tag:blogger.com,1999:blog-1629175743855013102.post1625071653883655438..comments2024-02-25T02:24:14.972-08:00Comments on Whole Health Source: Uncovering the True Health Costs of Excess WeightStephan Guyenethttp://www.blogger.com/profile/09218114625524777250noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-1629175743855013102.post-19095314038702708502015-11-12T05:19:37.713-08:002015-11-12T05:19:37.713-08:00If I look at the paper, all that I see is: Don'...If I look at the paper, all that I see is: Don't be fat and loose weight to normal, it will kill you!<br />Sure, this is provoking, but it is the essence...Anonymoushttps://www.blogger.com/profile/13446888538111923484noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-81114028416720943882014-08-09T09:49:47.410-07:002014-08-09T09:49:47.410-07:00Hi Stephan,
I can see the issue with self-reporte...Hi Stephan,<br /><br />I can see the issue with self-reported BMI being by far, the largest issue.<br /><br />There's still a lot of questions:<br /><br />1. Maximum BMI: Does losing the excess weight cause the mortality to reverse? In the case of tobacco uses, after quitting for about ~20 years, it drops back to almost normal for risks of mortality. <br /><br />For Maximum BMI, one question worth asking is, does the risk drop back to normal for those who lose the excess weight? If the answer is, only partially, or an outright no, that could have huge implications.<br /><br />Perhaps more research is needed. It would be an expensive study I propose. Follow a large group of people, divide them into: people who did not lose weight, people who lost weight but regained it, and people who lost weight and managed to keep it off (small group I know). Test for mortality. <br /><br />2. As noted the reported BMI is an imperfect method. First because people are less likely to report their correct mass.<br /><br />The other issue is BMI accuracy. Perhaps a better measure may be visceral fat? But how? East Asians in particular tend to accumulate such fat at lower BMIs than other races.<br /><br />Hmm ... the reason why BMI was adopted was because it was quick and easy to measure. Maybe measuring the circumference of one's waist and adjusting for height is the best way? It's quick and easy too.AltandMainhttps://www.blogger.com/profile/01014823246265859953noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-34118141451793006282014-04-08T20:04:57.602-07:002014-04-08T20:04:57.602-07:00Almost certainly the right variables some combinat...Almost certainly the right variables some combination of time and BMI. Someone who was obese for 20 years will die sooner than someone who was obese for 10. The ground breaking part of this is the elimination of confounding effects, and although it is not proven, it is very reasonable to assume that the least time one spends in the obese zone, the worse the outcome. Yes, to prove this rigorously would be a bitch, following people for 30 years or so.glibhttps://www.blogger.com/profile/17667027419577956753noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-9902755874883225282014-04-03T17:55:52.985-07:002014-04-03T17:55:52.985-07:00Stephan,
How would using average BMI over a period...Stephan,<br />How would using average BMI over a period compare to maximum BMI?Anonymoushttps://www.blogger.com/profile/09483281640258855953noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-57360554227125396792014-04-03T08:54:14.515-07:002014-04-03T08:54:14.515-07:00Woops just refreshed. I find it a little difficult...Woops just refreshed. I find it a little difficult to imagine that undermuscled overweight people is a serious confounding variable. LBM almost invariably goes up as a result of increasing body weight. I suppose it might equalize, but I'd be skeptical until I saw some data.<br /><br />Another thought, I would imagine health care provision would be greater in the increasingly obese, whereas unexpected deaths would be more likely in people who otherwise appear healthy. (The skinny fat, so to speak.)Scott Russellhttps://www.blogger.com/profile/17221933596021597469noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-9546982385046814762014-04-03T08:41:43.120-07:002014-04-03T08:41:43.120-07:00Hi Reijo,
Thanks for the links. One other way to...Hi Reijo,<br /><br />Thanks for the links. One other way to analyze the data is to look at the total duration of overweight or obesity. There are some interesting studies supporting the idea that the duration of obesity is more strongly related to health risks than current obesity. That way of looking at it makes good sense to me.<br /><br />Hi Phil and Matt,<br /><br />BMI is a crude measure on an individual basis, but it works fairly well in studies that look at averages of groups of individuals. That's because muscular people tend to be balanced by under-muscled people in each category. Getting more sophisticated measures of body comp is a lot harder than BMI, and they may not be that much better at identifying health risks.<br /><br />Hi raphi,<br /><br />Maximum weight was self-reported, and objectively recorded height was used to calculate BMI from it. Other BMI points were from objectively collected data.Stephan Guyenethttps://www.blogger.com/profile/09218114625524777250noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-77376354355596973552014-04-03T08:07:44.266-07:002014-04-03T08:07:44.266-07:00Former smoking eventually drops a person's ris...Former smoking eventually drops a person's risk somewhat close to baseline over IIRC 15 years. But it never returns totally to baseline. I would suspect something similar with weight loss. RobRLLhttps://www.blogger.com/profile/13850927095383579725noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-14425452797911129142014-04-03T00:34:42.695-07:002014-04-03T00:34:42.695-07:00Hi Stephan,
