The stupid explodes: obesity now a disability

[Tsukasa Buddha]

Look at the fore arm in my avatar.

If I squint I see a mint green blob . But seriously, many men fall into this trap of saying they are "strong", and in denial of carrying stones of excess adipose tissue and visceral fat.

If you haven't been paying attention, I have a lean body mass of 220 lbs. Look at the fore arm in my avatar. Stable calories at that body mass, add a reasonable amount of fat- say 10%, plus it's attendant added water, we get about 250 lbs. Break even calories is probably 2700? Today I am 294, so 3000 is basal.

Or should I starve to cachexia to lose muscle mass?

I'm not understanding what you are saying. By this math (220 lean, 294 total) you are at 25% body fat. So why would decreasing your caloric intake below your energy expenditure lead to muscle loss as opposed to fat loss? Cutting (calorie deficit to lose fat) after bulking (calorie surplus to increase muscle) is an important part of most body builder routines. We don't have a set "lean body".

In addition, 25% body fat is obese. So by your own estimates (which I would wager are inaccurate) your BMI is accurate in classifying you as obese.

Studies are trumped by individual history.

I don't think this statement makes sense, but I want to disagree with what I think you are saying.

Not to mention that I an 98th percentile in every way- ht, wt, glucose, creatinine clearance, number of surgeries to hands, IQ. So I'm off the charts on those studies.

I... This doesn't make sense. 98th percentile glucose is not a thing, and if it were I am pretty sure you would have uncontrolled diabetes. Not to mention "my current blood work" is a fallacious argument because healthy obesity leads to unhealthy obesity.

 

[Rolfe]

I was debating whether to say anything, because I don't understand the individual numbers the way Tsukasa Buddha does, but this doesn't compute for me either. This repeated insistence that a BMI of up to about 35 is "healthy" is also a bit off the wall. We don't know how tall Casebro is, but 294 lb is exceedingly heavy by any metric, even if he's six feet six. He explains this by asserting that he has extremely heavy muscle development.

Now this may be so, or rather may have been so at one time, but there are a lot of problems with the story as we're hearing it. The remark about "starving myself into cachexia" may be the key here.

Cachexia is the situation where the body is consuming so little nutrient that it starts to cannibalise its own tissues for energy, protein and other essential elements. It is seen in extremes of malnutrition, including situations where the patient has essentially no appetite. It is not a good thing. Obviously, one of the things that happens is loss of muscle mass, as muscle tissue is consumed. Think pictures of famine victims with their stick-thin arms and legs, carrying far less muscle tissue than would be normal. Nobody should starve themselves into that condition.

But there is another situation where muscle mass regresses or atrophies and it's entirely normal and not in the least unhealthy. That is when someone with very well-developed musculature stops doing the exercise that caused the muscles to develop to that extent. (You even see it in normal weight loss, when the body no longer needs to carry around that 20 kg fat that has been dieted off, and so muscle bulk atrophies a bit as a consequence of stopping that "weight training".) If you don't or can't exercise, your muscles will at the very least regress to normal for your height.

We all know the stories of the retired power athletes where "the muscle turns to fat". Of course muscle can't actually turn into fat but that's what seems to happen. The athlete stops the exercise but goes on consuming the same amount of food as he did when he was in training. Result, the muscle atrophy happens anyway, as it inevitably will, and he puts on a lot of fat because he's eating far too many calories for his new activity level.

Anyone, especially someone who is heavily muscled, needs to reassess their calorie intake drastically if their activity level drops off dramatically. I have every sympathy with anyone who is disabled to the point where they can't leave their chair, but 3000 calories a day is a lot to be eating in that situation. And of course someone who is very heavy is going to have a much more difficult time coping with day-to-day living if they have an orthopaedic condition that makes moving difficult, and indeed excess weight (whether fat or muscle) is obviously going to predispose to joint injuries and degeneration.

So it's all a bit of a strange story and sounds very much like someone in denial, rationalising away their situation as "I'm a special snowflake".

 

[Rolfe]

But this isn't getting us anywhere as regards what seems to be the actual topic of the thread, which is the normalisation of obesity and the medicalisation of disabling obesity. There is some extremely interesting discussion above about approaches to this problem on a population basis which is what I really wanted to explore further.

