patrick.net

Blurtman says

In a nationally representative sample of US adults, the prevalence of diabetes increases with increasing weight classes. Nearly one fourth of adults with diabetes have poor glycemic control and nearly half of adult diabetics are considered obese suggesting that weight loss is an important intervention in an effort to reduce the impact of diabetes on the health care system.

Yep, but few people actually die directly of diabetes. Here is the #1 killer, Cardiovascular disease, risk by weight class.

From Nature:
http://www.nature.com/nrcardio/journal/v8/n4/fig_tab/nrcardio.2010.209_F1.html

Again, it's not until you get into Obesity Class II that major health risks occur. However, being just a little underweight is just as bad as the third higher level of "Fat".

GRAPH: Prevalence of high blood pressure, diabetes and heart disease,

Again, cronic conditions != Death. People with heart disease are alive. Also, above chart does not show underweight for comparison.

Many underweight people have horrible heart conditions because of the lack of good cholesterol, limited iron, B12, etc.

I imagine not too many obesity class II people suffering from anemia, for example.

The Mortality Risk from average to Class I obesity not being much different is one of the most ignored statistics there is. It's not good for the gym and diet snack business. Or whinging media, or government grants.

New England Journal of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066051

You have to get into Obesity Class II before Mortality Risk is greater than being Underweight, and there's no difference between Average and Overweight for Mortality.

If you're a couple of 10 lb overweight, don't worry about it, unless you have a family history of heart disease or diabetes. In those cases, changing your diet and exercise is more important than the total weight anyway.

thunderlips11 says

Do Obesity Stats control for an aging population?

Generally no.

thunderlips11 says

Again, overweight has no statistically significant mortality risk, so worrying about it is a huge waste of resources. Obesity, yes, but really not until you reach Class II.

You keep saying this, but:

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"Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period Arch Intern Med. 2001;161:1581-1586

Conclusions: During 10 years of follow-up, the incidence of diabetes, gallstones, hypertension, heart disease, colon cancer, and stroke (men only) increased with degree of overweight in both men and women. Adults who were overweight but not obese (ie, BMI 25.0 to BMI 29.9) were at significantly increased risk of developing numerous health conditions. Moreover, the dose-response relationship between BMI and the risk of developing chronic diseases was evident even among adults in the upper half of the healthy weight range (ie, BMI of 22.0-24.9), suggesting that adults should try to maintain a BMI between 18.5 and 21.9 to minimize their risk of disease. "Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period Arch Intern Med. 2001;161:1581-1586

Conclusions: During 10 years of follow-up, the incidence of diabetes, gallstones, hypertension, heart disease, colon cancer, and stroke (men only) increased with degree of overweight in both men and women. Adults who were overweight but not obese (ie, BMI 25.0 to BMI 29.9) were at significantly increased risk of developing numerous health conditions. Moreover, the dose-response relationship between BMI and the risk of developing chronic diseases was evident even among adults in the upper half of the healthy weight range (ie, BMI of 22.0-24.9), suggesting that adults should try to maintain a BMI between 18.5 and 21.9 to minimize their risk of disease.

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In the Nurses' Health study (Manson et al., 1995), the association between body-mass index and mortality was assessed in a large cohort of U.S. female nurses-levels of consumption were not directly measured. In this study, over 100,000 female nurses were recruited and studied over a 16-year period. In contrast to previous studies of the relation between body-mass index and mortality (see, e.g., Stevens et al., 1992; Tuomilehto et al., 1987; Wilcosky, Hyde, Anderson, Bangdiwala, & Duncan, 1990), this study controlled the confounding effects of cigarette smoking, which is more prevalent among relatively lean people (Garrison, Feinleib, Castelli, & McNamara, 1983). In addition, it controlled the effects of several other potential confounds, including age, levels of alcohol consumption, levels of dietary fat intake, menopausal status, preexisting disease, illness-related weight loss, and levels of physical activity. Most notably, the results revealed a positive correlation between body-mass index and mortality, with the lowest mortality rate occurring among those nurses with body-mass indices below 19-that is, among those nurses weighing at least 15% below the average weight of U.S. women of a similar age and at least 10% below their recommended weights according to the widely used Metropolitan Life Insurance Company Table of 1983. Furthermore, negative correlations were observed between body-mass index and various measures of health: Diabetes, gall stones, hypertension, and nonfatal myocardial infarction were all less frequent in the leanest nurses than in the normal-weight or overweight nurses. Apparently, the various health advantages of a low body-mass index had not been detected in previous studies (e.g., Tuomilehto et al., 1987) because they had not controlled for cigarette smoking.
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1) A large, 5 year study found:

“We analyzed the association between body mass index (BMI) and both all-cause and cause-specific mortality among 85,078 men aged 40 to 84 years from the Physicians' Health Study enrollment cohort. … Among never smokers, in multivariate analyses adjusted for age, alcohol intake, and physical activity, the relative risks of all-cause mortality increased in a stepwise fashion with increasing BMI… Higher levels of BMI were also strongly related to increased risk of cardiovascular mortality, regardless of physical activity level (P for trend, 25] are associated with increased risk of colon cancer. However, no prospective studies address the influence of weight change in adulthood on subsequent colon cancer risk. In this study, we investigated whether weight change influences colon cancer risk utilizing prospectively collected weight data. We included 46,349 men aged 40-75 participating in the Health Professionals Follow-Up Study. Questionnaires including items on weight were completed every second year during follow-up from 1986 to 2004. Updated weight change between consecutive questionnaires during follow-up and recalled weight gain since age 21 was evaluated. All eligible men were cancer-free at baseline. Proportional hazard and restricted spline regression models were implemented. Over an 18-year period, we documented 765 cases of colon cancer. Cumulative mean BMI >22.5 was associated with significantly increased risk of colon cancer. The short-term weight change in the prior 2 to 4 years was positively and significantly associated with risk [HR = 1.14 (95% confidence interval, 1.00-1.29) for 4.54 kg (10 pounds) increment, p = 0.04 for overall trend]. Weight gain per 10 years since age 21 was associated with significantly increased risk [HR = 1.33 (1.12-1.58 ) for 4.54 kg increase per 10 years, p = 0.001]. We estimated that 29.5% of all colon cancer cases was attributable to BMIabove 22.5. Our results add support that overweight and obesity are modifiable risk factors for colon cancer among men and suggest that weight has an important influence on colon cancer risk even in later life.
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RESULTS
The median baseline BMI was 26.2. During a median follow-up period of 10 years (range, 5 to 28), 160,087 deaths were identified. Among healthy participants who never smoked, there was a J-shaped relationship between BMI and all-cause mortal- ity. With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00 (95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17) for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to 34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI, 2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the men were similar. Hazard ratios for a BMI below 20.0 were attenuated with longer-term follow-up.

Conclusions
In white adults, overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0 to 24.9.

N Engl J Med 2010;363:2211-9.
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For kids:
http://men.webmd.com/news/20110406/over ... print=true
“The risk goes up significantly for diabetes with a BMI value of 22.3 and for cardiovascular disease above a BMI of 20.9 and above,” says study researcher Amir Tirosh, MD, PhD. Tirosh is a fellow in the department of medicine, division of endocrinology, diabetes, and hypertension at Brigham and Women’s Hospital in Boston.

A male who stands 5 feet 6 inches and weighs 130 pounds has a BMI of 21, for example.

Teens who had BMIs higher than 25, which is the threshold for overweight, had nearly three times the risk of developing diabetes and nearly eight times the risk of having heart disease as young adults, compared to the lightest group, which averaged 5 feet 6 inches in height and weighed about 114 pounds.
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Body Mass Index vs Cholesterol in Cardiovascular Disease Risk Prediction Models
David Faeh, MD, MPH; Julia Braun, MSc; Matthias Bopp, PhD, MPH
Arch Intern Med. 2012;172(22):1766-1768.
RESULTS.

