Excess weight, obesity more deadly than previously believed

https://www.colorado.edu/today/2023/02/23/excess-weight-obesity-more-deadly-previously-believed

by CharlesW • 3 years ago

131 144 3 years ago

exfatloss42• 3 years ago

Previously believed by whom? Pretty sure we've been aware that obesity is a huge problem for a generation now. I mean we literally talk about an obesity epidemic.

Next, science is going to find out that water is wet.

saurik• 3 years ago

The "science" has been saying for a long time now that there's might even be a health benefit from being a bit overweight, and that --as this article carefully explained (which means I guess you didn't read it)-- there is a "U-shaped" distribution of outcomes; in contrast, this study claims all that prior work is wrong, and that there is a "straight upward line".

dkarl• 3 years ago

The U-shaped distribution of outcomes has been discussed for many, many years, and I've never seen it mentioned without the caveat that most doctors and scientists suspect that it's a misleading statistic attributable to serious illnesses that cause weight loss. This definitely isn't the first study to support that interpretation, either.

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.

netrus• 3 years ago

The point is not that its deadly, but more deadly then previously thought (as indicated by the title).

vanilla_nut• 3 years ago

I don't believe this myself, but I do know a lot of people who believe being overweight is unfairly demonized and not as harmful as TPTB would have us believe. Many point to BMI as an inaccurate gauge of healthiness (there's a fair point there about eating disorders and ethnic predispositions towards higher BMIs) and unhealthy obsessions with thinness (as opposed to fitness). Look up "Fat Acceptance" if you'd like to know more.

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.

rootusrootus2• 3 years ago

I do know a lot of people who believe being overweight is unfairly demonized

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.

exfatloss42• 3 years ago

some people need a bit of a push to kick bad habits like overeating

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.

swatcoder• 3 years ago

The dirty secret is that unhealthiness is demonized. Health has been adopted as a moral responsibility.

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.

Someone12342• 3 years ago

Previously believed by whom?

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...

8f2ab37a-ed6c2• 3 years ago

https://asdah.org/health-at-every-size-haes-approach/ - and similar efforts have sprouted like wildfire these last several years in the name of inclusivity. Claiming or hinting that obesity is bad for one's health is considered highly gauche in polite company.

gnicholas• 3 years ago

Masters pointed out that a lifetime carrying excess weight can lead to illnesses that, paradoxically, lead to rapid weight loss. If BMI data is captured during this time, it can skew study results.

“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).

cscurmudgeon• 3 years ago

Reminds of the parachute study that was shared here recently:

https://healthjournalism.org/blog/2019/02/breakthrough-resea...

HPsquared• 3 years ago

I love the meta irony of this article, taking the (somewhat satirical) journal article and playing along as an example of overblown science journalism with the headline "Breakthrough research reveals parachutes don’t prevent death when jumping from a plane".

It's beautiful....

suresk• 3 years ago

He discovered that a full 20% of the sample characterized as “healthy” weight had been in the overweight or obese category in the decade prior. When set apart, this group had a substantially worse health profile than those in the category whose weight had been stable.

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.

Izkata• 3 years ago

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.

Don't people typically gain weight in that age range, the opposite of what would explain that?

ehPReth• 3 years ago

Man, food is so addictive and not like you can just stop eating it like you can quit drinking booze or quit smoking!

8f2ab37a-ed6c2• 3 years ago

What's unique about food is that unlike smoking, drugs or booze, a human will always have to go back to eating, it's essential for day-to-day life unlike Jameson, Marlboro and meth.

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.

exfatloss42• 3 years ago

I don't think willpower has anything to do with it.

nugget• 3 years ago

For me, carbohydrate consumption and appetite are massively correlated.

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.

exfatloss42• 3 years ago

Cutting out carbs + protein worked even better for me: https://exfatloss.substack.com/p/losing-43lbs-in-144-days-on...

rdl2• 3 years ago

Same for me with eliminating carbs; combining keto + IF is pretty effective and I've lost about half of the weight from ATH to where I want to be through it. IF is nice because it provides an "all or nothing, but not forever" restriction, and keto is a reasonable framework for food selectivity. Keeping enough protein for not losing muscle and overall ideal; I wish I'd done this when I was 16 and not when I was in my 40s.

outside1234• 3 years ago

I don't try to adjust my food intake. Instead I adjust my exercise upwards if I gain a few pounds.

exfatloss42• 3 years ago

This has also been proven to not work for people who are already obese.

vkazanov9• 3 years ago

This approach his its limits. I used to run, climb, do boxing... eat whatever i felt like eating.