Individual stories can be very illuminating as they demonstrate the different approaches that work for different sections of the population, but concentrating on a particular case which is said to be "off the charts" isn't really getting us anywhere.

I think the contrast between the people MikeG talked about who joined cycling clubs and cycled really seriously while not altering their dietary habits, and someone like me who cut down to around 6000 calories a week (with time off, as both psychological and physiological relief) while not introducing any extra exercise at all, is interesting. The balance between extra exercise and reduced intake which works seems to very a lot between individuals, and trying to get people to stick to a regime which isn't right for them is probably doomed to failure.

How to get people motivated, and help them find the balance that will work for them?

 

[Rolfe]

I'm old enough to remember when my mother went to the grocer and the butcher and even maybe the baker with a shopping list and asked for what she wanted and was served with these items individually over the counter. There were displays of the wares of course but they were relatively limited. (I still remember standing inches from whole lamb carcasses in the butcher's shop, not much chance of shielding small children from the reality of meat production then.)

I remember when supermarkets started to be a thing and instead of going to Aunt Mollie (who died a few years back at the age of 100) with your "line" you went round with a basket and picked up the things you wanted for yourself. That of course started you thinking about buying things you didn't intend to buy when you went into the shop. But the produce was still much the same as it had always been.

Cakes were baked in the home, and that was much nicer than shop-bought cake. Sweets were consumed, and after all we were very active children, running round on our bicycles or climbing trees or hills, and I particularly remember an improvised dry sledging slope on a slag heap ("bing") nearby where we used to toil up repeatedly dragging rubber mats so we could slide down with whoops of glee.

Portions weren't huge and there weren't any fancy buttery or oily sauces and dressings. Eating between meals was vocally discouraged.

Takeaway food outlets did exist, principally the chip shop, but when I was a child there wasn't one in the village and it was a treat for seaside holidays. Even then, the portion sizes were much smaller. There was a wee paper poke which even filled to overflowing (which it was) didn't hold an awful lot. For 6d. Now you pay maybe £1.50 for an absolutely ridiculous pile of chips.

But in particular these hugely calorie-laden ready-meals didn't exist. 650 calories for a single-person portion? What the hell is that all about? It all seems to be about selling us as much as possible and making us hungry enough to come back for more. And nobody can do anything about it. That's capitalism for you. The market rules. And in this case the market is a population who have evolved some pretty powerful primal urges to grab high-energy food and consume it when they see it's available.

Oh dear.

 

[casebro]

Let me try the math again. Point being, what is a healthy weight w/ 15% fat ? Because basically, "healthy BMI" IS 15% body fat. ( Posted by me somewhere above was a scatter plot of BMI vs body fat%)

I have a lean mass of 220 lbs. add 15% for fat, = 250#. Calories per day needed to maintain that healthy weight, about 2700. Current weight is not in this part of the discussion. Last time I was down to BMI 35, still "obese", diabetes was gone along with sleep apnea. So that is a healthy weight for me- minimum morbidity..

The Kaiser study that I linked above is one of the few that actually looked at BMI vs mortality. It says 17-34 is fine. I have no clue where the "healthy BMI is 22" came from, haven't ever seen a study. I believe it is from conversion of the Metropoloitan Life Insurance tables that go back to the 1920s, and again, no science backing for it.

Now back to personal- current wt 294, ht 6'3" BMI 37.6. Currently very sedentary due to temporary health issues. Wt stable, so 3,000 calories per day. Health plan is to get a couple surgeries, and get active, burning 5,000 calories per day. Lose 5-10 pounds per week. So tell me, how can I melt away muscle mass, and still do that much 'training'?

Ht, 98th percentile, outlier, studies are meaningless. Lean mass, 220, outlier, studies are meaningless. Body fat % is the bet indicator.

I've done this before, 2011. And I am in better condition now than I was then. Meantime, also, I've learned a bit more about my genetic metabolism. I need more choline (eggs or liver) and stay away from tyramine (fermented foods). LDL s down in the
80s, kidneys have recovered from the Vancomycin. A1C 7.1, fine for someone on insulin. I'm rarin' to get with it.

