So the research into this is hilariously terrible. The podcast maintenance phase has a pretty good couple of episodes on just how fucking garbage the data on what being fat actually does to your health is. e.g. this one https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5idXp6c3Byb3V0LmNvbS8xNDExMTI2LnJzcw/episode/QnV6enNwcm91dC05NTUxNTU1
Outside of extremes by far the overwhelming factor in health outcomes is exercise
Yet when you go to the doctor how much time do they spend talking about your cardio routine vs popping you on the scales or talking about weight? Doctors also generally provide much worse care to fat people, and frequently blame unrelated medical conditions on weight. Further we have very little idea how to help people moderate their rate. It’s not like tendon damage or whatever where we can prescribe a specific activity with good patient compliance and outcomes, mostly people just vaguely gesture at calorie restriction which almost nobody can sustain indefinitely.
So we really need better research and education here, and if you’re worries about your health I’d say stop pinching your tummy in the mirror and start something like the couch to 5k program.
Also P.S. before you poke somebody over their weight or sneer or judge consider how you would feel if someone judged you as morally inferior because your resting heart rate is over 65 you sloven. What’s that? you have reasons? whatever you say it’s simple, just workout more.
Not a nice or useful interaction is it? we’re all trying our best and generally don’t appreciate unsolicited advice that comes with judgement.
Yet when you go to the doctor how much time do they spend talking about your cardio routine vs popping you on the scales or talking about weight?
Well, last doctors I 've seen actually got angry when I mentioned that I 'll get back on my bike. They said 2 weeks after the surgery to insert plate and screws after my crash were not enough. They didn’t bother to ask my weight at any instance. Orthopedic surgeons… XD
Seriously though, effects of exercise on human health are not exactly lacking in research. Its pretty old, but I found it really very interesting.
surgeons just hate everyone less compliant than a corpse :p
2020 seems fairly recent to me. I was expecting 1987 or something.
True, for some reason I was under the impression it was a little older. No, not that old though. I won’t edit the comment, my sense of time is pretty bad anyways…
I love Maintenance Phase, such a good podcast.
Michael Hobbs is my spirit animal
YES. Me too. If Books Could Kill is also excellent, if you haven’t yet heard it. (I’m guessing you have, though!)
It’s wild how fat America has gotten. I don’t even know what works and what doesn’t from a health advice perspective, anymore.
There’s also a big difference between “life expectancy” and “quality of life”. Being overweight is uncomfortable, limiting, and can be a burden on people around you. I have no way of knowing if I’ll live longer, but my life has become immeasurably better since I went from nearly obese to normal weight.
Additionally, I think the biggest factor to control for is socioeconomic status. A well-off fat person is probably going to have better life expectancy than a poor skinny person.
Being overweight is uncomfortable, limiting, and can be a burden on people around you
While I am not disagreeing in any way, I believe it’s important to point out that there’s also a distinct difference between obese and overweight. Often times overweight is being used as an adjective to indicate that someone is outside the normal weight range, but in the context of medicine and the context of this article, it’s a range of BMI values between the normal and obese categories.
Quality of life measures generally find little to no negative effects with the overweight category, but decrease as you continue into obese categories.
High five on changing your trajectory. That’s great.
I too have a similar story, where last year I read “patient appears overweight” for the first time on a doctors chart, and decided to get back into shape.
This is about the overweight BMI category, not obese categories. It’s also talking about how it’s actually not associated with an increase in overall mortality, but rather the opposite. This observation has been around in literature for quite some time, predating the obesity crisis.
What are you trying to even say with this comment?
America is getting really fat. Reading the article reminded me of how fat this country is getting.
While I appreciate your concern for how fat America is, I’m struggling to see how this comment is helpful or leads to a productive discussion in any way 🤷♀️
Lots of discussion going on around my comment right now.
The discussion trying to process your extremely vague statement is not productive.
I think you’re being a bit of a buzzkill.
We’re not a space for low effort reddit/twitter style gotchas. Be better.
What are you trying to even say with this comment?
Haven’t you heard? America bad.
You’re suggesting that all fat people are bad?
No
Were you being hyperbolic, as a mild defensive response to a perceived slight against your country and the people in it, when the real problems are public education failure, health system failure, political corruption, and a food industry that intentionally gets your youth hooked on things like HFCS at an early age?
