Excess weight, obesity more deadly than previously believed
colorado.edu
colorado.edu
“I would argue that we have been artificially inflating the mortality risk in the low-BMI category by including those who had been high BMI and had just lost weight recently,” he said.
It's like the teetotaling bias — a chunk of people who teetotal do so because they have an illness that makes drinking very unwise (or would conflict with medication).
https://healthjournalism.org/blog/2019/02/breakthrough-resea...
It's beautiful....
I'm still crying. :)
There are a few odd things about this approach.
First, 20% of people in a healthy weight being previously overweight/obese? This seems high? Could there be reporting bias or other things here? I'm still trying to understand the full study, but it is odd that more people lost weight than gained weight, according to the numbers I'm seeing in it. Although that may be partially explained by the fact that it was limited to people 45 - 85 years old.
Second, the methodology of taking anyone who was previously overweight/obese and is now healthy (weight-wise) into their own group and then attributing increases in mortality purely to weight seem suspect? There are a lot of things that can cause you to lose weight and lead to increased mortality that aren't related to weight, and those would be captured in here.
The conclusions definitely make sense and "feel" right, at least directionally, I'm just a little confused about some of the methodology to get there.
Don't people typically gain weight in that age range, the opposite of what would explain that?
A lot of it is explained by muscle loss.
I do not believe that there is a significant portion of the human population that wakes up each day and decides to actively diminish their long-term health by overeating sheerly because he or she lacks the willpower/motivation to improve themselves. I feel that the minor, medium, and major stressors in life are what subconsciously steer one down this path. It's not like people who abuse substances[1] are completely oblivious or ignorant to the negative consequences of the substance.
I think most people understand living an active lifestyle and eating a healthy diet is beneficial, but it's just not plausible for many. Be it time, money, or energy -- I do not think the average person has enough of all three at the end of any given day.
Educating people on how to better take care of themselves is not enough. Obesity is a symptom not a disease in my eyes. I am starting to believe onus of responsibility is less on the individual than we might think for when many of the rats in this rat race are dropping like flies, then perhaps the issue the with the race and not the rats?
[1] I consider food, especially junk food, to be a substance which can be abused.
I view the issue much like burnout. Who's fault is it for burnout? The employee or the employer? To be honest, just like obesity, it's probably a bit of both (not claiming employers are causing obesity).
> How hard is it to eat chicken/tofu + veggies for one meal a day and cut out pizza/pasta/rice/wheat?
It depends on how much one earns. It's a lot easier for someone making a HS salary than minimum wage which in my state, is still $7.25/hr.
I am not saying individuals are not responsible, but I do not agree that individuals are solely responsible. There are other factors at play.
I think we have a societal issue -- people are overworked and overstressed on average. Hell, depending on the source of information, around 20%-25% of Americans are prescribed psychiatric medication. That signals we are facing systemic issue within our society. Why are people so depressed, anxious, and or flying off the rails?
Another issue is that our society has become more sedentary as a whole -- especially in the work place. I imagine there were much less sitting/standing at a desk all day in 1923 than there is in 2023 on average. I think a lot of people were able to fulfill their minimum exercise needs without much effort -- be it factory work, more walkable cities, etc.. Is the increase in sedentary jobs, lack of walkable cities, etc.. an individual's fault or society's?
Maybe I am just talking out of my ass, but I would like to see any kind of research, if it even exists, on if there is a correlation between hours worked in a sedentary job and obesity.
Again, this still is not the fault of an individual which was I the point I was trying to make. Thank you for this bit, I will try to add this to my opinions next time I have a discussion about obesity.
Much easier to say no to a 300 cal donut than to run 30 minutes.
Cutting out the daily donut for two weeks is about a pound of fat.
Maybe we need a “just say no” to junk food campaign like we had in the 90s.
Lean meat, tofu, tempeh, seitan, veggies, low calorie sauces, limited fruits, protein smoothies (watching the sugar/fat)
Do a few pushups, a light run, increase slowly.