Today is consult with thumb surgeon. If I need surgery, I won't be able to use the walker in 10 days, for the knee replacement. So it may get put off another month or two.

Diabetes is no good for me, sleep apnea is strangling me, but a few crackers with peanut butter still sounds good. Exercise is more doable than diet.

 

[rustypouch]

Let me try the math again. Point being, what is a healthy weight w/ 15% fat ? Because basically, "healthy BMI" IS 15% body fat. ( Posted by me somewhere above was a scatter plot of BMI vs body fat%)

I have a lean mass of 220 lbs. add 15% for fat, = 250#. Calories per day needed to maintain that healthy weight, about 2700. Current weight is not in this part of the discussion. Last time I was down to BMI 35, still "obese", diabetes was gone along with sleep apnea. So that is a healthy weight for me- minimum morbidity..

The Kaiser study that I linked above is one of the few that actually looked at BMI vs mortality. It says 17-34 is fine. I have no clue where the "healthy BMI is 22" came from, haven't ever seen a study. I believe it is from conversion of the Metropoloitan Life Insurance tables that go back to the 1920s, and again, no science backing for it.

Now back to personal- current wt 294, ht 6'3" BMI 37.6. Currently very sedentary due to temporary health issues. Wt stable, so 3,000 calories per day. Health plan is to get a couple surgeries, and get active, burning 5,000 calories per day. Lose 5-10 pounds per week. So tell me, how can I melt away muscle mass, and still do that much 'training'?

Ht, 98th percentile, outlier, studies are meaningless. Lean mass, 220, outlier, studies are meaningless. Body fat % is the bet indicator.

I've done this before, 2011. And I am in better condition now than I was then. Meantime, also, I've learned a bit more about my genetic metabolism. I need more choline (eggs or liver) and stay away from tyramine (fermented foods). LDL s down in the
80s, kidneys have recovered from the Vancomycin. A1C 7.1, fine for someone on insulin. I'm rarin' to get with it.

Today is consult with thumb surgeon. If I need surgery, I won't be able to use the walker in 10 days, for the knee replacement. So it may get put off another month or two.

Diabetes is no good for me, sleep apnea is strangling me, but a few crackers with peanut butter still sounds good. Exercise is more doable than diet.

Where do you get the lean mass number from? Those numbers are a lot to believe. If true, you're on par with Arnold in his prime in terms of musculature. His height is 6'3", and his competition weight was 235.

 

[casebro]

Where do you get the lean mass number from? Those numbers are a lot to believe. If true, you're on par with Arnold in his prime in terms of musculature. His height is 6'3", and his competition weight was 235.

Actually,he doesn't make 6'. 5'8"? 5'10" ?

But the HMO has an electronic scale, plus the Zone diet book has a chart that is +/- 2%, plus some other calculation method I can't recall. '

My rib cage below my breast muscles, above my gut, not much fat there even now, measures 51 inches relaxed, 53 on inhale. Wrist is 8 1/2" around.

Pretty much outlier, eh?

But my gut measures 50" too.

 

[Rolfe]

Let me try the math again. Point being, what is a healthy weight w/ 15% fat ? Because basically, "healthy BMI" IS 15% body fat. ( Posted by me somewhere above was a scatter plot of BMI vs body fat%)

I have a lean mass of 220 lbs. add 15% for fat, = 250#. Calories per day needed to maintain that healthy weight, about 2700. Current weight is not in this part of the discussion. Last time I was down to BMI 35, still "obese", diabetes was gone along with sleep apnea. So that is a healthy weight for me- minimum morbidity..

The Kaiser study that I linked above is one of the few that actually looked at BMI vs mortality. It says 17-34 is fine. I have no clue where the "healthy BMI is 22" came from, haven't ever seen a study. I believe it is from conversion of the Metropoloitan Life Insurance tables that go back to the 1920s, and again, no science backing for it.

Now back to personal- current wt 294, ht 6'3" BMI 37.6. Currently very sedentary due to temporary health issues. Wt stable, so 3,000 calories per day. Health plan is to get a couple surgeries, and get active, burning 5,000 calories per day. Lose 5-10 pounds per week. So tell me, how can I melt away muscle mass, and still do that much 'training'?