Pictures and home movies from the 1970s are shocking. People were so much leaner then than now. And going further back, the silent movie actor “Fatty Arbuckle” was considered so fat it was his nickname, yet he wouldn’t look at all extraordinary today.
Seems like it’s the snacking culture, so much snacking “3 meals and 3 snacks” is normal. It didn’t used to be.
When talking in a clinical sense, I think we need to standardize on a numerical standard, like body fat percentage or BMI. It’s my understanding that people want to get away from BMI because it’s crude, and I agree, but communicating in numbers will make things less confusing. Healthy body fat ranges depend on race, gender, and age, but it would still be better than using words the public has coopted to become unclear.
BMI does use numbers, but is complete pseudoscience, and should absolutely be moved away from.
https://www.npr.org/templates/story/story.php?storyId=106268439
Kinda like the Myers’s Briggs is pseudoscience, and lie detectors, and a lot of other shit we use frequently in society.
I think what we need is just something scientifically based, like at all. Numbers or no numbers.
Calling all of these “pseudo science”, shows a gross misunderstanding of either the term, or the subjects mentioned.
If you can show me that any of those things are actually supported by scientific study, I’m happy to learn, but yes, based on everything I’ve learned about them, they are pseudoscience. None of them are supported by any sort of research findings.
It’s rather trivial to find a study talking about BMI, but talking about it in extremes like this does no one any good. I would highly suggest you go educate yourself on public health or at least read something in the literature before making such extreme claims. To help you get started, here’s a fairly comprehensive review on BMI in the clinical context.
You do bring up a good point in that it’s important how we use BMI and just what it represents. Major institutions such as the AMA have started to reassess exactly how BMI is interpreted (and providing guidelines) in the clinical sense, because there are problematic ways to use BMI. Of note, they do not advocate against using BMI, but rather it should be one of many indicators, as that’s the basis of differential diagnosis in the first place.
I’ve already educated myself on this stuff, and continue to do so as more information comes out, but thanks.
The condescending tone is classic considering the thing you linked has right in it:
“However, it is increasingly clear that BMI is a rather poor indicator of percent of body fat. Importantly, the BMI also does not capture information on the mass of fat in different body sites. The latter is related not only to untoward health issues but to social issues as well. Lastly, current evidence indicates there is a wide range of BMIs over which mortality risk is modest, and this is age related. All of these issues are discussed in this brief review.”
It’s a poor indicator because it lacks scientific rigor, aka pseudoscience.
The question was whether it was a clinically relevant metric - it is absolutely a useful one. You are correct that it is not an indicator of percent of body fat, it was not designed to measure this and using it for this purpose is mislead. But there’s a world of difference between “it’s bad at measuring body fat” and “BMI is pseudoscience”. It’s unfair to characterize it as lacking scientific rigor because there are plenty of scientifically rigorous studies involving BMI. It is extremely useful as a clinical indicator of one’s health, in the same way that body temperature can tell us things in the context of other metrics and can also tell us some high level information about a person’s general health.
But perhaps most importantly, it’s extremely useful when we come to population health where generalized indicators are often more useful than hyper-specific ones. Indicators which are easy to measure and gather from relevant data sources are also often more useful than ones which may be more accurate on a per-individual basis, but less important when measuring the health of entire populations. I apologize for any condescension in my comment, I was suggesting that you become more educated in matters of public health because indicators like BMI are invaluable in this space.
So it is a gross misunderstanding of the term, sad.
Feel free to explain instead of being condescending for no reason, then.
Like I said I’m willing to learn, but from wiki -
Pseudoscience is often characterized by contradictory, exaggerated or unfalsifiable claims; reliance on confirmation bias rather than rigorous attempts at refutation; lack of openness to evaluation by other experts; absence of systematic practices when developing hypotheses; and continued adherence long after the pseudoscientific hypotheses have been experimentally discredited.
If you can tell me how the things I listed don’t fit into that definition, great. Please do so.
BMI is useful for historical population comparisons because you can calculate it using just height and weight and it’s already been in use for a very long time. It’s so crude as to be very misleading when applied to individuals, especially if you decide to turn your brain off when deciding how to evaluate the information.
The origins of the calculation are immaterial. It’s value is in comparative studies, not direct judgement. The actual judgement of “good” vs “bad” BMI numbers is dumb(ish) but it is good for comparing populations across both time and space.
