What physicians get wrong about the risks of being overweight
What physicians get wrong about the risks of being overweight
Stanford medicine statistician Maya Mathur found that doctors have misconceptions about being overweight shortening lifespans.
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.
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.
The amount of times I've heard this used as fat-shaming rhetoric is shocking.
"You're immoral, you're selfish, why can't you think about everyone around you who has to put up with, and is affected by, your obesity."
It's inexcusably vile. It's hateful rhetoric. I'm sure you don't mean it that way, but that's what it is. And the problem is that such hateful language toward fat people is so, so pervasive, accepted, and woven throughout our society, that people say things without even realizing how harmful they are.
Also, socioeconomic status is probably the most important factor. As you said, a fat person with access to affordable health care with competent doctors that don't blame everything on weight, is going to be much healthier than a poor skinny or poor fat person. Further, if you're in a marginalized community, it makes it even more challenging. Then you have food deserts, long working hours, poor wages, lack of affordable child care. Lack of affordable education to help get out of your situation. Lack of social mobility depending on who you are.
It's almost like the person's body weight is barely even a factor in deciding their health.
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?
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.
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.