Make it sustainable, not a flash crash.
I counted the steps. Under 600 steps. Not even around the block, and a ~20mg/dL reduction in blood glucose.
Similarly, people probably walk way way less than you would expect. It is kind of scary to see how few steps I can get on a standard day.
That's maybe the magic of "walkable neighborhoods." You just walk over to the store/the cafe/the restaurant real quick, and then you walk back. It was only maybe a few hundreds steps, but that's enough to put away a ton of the glucose you just dumped into your bloodstream.
It is shocking how little walking is necessary to have a massive impact on glucose. 500 steps or so is easily enough for me.
I went down to 1800 calories and the remaining 10kg were gone in 6 weeks.
I wrote earlier that reforming my diet to protein-centric, 1800-2000cal a day + 15k steps walking + some lightweight kettlebell work was enough to get things going. I used myfitnespal, really useful.
It wasn't too hard, to be honest, as I am relatively used to training. For some ppl even walking 10k a day is a challenge.
For comparison, I recently went from 132kg (290lbs) to 111kg (245lbs) in the last 5 months without counting calories, on a very-low-protein, ultra-high-fat diet.
Re. the abs, I've never had them but my impression is they're hidden by basically the last 5lbs of fat you'll lose. So nothing and then they're suddenly there makes sense. Congrats!
My collegue went from 115kg to 85kg some time ago. I know it's a different kind of game. Took a year for him. He was younger, in his late 20s, so running was still an option for him. I am In my late 30s, and traumas accumulated so i had to accept that calorie counting was the only remaining option.
Also, I'd suggest still working from a high-protein approach. You get to keep you muscle, especially if you do some reasonable amount of training.
Back when i doing boxing in early 20s I was as low as 69kg, and still didn't see the full 6-pack. Go figure....
For many people, no it's not. Becuse their metabolism just decreases by the exact same amount they cut calories. They cut out the daily donut, and they find themselves fidgeting less and wearing a sweater because they're suddenly a little chilly a lot of the day. And the scale doesn't budge.
For many people, losing weight is a whole lot more complex than reducing by x calories per day. Getting your body to burn fat rather than slow its metabolism can be maddeningly difficult.
That said, as someone who struggles with weight loss, it's still hard. There are both physioloical and psychological issues that make it challenging.
As an aside, keto is the only thing thats worked reliably for me so far - largely because of the caloric restriction it inherently forces. I stopped following it because people kept telling me they were concerned it was unhealthy, but I'm sure the weight is worse than anything else.
Not sure who told you it was bad for you, I've predominantly heard it being touted as beneficial and longevity-increasing.
I've seen people losing 40kg (120kg to 80kg) by just walking and counting calories. It's the last 5-6 kg that are harder than the first 20kg is almost trivial to lose - one all the right habits are in place.
And habits are the hardest part. It's not the body, not laws of thermodynamics, it's just your habits (most of the time).
Obviously different people are different.
And it has utterly nothing to do with habits, you can see my other comment. It's about the whether you can even manage the other health consequences you suffer from your metabolism being so low.
Given lightweight excercise (walking,kettlebells, etc) that's almost impossible!
Yes, but at the cost of your immune system severely degrading so you suddenly get colds all the time. At the cost of extreme fatigue and brain fog. At least that's what's made weight loss difficult for me at times.
Because for some people (like me), your body drops its metabolism to well below what's healthy before it even thinks about burning fat. It's not any question at all of willpower or psychology, it's purely physiological.
For a few people losing weight is complex. For most people, it’s simple.
Eat less. Move more.
Saying otherwise is a cop out.
Unless you have some fundamental food-related disorders it's not that hard. Our bodies were meant to gain weight weight quickly - and lose it if necessary. For most people losing 10-20 kg is a question of 3-4 months, or even less.
If it were that simple, most people would be able to do it. The actual evidence shows it's far more complex than you think.