Compared with cholesterol (eFigure), the BMI model (Figure) showed higher risks at all ages and could better discriminate persons at high and low CVD risk. Moreover, the synergistic effects in combination with smoking and in particular with blood pressure were stronger than with cholesterol. Body mass index, but not cholesterol, was significantly associated with mortality.
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Myocardial Infarction and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome
JAMA Intern Med. Published online November 11, 2013. doi:10.1001/jamainternmed.2013.10522

Main Outcomes and Measures Hazard ratios for incident MI and IHD according to combinations of BMI category and absence or presence of metabolic syndrome.

Results During a median of 3.6 years’ follow-up, we recorded 634 incident MI and 1781 incident IHD events. For MI, multivariable adjusted hazard ratios vs normal weight individuals without metabolic syndrome were 1.26 (95% CI, 1.00-1.61) in overweight and 1.88 (95% CI, 1.34-2.63) in obese individuals without metabolic syndrome and 1.39 (95% CI, 0.96-2.02) in normal weight, 1.70 (95% CI, 1.35-2.15) in overweight, and 2.33 (95% CI, 1.81-3.00) in obese individuals with metabolic syndrome...

Conclusions and Relevance These findings suggest that overweight and obesity are risk factors for MI and IHD regardless of the presence or absence of metabolic syndrome and that metabolic syndrome is no more valuable than BMI in identifying individuals at risk.

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http://www.healthline.com/health-news/heart-excess-weight-raises-risk-of-heart-attack-without-metabolic-syndrome-111113
Study: 'Healthy Obese' Still at Increased Risk of Heart Attack
Written by Shawn Radcliffe | Published on November 11, 2013

Even metabolically “healthy” overweight and obese people are at an increased risk of heart attack and heart disease, according to a new study.

Maintaining a healthy body weight is essential for reducing the risk of heart disease, according to a new study from Denmark. This is true even for people who don’t have metabolic syndrome (MetS), a group of risk factors for heart disease, diabetes, and stroke.

“We documented that overweight and obese individuals have an increased risk of heart attack and disease even in the absence of metabolic syndrome,” says Dr. Børge Nordestgaard, co-author of the new study, published today in JAMA Internal Medicine. “In other words, even metabolically healthy overweight and obese people are at an increased risk of heart problems.”
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This one indicates that weight stability is more important than static bmi:
Zheng H, Tumin D, Qian Z.
Am J Epidemiol. 2013 Dec 1;178(11):1591-9. doi: 10.1093/aje/kwt179. Epub 2013 Sep 7.
PMID:24013201

Abstract

Little research has addressed the heterogeneity and mortality risk in body mass index (BMI) trajectories among older populations.

Applying latent class trajectory models to 9,538 adults aged 51 to 77 years from the US Health and Retirement Study (1992–2008), we defined 6 latent BMI trajectories: normal weight downward, normal weight upward, overweight stable, overweight obesity, class I obese upward, and class II/III obese upward. Using survival analysis,

we found that people in the overweight stable trajectory had the highest survival rate, followed by those in the overweight obesity, normal weight upward, class I obese upward, normal weight downward, and class II/III obese upward trajectories. The results were robust after controlling for baseline demographic and socioeconomic characteristics, smoking status, limitations in activities of daily living, a wide range of chronic illnesses, and self-rated health. Further analysis suggested that BMI trajectories were more predictive of mortality risk than was static BMIstatus. Using attributable risk analysis, we found that approximately 7.2% of deaths after 51 years of age among the 1931–1941 birth cohort were due to class I and class II/III obese upward trajectories.

This suggests that trajectories of increasing obesity past 51 years of age pose a substantive threat to future gains in life expectancy.
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The Natural Course of Healthy Obesity Over 20 Years
Joshua A. Bell, MSc; Mark Hamer, PhD; Séverine Sabia, PhD; Archana Singh-Manoux, PhD; G. David Batty, PhD; Mika Kivimaki, PhD

After 20 years, approximately one-half of healthy obese adults were unhealthy obese, and only 10% were healthy nonobese. Healthy obese adults were nearly 8 times more likely to progress to an unhealthy obese state after 20 years than healthy nonobese adults, and these subjects were consistently more likely to make this adverse transition than unhealthy nonobese adults. Progressions from healthy to unhealthy obesity also increased steadily with increasing follow-up duration when using maximum samples of healthy obese adults over the follow-up period.

