureable outcomes. But these are hard to implement: the commercial interests that profit from increasing the sale of calories push back and finance miseducation programs and lobbying, which erodes public support.

Jonathan Haidt's work help explains this situation we find ourselves in (rejecting proven solutions because we don't like them) - The psychology of morals comes into play. One of the six 'modules' of instinctive morality is sometimes labelled "fairness (2)", and can also be called "rewards in proportion to effort" - when we combine this with another module called Liberty, we have a problem empowering publicly enforced environment shaping solutions to problems that also have a personal behavior root cause.

To some extent, this thread is a demonstration of this conflict of values: for those who value Liberty and Fairness(2) (Proportionality) - traditionally associated with conservativism - learning that there are validated public solutions triggers motivated thinking: these people are inspired to dig for even the weakest critiques and very immune to the body of supporting evidence.

 

[blutoski]

They used BMI though. It seems possible that people who believe that exercise is the best way to lose weight exercise more than the others and therefore tend to have more muscle mass.

It's possible that a small portion of them do, yes, but c'mon... "I have a high BMI but I'm probably muscly so it's OK," is up there with 'I'm large boned'.

To put this into probabilities: A BMI gap of 3 for a 5'6" BMI 28 person represents 40lbs. 40lbs of muscle is a lot of muscle, putting an additional 25% of body mass into muscle. As a person who has managed strength trainers and reviewed percentiles, such a person would be in the 99th percentile in Canada. Meaning one in a hundred of those people could be seeing the observed BMI difference from muscle mass, yes. Nothing to hang hopes on.

The parsimonious answer based on the information available is that this is adipose tissue.

 

[Modified]

It's possible that a small portion of them do, yes, but c'mon... "I have a high BMI but I'm probably muscly so it's OK," is up there with 'I'm large boned'.

To put this into probabilities: A BMI gap of 3 for a 5'6" BMI 28 person represents 40lbs. 40lbs of muscle is a lot of muscle, putting an additional 25% of body mass into muscle. As a person who has managed strength trainers and reviewed percentiles, such a person would be in the 99th percentile in Canada. Meaning one in a hundred of those people could be seeing the observed BMI difference from muscle mass, yes. Nothing to hang hopes on.

But on the other end, there are a lot of skinny-fat people - those who appear thin or normal size, but have a high body fat percentage. I suspect that almost none of those people do any regular exercise.

 

[blutoski]

Yeah, that too. I lost 60 pounds, had abs. Doc was not happy, I was still obese- by one pound. An electronic scale gave me a lean body mass of 216, total wt 235. Less than 10% body fat.

Link to the study I've quoted so often: http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.191/full

And I'm sure that I've stated up-thread that the lines of the BMI recommendation were taken form the Met Life tables, which work out to:

Men, 5' tall, 125# plus 5# per additional inch
Women, 5' tall, 100 pounds, plus 5# per inch.

Dunno where Met Life got their data, but that seems a little tooo pat.

Whereas that study of 11,326 people over 12 years say the class I obese live as long as "ideal weight". Overweight has an RR of only .83.

So, that important difference between BMI 25 and BMI 28 is meaningless from a longevity point of view. And what better way to quantify "health" than longevity?

I would want to consider a metric called "DALY" (disability adjusted life years) - it measures the number of years a person has the ability to perform the activities they enjoy (as opposed to extended lifespan hooked up to machines).

I'm not big on using BMI thresholds - 25, 30, 35... those are arbitrary cutoffs. In general, there is a gradient of increasing risk with increasing BMI above the low 20s. The thresholds are useful the same way blood pressure brackets and cholesterol brackets are useful, but in general there's a good patch above which there's incrementally increasing risk of morbidity, while not outright mortality. This is a Western phenomenon, and noticeable in Canada where we have public healthcare that can extend lifespan with medical interventions. Note the conclusion in the Canadian study that you linked to:

Care should be taken before extrapolating results on mortality to morbidity. Overweight and obesity have been clearly associated with morbid conditions like heart disease, hypertension, and type 2 diabetes (5,10). The threshold for morbidity may differ from the threshold for mortality, indicating the need for the use of summary measures of population health that incorporate both mortality and morbidity consequences of excess weight. This is an important public health message, because while overweight may not be a risk factor for mortality, becoming overweight is a necessary step between being of acceptable weight and becoming obese....