There's no cop out here. Many people's bodies simply refuse to burn fat until their metabolism has gone so low it has other dangerous health consequences.
Also, as for "move more", the evidence shows that people generally eat even more after exercise to compensate. Exercise is great for general health, but it's a terrible strategy for most people for losing weight. It simply backfires.
While I'm completely behind your post in general, unfortunately it's much more complicated. It comes down to calories in vs energy consumption. If you oversupply your buddy with calories however most science I read states 7.000 calories of surplus to be one kilo in fat in the average human. Highly recommend the Huberman episode about nutrition.
If you have a healthy relationship with food then you're fine, otherwise every day you're faced with willpower checks that you might struggle to consistently pass.
>Among these patients, lean mass accounted for approximately 39% of total weight loss – substantially higher than ideal. In a substudy of 178 patients from the SUSTAIN 8 trial on semaglutide as a diabetes treatment, the average proportion of lean mass loss was nearly identical at 40%, despite lower doses and less total weight loss than in the STEP 1 trial. [...]
Or in other words, 60% of the weight loss was in fat. The article paints this as concerning, but doesn't provide justification why. Sure, it'd be better to have 0% lean body mass loss, but how does 40% stack compared to calorie deficit diets? The mechanism of action behind the drugs is to cause you to eat less, and if the side effects are consistent with eating less, I don't see why people should be extra concerned.
The justification is provided: this is nearly double the lean body mass loss usually seen in drastic weight loss. Yes, 0% is impossible, but this is worryingly high. It might be OK in younger individuals who have a ton of fat mass to lose, and they might gain any lean body mass back. But in older individuals that are already having a hard time exercising, it's unlikely that lean body mass will ever come back.
Makes me think these drugs should probably be a measure of last resort. Unless more studies defuse this.
For the rest of us there's discipline and sheer willpower, as well as smart energy management.
Train too hard? My appetite goes nuts. Train not enough? The weight loss is muscle. It kind of never stops.
(Speaking as someone fast approaching the big five oh, on the very upper end of the normal BMI and not enough muscle to sugar coat all the excess gut fat which somehow disappears when clothed thanks to an above average height yet is still very much a risk factor.)
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To emphasize: the real point is the meta-framework of experiments. Formulate a hypothesis, design a 30-day experiment, test it. I’ve probably done dozens of these over the years.
Here are some examples from the last few years:
30 days of cold showers
90 days of no online news (I thought stress might contribute)
90 days of the carnivore diet
30 days of eating only at In’n’out burger
Doing Starting Strength, a beginner’s powerlifting program
Doing Simple & Sinister, a kettlebell training program
30 days of a low-fiber diet
30 days of a low-protein diet
30 days of a potato diet
30 days of drinking only distilled water (including for coffee)
Eating only pemmican, a raw meat paste invented by Native Americans
But I had that "willpower" for decades and didn't lose much weight. Certainly "pushing harder" didn't change anything.
And then flicking one little switch made it super easy with no willpower involved. So I just don't see how the willpower is related to losing fat.
Do have to add - it's impressive that you went through all these documented efforts. In the name of science and all that.
2) I didn't lose the weight on keto. I did keto for 7 years and managed to gain 100lbs back while on keto. This fat loss is very recent, and while it's still a ketogenic diet, it really is some magic little switch that I've flicked - I just don't know (yet) which one :)
It's far easier for me to just do caloric restriction. Granted I wouldn't lose weight as quickly.
That might have been your experience but millions of other people claim otherwise. Either a million people are wrong, or you're an anomaly. I think the latter is more likely.
Of course you should change how you eat if how you ate caused you health problems. But I'm advocating for making a conscious change that will then enable you to eat without having to use willpower.
That's why "just eat less" is terrible advice and works for practically nobody.
It's like finances. "Just save more" is terrible advice. Getting a degree or finding a high paying job or setting up automatic 401k contributions doesn't require willpower day-to-day, and has a much higher chance of success.