Ht, 98th percentile, outlier, studies are meaningless. Lean mass, 220, outlier, studies are meaningless. Body fat % is the bet indicator.

I've done this before, 2011. And I am in better condition now than I was then. Meantime, also, I've learned a bit more about my genetic metabolism. I need more choline (eggs or liver) and stay away from tyramine (fermented foods). LDL s down in the
80s, kidneys have recovered from the Vancomycin. A1C 7.1, fine for someone on insulin. I'm rarin' to get with it.

Today is consult with thumb surgeon. If I need surgery, I won't be able to use the walker in 10 days, for the knee replacement. So it may get put off another month or two.

Diabetes is no good for me, sleep apnea is strangling me, but a few crackers with peanut butter still sounds good. Exercise is more doable than diet.

Lean body mass of 220 lb in someone of 6 feet 3 inches who is currently unable to exercise at all. Is that realistic or indeed healthy? No it is not. It's the musculature of someone doing a great deal of weight training. It's not a situation that can be maintained without keeping up that weight training.

Without the weight training, muscle mass will reduce considerably. If the person goes on eating as if that muscle mass was still there, it becomes the perfect "muscle turns to fat" scenario. Someone unable to exercise for whatever reason has to adjust his diet to the normal for his height, excluding the muscle hypertrophy. Or else run to rather a lot of fat.

Simply not being diabetic or having problems with sleep apnoea does not equate to healthy. It simply reflects "not quite as unhealthy as all that".

Now you may think that exercise is "more doable" for you than calorie restriction, and that does seem to be the case for some people even though it has been discussed at length in the thread just how much exercise is needed to burn off a small chocolate biscuit. (I have the opposite experience - for me calorie restriction is not especially difficult at all and I'd rather do that than exercise. This is the point I've been trying to make, that individuals differ in the approach they find most practical.)

But if you can't get out of your chair because of an orthopaedic problem then self-evidently exercise is not "more doable" for you at the moment. And eating as if you have a musclebound frame that is not going to change even if you just sit there and don't move isn't going to help.

Lots of people are 6 feet 3 and more. Lots of people are quite well-muscled. This doesn't make them special snowflakes that normal rules don't apply to.

 

[Skeptical Greg]

....

But my gut measures 50" too.

A 50" gut ( waist? ) has got to have a lot of fat...


What is your hip measurement?

 

[casebro]

Lean body mass of 220 lb in someone of 6 feet 3 inches who is currently unable to exercise at all. Is that realistic or indeed healthy? No it is not. It's the musculature of someone doing a great deal of weight training. It's not a situation that can be maintained without keeping up that weight training.

Without the weight training, muscle mass will reduce considerably. If the person goes on eating as if that muscle mass was still there, it becomes the perfect "muscle turns to fat" scenario. Someone unable to exercise for whatever reason has to adjust his diet to the normal for his height, excluding the muscle hypertrophy. Or else run to rather a lot of fat.

Simply not being diabetic or having problems with sleep apnoea does not equate to healthy. It simply reflects "not quite as unhealthy as all that".

Now you may think that exercise is "more doable" for you than calorie restriction, and that does seem to be the case for some people even though it has been discussed at length in the thread just how much exercise is needed to burn off a small chocolate biscuit. (I have the opposite experience - for me calorie restriction is not especially difficult at all and I'd rather do that than exercise. This is the point I've been trying to make, that individuals differ in the approach they find most practical.)

But if you can't get out of your chair because of an orthopaedic problem then self-evidently exercise is not "more doable" for you at the moment. And eating as if you have a musclebound frame that is not going to change even if you just sit there and don't move isn't going to help.

Lots of people are 6 feet 3 and more. Lots of people are quite well-muscled. This doesn't make them special snowflakes that normal rules don't apply to.

Sure, 2% of the population is 6/3 or taller, but how many of the population have a 50" rib cage? 2%? 2%of 2% is .o4%, 4/1,000.

Maybe I forgot to mention that I am one of Jerry's Kids. Though I think I did mention myoglobinuria, didn't I? Ragged red fibers, lipid storage vacules, pyknotic nuclear clumps. Been that way all my life. Recently found that choline helps.