 

[blutoski]

But on the other end, there are a lot of skinny-fat people - those who appear thin or normal size, but have a high body fat percentage. I suspect that almost none of those people do any regular exercise.

Sure. There's people in the tail ends. There are people with specific conditions such as amputations who have low weight for their height, too. We can find out how many with percentile tables, and decide if it makes sense to accommodate outliers in a public message. So far, it doesn't look like good advice. This is why this is one study of many. We have to glue them together to get a good overall picture. There is no definitive study. There is no single strategy to lose weight.

 

[blutoski]

Sure. There's people in the tail ends. There are people with specific conditions such as amputations who have low weight for their height, too. We can find out how many with percentile tables, and decide if it makes sense to accommodate outliers in a public message. So far, it doesn't look like good advice. This is why this is one study of many. We have to glue them together to get a good overall picture. There is no definitive study. There is no single strategy to lose weight.

Just as an example: I have incredibly low blood pressure because of my athleticism. There is a medical risk to having very low blood pressure for people who are not athletic. My rare exception does not mean we can stop monitoring for low blood pressure in the population, those people are the majority, and they're in danger.

Another one is cholesterol levels. There are people with a genetic mutation (Milano allele) that have astronomically high cholesterol levels... but they're quite healthy. Their acknowledged exception does not mean we should abandon the general strategy of intervention to reduce high cholesterol levels.

 

[rustypouch]

But on the other end, there are a lot of skinny-fat people - those who appear thin or normal size, but have a high body fat percentage. I suspect that almost none of those people do any regular exercise.

There are indeed. BMI is a decent starting point, but not great, as it tends to underestimate obesity when compared to bodyfat percentage.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033308

"BMI characterized 26% of the subjects as obese, while DXA indicated that 64% of them were obese. 39% of the subjects were classified as non-obese by BMI, but were found to be obese by DXA."

 

[blutoski]

There are indeed. BMI is a decent starting point, but not great, as it tends to underestimate obesity when compared to bodyfat percentage.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033308

"BMI characterized 26% of the subjects as obese, while DXA indicated that 64% of them were obese. 39% of the subjects were classified as non-obese by BMI, but were found to be obese by DXA."

I think this is one of the reasons there's a model of BMI risk that considers the risk to possibly be not completely about body fat percentage. In other words: there may be something about being generally 'big' (including bulky muscle) that increases risk of negative health outcomes.

But that aside, yes, for individual analysis, I would use a variety of methods to evaluate a client's fitness goalsetting; I use TANITAs and measuring tape more than BMI on a day to day basis. It would be a more accurate measure of how much weight they can safely lose.

 

[rustypouch]

I think this is one of the reasons there's a model of BMI risk that considers the risk to possibly be not completely about body fat percentage. In other words: there may be something about being generally 'big' (including bulky muscle) that increases risk of negative health outcomes.

But that aside, yes, for individual analysis, I would use a variety of methods to evaluate a client's fitness goalsetting; I use TANITAs and measuring tape more than BMI on a day to day basis. It would be a more accurate measure of how much weight they can safely lose.

Oh, absolutely. BMI is just one tool, and great for populations.

In regards to being big having negative consequences, I can see the same stress being put on joints and circulatory system at a given weight, regardless of body composition.

 

[casebro]

There are indeed. BMI is a decent starting point, but not great, as it tends to underestimate obesity when compared to bodyfat percentage.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033308

"BMI characterized 26% of the subjects as obese, while DXA indicated that 64% of them were obese. 39% of the subjects were classified as non-obese by BMI, but were found to be obese by DXA."

But what was the definition of obese they used? Oughtn't it be "likely to suffer higher mortality"?

Morbidity might be better, but it won't draw a definitive a line as mortality.