I applaud Andrew Stokes' decision...Hi Stephan,<br /><br />I applaud Andrew Stokes' decision to publish in an Open Access Journal. "Impact Factor" is a primitive method of judging the scientific 'track record' of a journal and is highly susceptible to political/corporate opportunism.<br />You want to know what is what? Publish all data & make it available to everyone - that's it!<br /><br />Stephan, the study doesn't seem to specify - did the subjects have their BMI officially recorded and then went on to report their highest BMI they can recall with that reference measurement in mind? Or did these people simply report what they thought was their highest BMI, simply based on a their understanding of what BMI is and where they might stand relative to others?<br /><br />The difference is small but may be disproportionately meaningful.<br /><br />Thanks!<br /><br />PS: the 'innovation' of how to make the best use of poor data is at the heart of good science and an interesting example you provided here.raphihttps://www.blogger.com/profile/08992252569979714724noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-84554222103047053512014-04-02T17:48:41.636-07:002014-04-02T17:48:41.636-07:00>explanation for the paradox is that people oft...>explanation for the paradox is that people often lose weight before dying, so their death is associated with a lower BMI group<br />____________<br />I've been reading this proposal since the early 80s - the earliest I can pinpoint my memory was in discussions of some of Reuben Andres's work and am surprised no one's found ways to tease out the contributory effectsSanjeevhttps://www.blogger.com/profile/09522727136330797375noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-67600817163508732142014-04-02T14:35:28.878-07:002014-04-02T14:35:28.878-07:00Another confounding factor is that not all BMI is ...Another confounding factor is that not all BMI is created equal. "Lean" people can have a fairly high body fat if they lack muscle mass. Likewise a very fit person can easily be overweight or even creep into obese if they are heavily muscled. <br /><br />BMI seems too crude to be useful, but maybe there aren't enough of these well-developed people to matter from total population aspect. <br /><br />For an average height male I would consider 185 to be close to an ideal lean weight. That's a little over 10 pounds into the overweight category according to BMI. My opinion, but the average American is not only fat, but also under-muscled compared to the genetic ideal. Matt Lentznerhttps://www.blogger.com/profile/12510000649043210096noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-90444952577134196952014-04-02T14:33:28.071-07:002014-04-02T14:33:28.071-07:00Well written review of the issues of BMI and morbi...Well written review of the issues of BMI and morbidity/mortality. As a RD I think there is a potential vast difference between an overweight individual who has achieved that via high fat/ fast food diet combined with lack of exercise, versus an individual of similar weight who exercises regularly, drinks alcohol modestly, and eats plenty of fruit and veg as part of a (calorie excessive) Mediterranean-style lifestyle. <br /><br />This weeks epidemiology paper on fruit and vegetable intake in England ( http://jech.bmj.com/content/early/2014/03/03/jech-2013-203500.full.pdf+html) threw up some interesting data. Across the quintiles of fruit and vegetable intake, an overweight BMI was consistently around 56% in all intake groups, similarly obese classification was relatively static at over 22% across all intakes of fruit and veg. Yet with increasing plant food intake, relative risk of mortality from cardiovascular disease and cancer was reduced - whatever the BMI. Perhaps we need to look objectively at what is first defined as a 'healthful diet' as a more acceptable approach to population dietary changes. I'm not advocating a HAES approach with the clinically obese, but perhaps allowing some 'wiggle room' around the healthy overweight concept may empower people to engage more with dietary messagesRD Catherinehttps://www.blogger.com/profile/14762645360029326537noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-1159439508205782752014-04-02T13:35:26.482-07:002014-04-02T13:35:26.482-07:00This is potentially very important finding.