My history trumps your personal opinion.

 

[Modified]

Where do you get the lean mass number from? Those numbers are a lot to believe. If true, you're on par with Arnold in his prime in terms of musculature. His height is 6'3", and his competition weight was 235.

That's not unusual at all. It's having that much muscle with very little fat that's essentially impossible without chemical assistance and training (well, competition-shape-Arnold-sized at his height is possible without roids for a very few people).

 

[Modified]

Actually,he doesn't make 6'. 5'8"? 5'10" ?

Nah, he definitely was over 6', and perhaps the 6' 1 1/2" as claimed. You can compare him on stage, barefoot, to other bodybuilders. He might have lost a few inches since then though. Also, when you're doing heavy load-bearing exercise as he was, you can easily wake up an inch taller than normal, so the claimed measurements might have been true but temporary.

 

[Skeptical Greg]

Sure, 2% of the population is 6/3 or taller, but how many of the population have a 50" rib cage? 2%? 2%of 2% is .o4%, 4/1,000.

Maybe I forgot to mention that I am one of Jerry's Kids. Though I think I did mention myoglobinuria, didn't I? Ragged red fibers, lipid storage vacules, pyknotic nuclear clumps. Been that way all my life. Recently found that choline helps.

My history trumps your personal opinion.

Not sure what a 50" rib cage gets you, when you are overweight..

... Or being one of Jerry's kids for that matter..


If you are in a special group, it would appear to be a group that has to work harder to stay healthy, if living longer and quality of life are important to you.

 

[Rolfe]

Sure, 2% of the population is 6/3 or taller, but how many of the population have a 50" rib cage? 2%? 2%of 2% is .o4%, 4/1,000.

Maybe I forgot to mention that I am one of Jerry's Kids. Though I think I did mention myoglobinuria, didn't I? Ragged red fibers, lipid storage vacules, pyknotic nuclear clumps. Been that way all my life. Recently found that choline helps.

My history trumps your personal opinion.

I'm a biochemist, so it's a bit more than personal opinon.

As Greg said, you seem to be in a special group as in specially challenged when it comes to maintaing a healthy body shape and size. If you choose to go for rationalisations and claims of exceptionalism rather than facing the challenges, well it's a free country.

I'm not sure though how enlightening it is to delve into the medical history of one special snowflake who thinks the rules don't apply to him, when the topic is the normalisation of obesity at a population level and the medicalisation of disabling obesity.

 

[GlennB]

Actually,he doesn't make 6'. 5'8"? 5'10" ?

1.88m or 6.16'. About 6'2"

Meanwhile, the last resort of a starving body is its own muscle protein. You can lose the weight of the fat around your 50" waist long before you start risking muscle.

 

[Rolfe]

Of course muscle will atrophy for other reasons too. The most obvious one is when someone who has been doing a lot of power lifting or similar exercise stops doing it. Eating more, or indeed eating the same diet as was being eaten while the exercise was being done, won't make a blind bit of difference to that. Nor will protein shakes or any fancy trace element supplements.

And one thing a lot of people fail to take acount of is the effect of the "power lifting" an overweight person is doing day in day out, all day, when moving their own body around. When a diet is successful and someone loses weight as in fat, the muscles aren't getting that workout any more and so atrophy to some extent. Anyone who wants to eliminate (probably impossible) or minimise this effect has to take up power lifting!

A lot of nonsense is talked about muscle loss when on a calorie-restricted diet. Some gurus paint it as a seriously bad thing that has to be combated at all costs. Don't lose weight too fast or you'll lose muscle and it's almost impossible to put that muscle back on! Nonsense. Lose weight at any speed and you'll lose muscle, naturally, unless you replace every pound you lose with a pound on an all-body weight-carrying suit. And it's almost impossible to put that muscle back on unless you take up the wearing of such a suit on a permanent basis. (Or put the weight back on of course.)

Obviously taking up a suitable exercise regimen will counter this to some extent, but you'd have to be into full-on bodybuilding to mimic the effect of carrying 30 kg of fat around with you everywhere you go.