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.

paulpauper3• 3 years ago

Yeah for sure. I kicked a 3 cig a day habit overnight. I was still eating junk food even into into a diet. Never really stopped, but I lost a lot of weight through aggressive portion control.

readonthegoapp• 3 years ago

they say ozempic curbs appetite for booze. ¯\_(ツ)_/¯

giaour• 3 years ago

And Buproprion is used (among other things!) both as a weight loss drug and smoking cessation aide.

WalterBright• 3 years ago

Excess weight or obesity boosts risk of death by anywhere from 22% to 91%

A strange statistic, as the actual risk of death is 100% for all of us.

inglor_cz• 3 years ago

Could this be meant as "risk of death at certain age"?

exfatloss42• 3 years ago

Obviously that's what they mean. It's just funny :)

qup• 3 years ago

So far.

tshaddox• 3 years ago

Strange in the same way it's strange that people might say that playing Russian roulette increases risk of death by an easily-calculable amount.

2OEH8eoCRo0• 3 years ago

"I intend to live forever, or die trying." - Groucho Marx

exfatloss42• 3 years ago

What if you eat a lot of vegetables though

cassianoleal• 3 years ago

Would that make you immortal? If not, still 100%.

paulpauper3• 3 years ago

I am guessing they mean premature death.

thriftwy• 3 years ago

There was an article[1] about two gene mutations which cause (a) lose fat, lose muscle, and (b) lose fat, gain muscule.

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...

Someone12342• 3 years ago

This seems useful. However, some people, both inside and outside medicine, believe that negative consequences' education can be a solution to the overweight/obesity issue, even though after 40 years we've seen near no positive correlation. We've seen some positive outcomes from interventions (e.g. mental health treatments, actionable plans, etc.) but the funding/resources for those continue to be scarce. So the trend keeps falling back to education in the professional setting or bullying in the social one as a "solution" because it is free, ignoring the lack of efficacy.

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/...

exfatloss42• 3 years ago

I actually think our "personal moral failing" thinking is a large impediment to actionable solutions for society

100%. We have no clue how to fix it, so we "do something" to feel in control as a society.

JamesBarney6• 3 years ago

Are there any studies showing a significant reduction in population body mass (our primary endpoint) following sugar taxes?

uptownfunk3• 3 years ago

For those struggling, controlling your diet is the single most effective thing you can do to make progress on 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.

taeric2• 3 years ago

True, but don't feel like you have to run for 30 minutes. Walking for that long will go a long way for a lot of folks. Really, walking should probably be looked at far more closely for many folks.

WillPostForFood2• 3 years ago

Walking for 30 minutes will go a long way to promote general health, but it's not a lot of calories burned.

JamesBarney6• 3 years ago

Studies don't really support that. They show that rapid weight loss is more effective, but slightly worse for body composition. And slower weight loss is of course the opposite.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702468/

exfatloss42• 3 years ago

+1 for the rapid fat loss. It's just that we don't even really know how to do one or the other reliably :)

crazygringo4• 3 years ago

Cutting out the daily donut for two weeks is about a pound of fat.

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.

tjohns• 3 years ago

Metabolism does slow down, but there is a lower limit. The exact numbers and rate will change, but the fact is that sufficient caloric restriction will cause weight loss.

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.

uptownfunk3• 3 years ago

That is why I said, you have to increase the workout intensity and duration gradually to offset the metabolic adaption that is triggered by the diet change

michaelborromeo• 3 years ago

I think “for many people” is more like “for a minority of people.”

For a few people losing weight is complex. For most people, it’s simple.

Eat less. Move more.

Saying otherwise is a cop out.