Anot...This is potentially very important finding. <br /><br />Another way to tackle the confounding caused by illness-induced weight loss might be to look peri-midlife BMI and its effect on mortality or morbidity. <br /><br />There is data from meta-analyses showing pre-midlife BMI is strong risk factor for CHD and midlife BMI for dementia.<br /><br />http://www.ncbi.nlm.nih.gov/pubmed/19506565<br />http://www.ncbi.nlm.nih.gov/pubmed/21348917<br /><br />And there is at least this US cohort for CVD mortality <br />http://jama.jamanetwork.com/article.aspx?articleid=202177Reijohttps://www.blogger.com/profile/16600461974345868939noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-11699233695237492014-04-02T13:17:46.139-07:002014-04-02T13:17:46.139-07:00Seems that some of the people assigned to the &quo...Seems that some of the people assigned to the "healthy overweight" group could be attributed to the fact that the BMI only measures height/weight ratio. BMI doesn't take into account a larger muscle mass, and thus, a healthier lifestyle than some "normal weight" people.Phil GBhttps://www.blogger.com/profile/03103765002604752394noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-45952574327924691532014-04-02T12:35:10.552-07:002014-04-02T12:35:10.552-07:00How would people who change their BMI deliberately...How would people who change their BMI deliberately be accounted for by this method? It seems that somebody who had a high BMI and managed to lower their high BMI by modifying food intake, somebody who had a BMI and lowered it due to illness, and somebody who had a high BMI and kept it til they died would all be treated the same by this metric?<br /><br />Did you mean that intentional weight loss has not been found to increase mortality, as you wrote, or not been found to decrease? rifhttps://www.blogger.com/profile/09408465377684869050noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-47707666080444718632014-04-02T12:34:46.219-07:002014-04-02T12:34:46.219-07:00I hope this study *doesn't* reach the popular ...I hope this study *doesn't* reach the popular press. If it does, a lot of overweight people might stop trying to lose weight. Why bother if it won't affect mortality.<br /><br />BTW, I think we're all going to die. What time frame does "risk of death"<br />refer to.Gretchenhttps://www.blogger.com/profile/17019921800841883073noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-78207076036260428482014-04-02T12:05:43.977-07:002014-04-02T12:05:43.977-07:00Hi Beth,
What you said makes sense. Perhaps a mor...Hi Beth,<br /><br />What you said makes sense. Perhaps a more accurate way of putting it is to say that elevated BMI-- and the diet/lifestyle that typically accompany it-- are strongly associated with elevated mortality. I struggled with the wording on that part of the post.<br /><br />Hi rif,<br /><br />That's another potential confounder, but it should also be accounted for by this method. BTW, intentional weight loss has not been found to increase health/mortality risks in other studies.<br /><br />Hi elbatrofmoc,<br /><br />Perhaps because he chose to publish it in a lower-impact journal. He explained the reasoning behind that decision when we spoke, but I can't share it without his permission. In any case, it may end up having a major impact anyway, but just take longer to do so, as the method becomes more widely adopted and published.Stephan Guyenethttps://www.blogger.com/profile/09218114625524777250noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-36007749472816937492014-04-02T11:44:21.247-07:002014-04-02T11:44:21.247-07:00Thanks a lot for reporting this and summarizing th...Thanks a lot for reporting this and summarizing the findings. Why hasn't it made headlines?? I know more studies are needed to confirm these results, but still, considering how many weak observational studies make the news, it's seems bizarre to me. This is huge, in my honest opinion. elbatrofmochttps://www.blogger.com/profile/16451090242017940286noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-66201168346207159232014-04-02T11:33:49.074-07:002014-04-02T11:33:49.074-07:00Fascinating. How can this deal with people who ch...Fascinating. How can this deal with people who change their food habits and lower their BMI? Their maximal BMI remains the same. A measure like this seems like it could never support the idea of lowering your BMI since the metric wouldn't change.rifhttps://www.blogger.com/profile/09408465377684869050noreply@blogger.comtag:blogger.com,1999:blog-1629175743855013102.post-40669034834711689682014-04-02T11:28:36.804-07:002014-04-02T11:28:36.804-07:00How does Stokes' study address other potential...How does Stokes' study address other potential confounds? E.g., a nutrient-poor, energy-dense Western diet that leads to weight gain and also presumably contribution to disease through inflammation etc. Or the implications of weight stigma on delaying health care and/or inappropriate health care (given the link between excess BMI and income).<br /><br />Wouldn't it be more correct to say "excess weight <b>is linked to</b> one out of three deaths among US adults age 50-84" rather than "excess weight <b>may cause</b> one out of three deaths among US adults age 50-84"?Beth@WeightMavenhttps://www.blogger.com/profile/17725838221780385439noreply@blogger.com