Most people who want to lose weight for aescetic or health reasons don't care about this at all, but they're often frightened to death by lurid tales of losing muscle they'll "never get back". Fitness and diet gurus have a lot to answer for. Glen is quite right, real cachexia leading to emaciation is a feature of extreme malnutrition, not a sensible dietary readjustment to trim off some weight or compensate for a reduction in exercise.

 

[blutoski]

On topic op/ed piece:

US News: [Many people's realities make lifestyle reform a nearly impossible luxury.]

Author is "an assistant professor of family medicine at the University of Ottawa, where he’s the founder and medical director of the Bariatric Medical Institute – dedicated to non-surgical weight management since 2004."

 

[Skeptical Greg]

Nonsense..

Everyone has 24 hours a day in which they can choose not to eat crap that makes them fat......

Just a lot of sympathy for people who make excuses about eating healthy and getting exercise for themselves and their children..

 

[Rolfe]

It doesn't take me any longer to pick up the makings of a decent variety of home-cooked meals than it does to pick up calorie-laden ready-meals. I use a lot of frozen vegetables which saves on preparation and eliminates waste. I don't have to use up veggies that are going soft. And it takes me about 20 minutes to cook the food - but I'm doing other things in the kitchen while it cooks.

I find fast food from takeaways very expensive compared to cooking for myself too, so it can't be that. I genuinely don't understand how people on low incomes can afford to be buying takeaways all the time.

 

[blutoski]

It doesn't take me any longer to pick up the makings of a decent variety of home-cooked meals than it does to pick up calorie-laden ready-meals. I use a lot of frozen vegetables which saves on preparation and eliminates waste. I don't have to use up veggies that are going soft. And it takes me about 20 minutes to cook the food - but I'm doing other things in the kitchen while it cooks.

As the cook in my household, I'm not sure that's true. I've challenged myself to do the different levels of 'from scratch'. Do you grind your own flour, for example? We all pay extra for 'convenience' - we just judge those who choose more convenience on the continuum as morally inferior and resent those further along the 'prep' chain who judge us as judgy mcjudgerton.

I'm also on record as somebody who believes many store bought frozen meals can be healthier than those cooked at home, and easier to monitor calorie counts for those who are using that strategy. What I'm saying is: I don't think there's a strong correlation with convenience vs home prepared and obesity, BUT that those cooking from fresh ingredients probably are self-selected as higher educated, which is itself correlated with better eating habits. I think it's a common cause connection rather than directly causal.

I find fast food from takeaways very expensive compared to cooking for myself too, so it can't be that. I genuinely don't understand how people on low incomes can afford to be buying takeaways all the time.

A few are, but not in proportion to obesity. Obesity is more correlated with low education than it is low income.

I think it depends on how low income we're talking about. For example, in the DTES where I volunteered with CHIUS, it's mostly single occupancy or shelters. No freezer, no kitchenette, no fridge. It's like a dorm: a hotplate is grounds for eviction, and stored food gets stolen pretty quickly. So it's mostly prepared food in that income bracket, if that answers your question.

Even grocery shopping can be a challenge for somebody with a long commute. I was at my sister's place, and the IR is about a 2 and a half hour bus ride from the nearest grocery store. So: frozen veggies are going to thaw, as an example, and pretty much off the shopping list for that community. Juice crystals, on the other hand, are immortal, so a logical choice for beverages. If your shopping is a 5 hour bus ride out and back, you're not buying a lot of spoilables or frozen food, as it's something you want to do infrequently (monthly). Not surprisingly, IRs have a very high obesity incidence.


In any case, the reactions are not surprising - as in predictable. There's just a chasm that I'm not sure how to bridge between people who very highly value personal accountability versus those who think it interacts with our environment enough to advocate for enforced restrictions in the name of public health. This topic is identical to vaccination, in my list of skeptical topics.

There's actually a science of morality (descriptive - not normative) with a model called "Moral Foundations Theory" that has identified what they believe are biologically predisposed 'moral dimensions' that people value, and how they cluster into different high level moral positions. The proposal to address a problem by environmental shaping is championed by those who strongly value Care and Fairness=opportunity, and opposed by those who strongly value Liberty and Fairness=proportionality. These are generally the same clusters as pro and anti vaccination cohorts.