Semaphor• 3 years ago

That's what I always felt like why keto helped me. Instead of just eating, I was now looking into everything. Almost 10 years ago, I went from 115kg to 86, and I had no issues keeping the weight.

thorio• 3 years ago

"Cutting out the daily donut for two weeks is about a pound of fat."

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.

smm11• 3 years ago

I believe 80 percent of all health issues faced by US citizens are caused by or at least exacerbated by dietary choices. I also believe that cutting carb intake to 30-35g daily would be a night/day change for national health.

exfatloss42• 3 years ago

Plus probably PUFAs

rdl2• 3 years ago

Making GLP-1 agonists and related drugs (ozempic, mounjaro) cheaply/widely available seems like it would be excellent public policy.

exfatloss42• 3 years ago

It seems that they also make you lose tons of lean mass. Normal diets you lose 25% of the lost weight in lean, these seem more like 40%.

https://peterattiamd.com/the-downside-of-glp-1-receptor-agon...

aantix• 3 years ago

“Lean mass loss was 2.6% versus 10.9%. Those on tirzepatide had about a threefold greater reduction in fat mass than lean mass, resulting in an overall improvement in body composition. Fat mass as a proportion of overall body mass decreased from 46.8% to 44.7% with placebo, compared with 46.2% to 38.5% with tirzepatide. Similarly, lean mass as a proportion of body mass increased from 50.7% to 52.4% with placebo, compared with 51.0% to 58.1% with tirzepatide. Fat-to-lean mass ratio improved more with tirzepatide than placebo, with greater improvements observed in patients who lost more body weight.”

https://www.practiceupdate.com/content/easd-2022-substantial....

JamesBarney6• 3 years ago

In an apples to apples study it showed similar effects to canagliflozin which works through an entirely different pathway. So it's probably not related to GLP-1 but to the speed and effectiveness of weightloss which will most likely be faster than a typical diet.

https://pubmed.ncbi.nlm.nih.gov/31897524/

paulpauper3• 3 years ago

The health effects of obesity are well advertised yet people continue to eat a lot. You see it on social media: people dining out with friends at restaurants with large plates of food, huge Superbowl parties, etc. evidently these people are not concerned. There are three ways of looking at this: these people are obvious to the risk, do not care, or the risks of obesity or being overweight are overblown. If the NYTs cares about stopping obesity, they should get rid of their food section, as food is the main contributor to obesity.

exfatloss42• 3 years ago

You're getting the causation reversed. These people are overeating because they're obese, not the other way around.

josephcsible3• 3 years ago

Does lung cancer make people start smoking too?

britch• 3 years ago

This is a joke, right?

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

rtev• 3 years ago

It’s very weird that out of 95 comments in this thread (at the time of writing), practically half of them are one person.

hirvi745• 3 years ago

The topic of obesity somewhat reminds me of a joke I once heard from a stand-up comedian whom I cannot remember the name of, but it went something along the lines of, "People always ask you why you quit drinking, but you know... People never ask you why you drank in the first place."

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.

uptownfunk3• 3 years ago

This seems to try and give people a way out which is the exact opposite of what is needed to deal with this. There has to be a commitment and a no-way-out approach. It quite literally can be life or death. If individuals are not responsible for their own health then who is? How hard is it to eat chicken/tofu + veggies for one meal a day and cut out pizza/pasta/rice/wheat?

hirvi745• 3 years ago

If individuals are not responsible for their own health then who is?

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.

kaba04• 3 years ago

Or Big Sugar not actively lobbying and promoting their propaganda would help greatly — it really is unbelievable that due to having loads of corn, the US decided to slowly kill their populace by forcing them onto an over-sweetened diet, purely for profit. For foreigners, plenty of food is simply not edible they are so sweet, like who puts sugar into bread?! And it being the way people grew up with, it is exceedingly hard to change. And it does show up very well on statistics between different first world countries.

hirvi745• 3 years ago

Wonderful contribution that didn't even cross my mind, but I completely agree.

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.

tomcam• 3 years ago

Masters pointed out that a lifetime carrying excess weight can lead to illnesses that, paradoxically, lead to rapid weight loss.

Well I mastered the first part

Excess weight, obesity more deadly than previously believed

Related Stories