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The Myth of Healthy Obesity
James O. Hill, PhD; and Holly R. Wyatt, MD

.Fifth, some believe that overweight is not as much of a priority for intervention as obesity. As Kramer and colleagues found (1), metabolically unhealthy overweight persons have increased risk for cardiovascular events and total mortality and are candidates for obesity treatment. Metabolically healthy overweight persons are at risk for gaining more weight and becoming obese. The priority for them might involve prevention of weight gain. This is an important distinction because, although large behavioral changes are needed to produce and maintain weight loss, prevention of weight gain can be accomplished with much smaller, and perhaps more feasible, behavior changes (9).
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Obesity and late-age survival without major disease or disability in older women.
JAMA Intern Med. 2014 Jan 1;174(1):98-106. doi: 10.1001/jamainternmed.2013.12051.
PMID:24217806

Mean (SD) baseline age was 72.4 (3.0) years (range, 66-81 years). The distribution of women classified as healthy, prevalent diseased, incident diseased, disabled, and died was 19.0%, 14.7%, 23.2%, 18.3%, and 24.8%, respectively. Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. Relative to healthy-weight women, adjusted odds ratios (95% CIs) of mobility disability were 1.6 (1.5-1. for overweight women and 3.2 (2.9-3.6), 6.6 (5.4-8.1), and 6.7 (4.8-9.2) for class I, II, and III obesity, respectively. Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability.
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Fontana, L. and Hu, F. B. (2014), Optimal body weight for health and longevity: bridging basic, clinical, and population research. Aging Cell. doi: 10.1111/acel.12207

Excess body weight and adiposity cause insulin resistance, inflammation, and numerous other alterations in metabolic and hormonal factors that promote atherosclerosis, tumorigenesis, neurodegeneration, and aging. Studies in both animals and humans have demonstrated a beneficial role of dietary restriction and leanness in promoting health and longevity. Epidemiological studies have found strong direct associations between increasing body mass index (BMI) and risks of developing type 2 diabetes, cardiovascular disease, and several types of cancer, beginning from BMIof 20–21 kg m−2. Although a recent meta-analysis suggests that overweight individuals have significantly lower overall mortality than normal-weight individuals, these data are likely to be an artifact produced by serious methodological problems, especially confounding by smoking, reverse causation due to existing chronic disease, and nonspecific loss of lean mass and function in the frail elderly. From a clinical and public health point of view, maintaining a healthy weight through diet and physical activity should remain the cornerstone in the prevention of chronic diseases and the promotion of healthy aging.
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Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults
The Lancet, Volume 384, Issue 9945, Pages 755 - 765, 30 August 2014
doi:10.1016/S0140-6736(14)60892-8
Published Online: 14 August 2014

Findings
5·24 million individuals were included; 166 955 developed cancers of interest. BMI was associated with 17 of 22 cancers, but effects varied substantially by site. Each 5 kg/m2 increase in BMI was roughly linearly associated with cancers of the uterus (hazard ratio [HR] 1·62, 99% CI 1·56—1·69; p

YesYNot says

thunderlips11 says

Do Obesity Stats control for an aging population?

Generally no.

So a substantial portion of the obesity crisis is simple aging. China, Europe, USA - very aged countries. You lose muscle mass and your metabolism slows with each passing year.

Now, if older people are more likely to be overweight or obese, how much cost is attributable to being 20lb overweight and how much to being over 55 years old?

As for smoking, yeah, many Whole Foods underweight shoppers are vegetarian smokers (and alcoholics). I never go there without seeing a few puffing on their American Spirits with a boxed wine and a squash in their bag/

Also, looking at the above, if I see the word obese, I assume they are using the 30+ BMI definition.