Not buying the bag of chips is an obvious example, as is buying a used car vs. leasing a new one.
Picking a diet that doesn't make you overeat is another one, and I'm in the process of figuring out what that means for me :)
Saying "willpower doesn't work" is just as bad.
I actually agree with what you are trying to say, but you're arguing it very poorly.
When I reduce carbs below 30g/day, my appetite is naturally suppressed (or avoids over-stimulation). Food feels much less addictive. It's easier not to snack in the face of stress. Keto probably added 10+ years on to my life expectancy.
YMMV.
No guarantee that it'll work (I haven't tried myself) but seems like a thing that could help you.
But traumas do accumulate. 10 km a day becomes impossible. Joints, spine, heart - everything has limits.
Counting calories isn't that hard and it works by the very definition of energy.
It doesn't "work" unless your definition of "work" is "lost a few pounds of water weight over a few weeks." Certainly does not work when going from obese to normal weight.
> Besides, if people can really accurately count their calorie intakes and won’t overeat what they use up, then it is thermodynamically impossible not to lose weight.
This is false. The body is a self-regulating system. You eat less, the body can just burn less. You eat more, the body can burn more. What you eat and what you do also plays a huge role.
And it doesn’t hurt your last point in anyway, both statements can be true.
I've lost "post-covid" 15 kg (93kg to 78kg, 180cm height) in about 3 months with counting calories and ensuring a reasonable deficit. MyFitnessPal did help here.
I was just getting about 1800-2000 calories daily (which is not too bad), walking about 10k-15k steps a day (a morning walk, lunch-time walk and an evening one) and doing some very lightweight kettlebell exercises. There are details on how you might want to track weekly averages instead of daily weight values.
Certainly, i was never obese just slightly overweight. Obesity can mean certain serious food-related disorders but most of the time it's just a bad diet together with not moving a lot.
It's very easy. Your calories in depends on your calories out, and your calories out on your calories in.
The body regulates both intake and expenditure dynamically, so if you mess with one of them and don't change anything else, it's most likely just going to adjust the other one.
This has been mainstream science for a generation or longer, read The Hungry Brain by Guyenet for a good introduction.
> Certainly, i was never obese just slightly overweight.
Then it works, of course. Your metabolism was not "broken." This is like buffing out a bump in your car door. Won't work to fix a full-on collision. It's just not the same problem.
If you could build a selector between these three modes (normal human, (a), (b)), you could solve HALF OF HUMANITY PROBLEMS. For real.
That's not a joke. I see a lot of people around whose lifes are crippled by the fact they're not in the body mass which would be most productive/healthy for them. People are losing a decade of life and another decade of productivity due to this. A lot of interpersonal problems are also due to this, more than you can imagine. Half of world's perceived social injustice go away once you fix BMI.
We do not even realize the amount of self-humiliation humanity suffers by not being able to control something so fundamental.
Disclaimer: My own body weight is normal, though I would perhaps accept additional muscle; but it pains me seeing people who suffer from this every day, people who are better than me in most other respects.
1. https://davidepstein.substack.com/p/the-diy-scientist-and-th...
https://peterattiamd.com/the-downside-of-glp-1-receptor-agon...
https://www.practiceupdate.com/content/easd-2022-substantial....
Next, science is going to find out that water is wet.
In other words, the longstanding conventional wisdom (at least as presented in the media) is exactly what this study set out to vindicate, not the opposite, like the press release claims.
It's possible that this study is a significant step up in quality from existing ones, and it's possible that their method of considering past BMI is new and interesting, but the framing of it as the first to challenge conventional wisdom is pure marketing hype.
I use quotes, because I personally only believe in body positivity for matters that are beyond control - eg disfigurements related to genetics or trauma. No-one should shame anyone - or feel shame - for things they have no say on.