 

[Tsukasa Buddha]

Yeah, that too. I lost 60 pounds, had abs. Doc was not happy, I was still obese- by one pound. An electronic scale gave me a lean body mass of 216, total wt 235. Less than 10% body fat.

Link to the study I've quoted so often: http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.191/full

And I'm sure that I've stated up-thread that the lines of the BMI recommendation were taken form the Met Life tables, which work out to:

Men, 5' tall, 125# plus 5# per additional inch
Women, 5' tall, 100 pounds, plus 5# per inch.

Dunno where Met Life got their data, but that seems a little tooo pat.

Whereas that study of 11,326 people over 12 years say the class I obese live as long as "ideal weight". Overweight has an RR of only .83.

So, that important difference between BMI 25 and BMI 28 is meaningless from a longevity point of view. And what better way to quantify "health" than longevity?

Well, this is why we shouldn't rely on one study. Especially in this field of research.

What is already known on this topic

• A high BMI is associated with increased risk of all cause mortality
• A recent meta-analysis found a reduced risk with overweight and that only obesity grade 2 (BMI ≥35) increased risk, but the results could have been confounded by smoking and prevalent and prediagnostic disease and biased because of exclusion of many large cohort studies

What this study adds

• In never smokers and healthy never smokers, there was a J shaped association between BMI and mortality, and the lowest risk was observed at BMI 23-24 and 22-23, respectively
• When analysis was restricted to studies with a longer duration of follow-up (to reduce confounding by prediagnostic weight loss) the lowest risk was observed with BMI 20-22
• Lack of exclusion of ever smokers, people with prevalent and prediagnostic disease, or early follow-up could bias the associations between BMI and mortality towards a more U shaped association

Linky.

 

[casebro]

Well, this is why we shouldn't rely on one study. Especially in this field of research.



Linky.

So once again a study shows overweight is OK, only BMI over 35 is bad.

So should we even use the term overweight ?

And I wonder about the shape of the curve? How much worse is 36 than 34?

My own history, which I know better than any study, agrees. At BMI 35, sleep apnea and diabetes were gone. Too bad I didn't keep a log, perhaps 38 was fine for me too?

Let's see if any of you can walk a mile in my shoes- lose 90 pounds, then give me weight loss advice.

But hey, my high was 325 ten years ago. I'm about 295 now. I lost 10% and kept it off for ten years!

 

[rustypouch]

But what was the definition of obese they used? Oughtn't it be "likely to suffer higher mortality"?

Morbidity might be better, but it won't draw a definitive a line as mortality.

Obviously you didn't read it. It's all explained.

And why? What's wrong with BMI? It correlates very well with what you're asking. It's great for large groups, and a decent starting point for an individual.

"BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5–25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30–35 kg/m2, median survival is reduced by 2–4 years; at 40–45 kg/m2, it is reduced by 8–10 years (which is comparable with the effects of smoking). The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases"

From here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60318-4/fulltext?_eventId=login

And for losing weight, I've lost 75 pounds. Is that enough to know how it's done? It's ridiculous how much it makes *everything* better.

 

[blutoski]

Let's see if any of you can walk a mile in my shoes- lose 90 pounds, then give me weight loss advice.

But hey, my high was 325 ten years ago. I'm about 295 now. I lost 10% and kept it off for ten years!

And for losing weight, I've lost 75 pounds. Is that enough to know how it's done? It's ridiculous how much it makes *everything* better.

As somebody who has worked in this field where clients seem to gravitate toward the trainers who have what we call 'currency' - I advise against falling into the trap of feeling you have to be fit to give qualified advice. That's capitulating to both hasty conclusion and the genetic fallacy, which skeptics should identify and reject as flawed reasoning.

We need to look at the literature, and ignore anecdotes, no matter how appealing.

 

[pipelineaudio]

At 5'9" and 200 pounds, I am Overweight/Obese according to the BMI. I was 270 and completely round, before I started this exercise program. I went down to 170 and then as I got skinnier from 170, by waist and abdomen measure, my weight went up to 200, but far skinnier than 170

https://www.instagram.com/p/BJ1qpyOBUBZ/?taken-by=pipelineaudio