A key trick is to lump overweight and obese together, to make the crisis look bigger than it is, even though there is little overall statistical reason (ie Mortality Rate, Cost, etc.) to treat overweight differently from average. Call it instead "Average I and Average II"

thunderlips11 says

Now, if older people are more likely to be overweight or obese, how much cost is attributable to being 20lb overweight and how much to being over 55 years old?

The impact of age is generally controlled for in studies on how obesity impacts mortality. Things like smoking also have to be controlled for, or the study is garbage. There are lots of studies that show that overweight (bmi 25-30) is worse than normal (bmi 18.5-25) when things like smoking and age are controlled for. Being overweight is worse than normal weight, but it's not as bad as being obese. Being overweight when young is correlated with being obese when older, so it's a bigger deal for young people. Obviously, there are other risk factors, but bmi is a good one.

What I meant was that when people report the percent of population that is obese, they are not correcting for age. However, within age brackets, people are getting fatter.

YesYNot says

There are lots of studies that show that overweight (bmi 25-30) is worse than normal (bmi 18.5-25) when things like smoking and age are controlled for.

Very slightly worse. The mortality risks from being in the "Overweight" category are minimal. A Risk Factor of 1.0 vs. 1.2 is nothing, especially if the study doesn't control for age.

If the study does control for age, smoking, alcoholism, etc. I would bet the minimal difference between average and overweight in terms of cost and mortality continues well into advanced age.

Ironman says

I'm sure the medical professionals who came up with these scales had a whole ton of data to go by, not just a few selected young guys. If you went and pulled everyone who walks into Walmart who is 5'-9" and weighs 170 - 180, they wouldn't look anything like those guys.

I gave three photos of 5'10" guys who are well into the "Overweight" range, and aren't bodybuilding or Olympic Weightlifting contestants by a long shot, just fit.

Average Joe at 5'10" or 5'9" and 190lb has a little pudge, you could pinch an inch. But healthwise, Joe presents negligible cost or mortality risk to society or himself even if he wasn't built.

Obese people are a problem, but Overweight people aren't. Let's stop worrying about people who are of average height, over 125 lb or under 200lb, and concentrate on the truly obese.

I think people that are fat are only thinking about themselves. Why not control your weight, exercise, and wear revealing clothes if you are a woman? Is that unreasonable?

Around a dozen years ago, researchers noticed that some patients with chronic conditions such as heart disease fared better than others. This should have been encouraging news, perhaps a clue to future treatments. Instead, researchers were baffled. Because the factor that seemed to be protecting these patients was fat: They were all overweight or mildly obese.

“When health-care professionals get their first nutrition books, there’s a chapter on obesity,” says Glenn Gaesser, director of the Healthy Lifestyles Research Center at Arizona State University. “And it generally says that fat people are unhealthy and thin people are healthy.”

Researchers immediately began trying to explain this “obesity paradox”—or, more often, to explain it away. Carl Lavie, a cardiologist in Jefferson, Louisiana, was one of the first clinicians to describe the paradox. It took him over a year to find a journal that would publish his findings. “People thought, ‘This can’t be true. There’s got to be something wrong with their data’,” he told Quartz.

Since then, dozens of studies have confirmed the existence of the paradox. Being overweight is now believed to help protect patients with an increasingly long list of medical problems, including pneumonia, burns, stroke, cancer, hypertension, and heart disease. Researchers who have tried to show that the paradox is based on faulty data or reasoning have largely come up short. And while scientists do not yet agree on what the paradox means for health, most accept the evidence behind it. “It’s been shown consistently enough in different disease states,” says Gregg Fonarow, a cardiology researcher at the University of California, Los Angeles.

The researcher who did most to kick off the debate, and in the process became the object of much of the pushback it generated, is an epidemiologist at the US Centers for Disease Control and Prevention named Katherine Flegal. Together with colleagues, she looked at hundreds of mortality studies that included data on body mass index (BMI), which is calculated by dividing a person’s weight in kilograms by the square of their height in meters. People with BMIs of more than 25 are classed as overweight, and those with a BMI over 30 as obese.

Almost all of the underlined items are the major causes of death.

According to new research this week in the Journal of the American Medical Association (JAMA), researchers say that being overweight may lead to a longer life.