Matters within scope of control should be addressed, however. At the very least not lied about and promoted as healthy, more importantly.
Personally, I don't think we should view fatness as a moral failing; some people do naturally tend towards higher weights, especially as they get older. But I also feel that fatness is really dangerous and unhealthy and the "Fat Acceptance" movement makes me a bit uncomfortable because, much like smoking cigarettes, some people need a bit of a push to kick bad habits like overeating. Obesity is very expensive, both in money and lives, so if we can reduce it, we should.
Because it is. As you yourself allude to later...
> I don't think we should view fatness as a moral failing
It clearly is not. I suspect the only people who believe that are the folks 'born on third base' as it were.
> some people need a bit of a push to kick bad habits like overeating
Some people? The vast majority of people are overweight. Anyone who isn't fit & trim has no business commenting on anyone else's bad habits and moral failings. None. Got a little bit of a spare tire? Shush. Got some love handles? Shush. Skinny fat? Shush again!
> if we can reduce it, we should
100% agree.
Edit: Downvote all you want, guys, most of you pushing that downvote button need to lose weight just as much as I do.
No its not. Its nowhere near demonized as it should be.
> It clearly is not. I suspect the only people who believe that are the folks 'born on third base' as it were.
It's a failure of self control.
> Some people? The vast majority of people are overweight. Anyone who isn't fit & trim has no business commenting on anyone else's bad habits and moral failings. None. Got a little bit of a spare tire? Shush. Got some love handles? Shush. Skinny fat? Shush again!
Untrue. The vast majority of people in rich countries are overweight.
Disagree. The root cause of the problem is that you can't apply to more willpower if you don't know how to actually fix it, and we don't.
There are currently 0 known methods to lose fat sustainably. Yea, you can starve yourself for a few weeks in a thousand ways, but none of them lead to lasting fat loss. Neither does any kind of exercise.
We need to find the true root cause, or this will not change.
Starving one’s self is not necessary. Not buying ice cream, cookies, chips, added sugar foods, and beer is necessary. Do not eat out, and do not let unhealthy foods into the house. And do not shop while hungry.
The root cause is all that unhealthy stuff gives everyone a dopamine hit they want.
Living in an environment that discourages walking and physical activity in exchange for sitting in cars also does not help.
I've done all that and more for 10 years and still gained 100lbs. Exercise didn't help, just made it worse. Yes, I've gained 20-30lbs (not muscle, I wish!) in a few months by exercising more. I've failed to lose fat doing 10 months of 4x per week intense exercise.
It just doesn't work.
Then I just lost almost 50lbs with some "crazy" diet experiment by eating as much heavy whipping cream as I feel like. No working out at all.
These mainstream theories of "just eat healthy" simply don't work for obese people.
You own failings are due to you lying to yourself about how much you eat.
Humans are not able to break the laws of thermodynamics. If you consume less than you burn, you will lose weight no matter what.
False. How much you eat is only indirectly related to energy partitioning, which decides if that food energy will be burned or stored. Trust me, I've tried more than you and am more obsessed with the topic :)
You probably decreased carbs and PUFAs significantly as part of "eating less."
> Humans are not able to break the laws of thermodynamics. If you consume less than you burn, you will lose weight no matter what.
Ah, the ol' accounting tautology :)
Of course you're right, but of course it has nothing to do with the topic. "Being in an energy deficit" does not necessarily come from "eating less" or "exercising more" and eating less or exercising more do not guarantee a deficit.
Turns out the human body is full of miraculous biochemistry, it's not an oven.
Ah, that explains it. You had a serious moral failing and you corrected it.
> It’s extremely obvious that doing something like running every day (if it leads to a calorie deficit) will make you lose fat.
But what if it doesn't because your body is a self-regulating dynamic system that changes energy partitioning and intake demands based on output?
The reason is, of course, that your body can downregulate energy expenditure according to energy intake. I've observed my body downregulate to about 1,000kcal/day. No fat loss on a 1kkcal/day OMAD diet for 2 months straight. No exceptions.