It’s my understanding that people want to get away from BMI because it’s crude
Pretty much the only people advocating for this are people who get into weightlifting and I’d say the vast majority of them were already in the overweight category before putting on extra muscle. BMI is by no means perfect, but it’s actually extremely good at doing what it was designed to do, which is give a quick and easy metric by which to judge someone’s general health. It’s meant to be a starting point for a discussion around exercise and other more important factors, when it’s clinically relevant to do so.
I would disagree that it’s only weightlifters. I’ve competed at an international level in a completely different sport, and my teammates have the same concerns. And this goes for people who have been selected to represent the national team and those who have not.
I’m in a sport where it’s beneficial to weigh less, and many of us are considered overweight by BMI standards.
My sport is not represented in the Olympics, so we are talking (for the most part) about normal people who like to do sport. My teammates are all teachers, doctors, IT professionals. We aren’t people who are paid to workout all day everyday.
I’d argue that many gym-goers who are dedicated (like HIIT classes, cyclers,etc) would also agree that BMI isn’t great. I don’t have any studies on hand to support my experience/anecdotal evidence. But I’ve been in sport and various gyms for 10+ years and all the trainers, coaches and athletes say the same thing: don’t look at the scale unless you need to weigh in.
Healthy body fat ranges depend on race
This isn’t really true. Unless what you’re suggesting is that there’s a biological component of race, which my understanding no scientist suggests. “Normal” ranges depend on race, but it’s not like 1 race is healthier at a different weight than another
While race is mostly a social construct, it’s easier to use race as shorthand for “populations with long-term historical ancestry in a loosely defined geographical area, accepting that population mixing has been occurring since the dawn of time and will continue to do so into the future” than it is to say that whole thing every time
BUT, it’s my understanding that, for example, Pacific Islanders are generally healthy at a higher body fat percentage than other groups of humans.
The weasel word in all this is “overweight (but not obese)”. This is because obesity is definitely associated with diabetes, heart disease, stroke, sleep apnea and the sequelae of these diseases. Excess fat in our body, glucose in our blood, and weight on our skeleton taxes the body and that will have consequences.
I think we are in a new era for how we see and treat obesity, with better understanding of how it affects us individually and societally, with more tools to tackle it. As such, we should not downplay the importance of weight in a person’s health.
Articles like this really don’t give a full picture of clinical decision making and the job of a physician to make high level research accessible to the patient (which involves simplifying things lots of the time). This leaves us with a headline that makes the public think that doctors don’t know about obesity, which simply is not true. It’s just that the nuance isn’t as big of a deal as this author makes it seem.
The weasel word in all this is “overweight (but not obese)”.
I think that’s the whole point of the article. Lots of doctors seem to assume that all-cause mortality is correlated with BMI in a straight line, but this article argues that it’s actually U-shaped with the minimum in the “overweight” range. It’s arguing that these specific people in that overweight but not obese category are getting bad medical advice and treatment because of assumptions derived from observations of the group of people who are overweight or obese.
Nuance in applying the BMI is important. Like I’m a short guy(how short I’ll leave it up to you) and according to the BMI I’d be a “healthy” weight at 120lbs. I can assure you if I ever drop down to 120 I would look like and feel like death(and honestly if I drop like that I might be!) .
The BMI can be a useful tool but what is and isnt a healthy weight can vary so much(and thats not even getting into lean athletes who are muscular obese and how silly that is). People have different body types and even then if you are visibly fat and not just broad shouldered or big breasted you can still be healthy. There’s definitely a point where people hit where you get too big and the health problems and mobility problems start coming, but where that line is can vary and it would be nice to see the BMI usage change. So we wont get doctors ignoring patient symptoms and problems and suggesting you lose weight when something is wrong.
Focusing excessively on being overweight as its own risk factor for mortality, independent of biomarkers or metabolic health, does not seem warranted.
I 'll quote this from the article for emphasis. The obesity range tho, is not challenged as far as health consequences go. While treating both ranges as if they are same is probably wrong, one doesn’t get obese without being overweight first. As for the excessive part, I laughed at the percentages :-)
As for the overweight part, in my experience, when it comes to my heart, whether it is just extra fat or extra muscle, it’s still extra weight to carry. Life is much easier without it. Beyond a point, I need a really good reason to maintain extra weight even if it is just muscle tissue and vanity is not even a bad one.