If you get below the bare minimum (say 1kkcal/day for me) your body will start shutting down pretty essential systems like the immune system, you won't be able to concentrate, sleep will be messed up.
Yes, I've done all these experiments, obviously.
So by "science", you mean your n=1 "experiment" and not conservation of energy?
Conservation of energy is a whole other story and I don't see how it's related to fat loss.
If someone isn’t losing weight on a caloric deficit, they’re not tracking their food intake and exercise properly.
I think this is the real culprit - the idea that overeating is the root cause and not a symptom, and that a little bit of a push makes a difference.
Overeating is the "how" not the "why" -- at least, that's how I see it.
It would be like saying alcohol is the root cause of alcoholism, when in reality, the root cause of alcoholism is often much more nuanced. Hence why many people with addictions tend to be polysubstance users or "hot swap" to a new vice after abstaining from another. It's not about the mechanism of escape, but rather the need to escape.
Yes, but that's not what we're talking about. It's an accounting tautology, not the root cause.
What are we talking about?
You’re not supposed to say out loud that you smoke, drink, or overeat because you enjoy it and have accepted that you might live a less long life and/or one with greater medical needs. You’re supposed to say that you’re ashamed and you can’t help yourself and that you know you’re supposed to be healthy.
This is the moral trap that makes people try very hard to find proof that X or Y is ultimately healthy. In Christian moral language, it’s like being handed a biblical passage that supports that thing you want to do. If being fat is healthy, you don’t have to wallow in shame, you just have to convince everyone that they misunderstand the facts.
It’s hard to make social systems like universal healthcare work when people are openly and unrepentantly unhealthy, but the fact is that health is no more universal a form of piety than faith in some specific God. Some people will just want to eat a lot of ice cream and hamburgers because they’re yummy.
The previous data/methodology. The whole point of the study was to look at three untracked externalities[0] in BMI-outcome research. They used historical NHANES data combined 2015 data on mortality data.
> (1) confounding bias from heterogeneity in body shape; (2) positive survival bias in high-BMI samples due to recent weight gain; and (3) negative survival bias in low-BMI samples due to recent weight loss.
https://www.tandfonline.com/doi/abs/10.1080/00324728.2023.21...
Indulging in a Superbowl party or birthday dinner will not make you obese.
Overeating or eating poorly over a long period of time will.
Cooking can be a great way to have healthy tasty food affordably
Well I mastered the first part
I actually think our "personal moral failing" thinking is a large impediment to actionable solutions for society, because instead of looking at WHY even 18-year-olds have gone from below 20 BMI in 1879 to over 26 BMI in 2022[0] we just go around and around in circles about how it is a personal responsibility issue not a systemic one, while the data continues to show that it is across all of society. We continue to subsidize sugar substitutes (corn turned into HFCS) at the production side but sugar taxes to offset the subsidies are seen as "attacks on freedom." The US's overproduction of HFCS has even lowered the international price of sugar indirectly.
Because sugar is so cheap, and so addicting, in our capitalist system the manufacturer willing to exchange other ingredients (e.g. fats, proteins, etc) for sugars may be both cheaper AND taste better, even if ultimately it isn't satiating. So we have a bunch of foods which are high in sugar relative to historical norms or that simply never existed because they exist to act as a "sugar delivery system" (e.g. soda).
After the UK introduced a soda tax (SDIL), we can see that due to both manufacturers reformulating their drinks AND changes in consumer behavior it resulted in lower calorie intakes that they did NOT make up by buying alternative sources of sugar (e.g., candy)[1]
[0] https://www.calciumhealth.com/the-american-obesity-epidemic-...
[1] https://www.instituteforgovernment.org.uk/article/explainer/...
100%. We have no clue how to fix it, so we "do something" to feel in control as a society.
A strange statistic, as the actual risk of death is 100% for all of us.