The somewhat surprising conclusion comes from an enormous, detailed review of over 100 previously published research papers connecting body weight and mortality risk among 2.88 million study participants living around the world. The new research confirms that obese people, and particularly those who are extremely obese, tend to die earlier than those of normal weight. But the findings also suggest that people who are overweight (but not obese) may live longer than people with clinically normal body weight.

Even those with diabetes live longer if their BMI Class is "Overweight" rather than "Average"

Researchers call this the obesity paradox. "Generally speaking, obesity puts you at risk of higher mortality," says Pierluigi Costanzo, MD, of the academic cardiology unit at Castle Hill Hospital in the UK. He recently authored a study published in the Annals of Internal Medicine that found that among people with type 2 diabetes, those who are overweight live longer than those of a normal weight. "In certain populations, there is this paradox," he says, "but we don't know why exactly."

My 2 cents: I think folks are eating a lot more fattening food these days. Maybe I'm wrong, but it seems the facts back me up.

Interesting subject.

thunderlips11 says

So a substantial portion of the obesity crisis is simple aging. China, Europe, USA - very aged countries.

People weren't so fat 50 years ago. Why are so many kids so overweight today? It's the sodas, burgers, fries, and donuts.
Unfortunately, some of the garbage people eat stays inside the body.

Strategist says

thunderlips11 says

So a substantial portion of the obesity crisis is simple aging. China, Europe, USA - very aged countries.

People weren't so fat 50 years ago. Why are so many kids so overweight today? It's the sodas, burgers, fries, and donuts.

Unfortunately, some of the garbage people eat stays inside the body.

This. I have seen many "greatest generation" lean guys continue working into their 80s and 90s, while fat boomers suffer expensive medical problems and in some instances die younger than their parents did.

Also a really significant number of kids are overmedicated, including anti-psychotics prescribed to children as young as three, thanks to CHIP and other government programs that have made prescriptions increasingly profitable. (See also here, though it's behind a paywall.) The children of poor families are at worst risk of these "benefits" because the parents tend to lack the education to say no. Also the corn subsidies have the effect of reducing the prices of the most unhealthy processed foods. Also the advertising of junk food and fast food shifts demand away from healthy food and towards foods that are engineered specifically to maximize consumption; for example, an apple is better in every way than a bag of Skittles, but kids willingly pay more for the Skittles, "as seen on TV."

The commercial "news" narrative, brought to you primarily by drug companies ("ask your doctor!"), blares endlessly on behalf of war all over the world, while ignoring their sponsors' chemical war against kids.

curious2 says

Also a really significant number of kids are overmedicated, including anti-psychotics prescribed to children as young as three, thanks to CHIP and other government programs that have made prescriptions increasingly profitable. (See also here, though it's behind a paywall.) The children of poor families are at worst risk of these "benefits" because the parents tend to lack the education to say no.

The doctors should be using appropriate judgement by not prescribing excessive medication. Many doctors just don't care. :(

Strategist says

curious2 says

Also a really significant number of kids are overmedicated, including anti-psychotics prescribed to children as young as three, thanks to CHIP and other government programs that have made prescriptions increasingly profitable. (See also here, though it's behind a paywall.) The children of poor families are at worst risk of these "benefits" because the parents tend to lack the education to say no.

The doctors should be using appropriate judgement by not prescribing excessive medication. Many doctors....

are under extreme pressure directly and indirectly from drug companies. Doctors complain that patients lie to get permission to buy drugs that are advertised DTC including on TV. Drug companies have also paid doctors and provided other incentives, and research has found that even a "free" lunch and some logo products (e.g. pens) can have a significant effect on prescribing patterns. Drug companies can run politicians too, and the ambitious overachievers that set regulatory policy, resulting in "mandatory continuing education" that tends towards drug company informercials. With the increasingly heavy regulatory and insurance overhead, many doctors find they can't even continue to practice on their own anymore, and must surrender to corporate employment, which can have its own pressures. Many doctors are struggling to cope within a broken system where they get all the blame despite having less and less autonomy.

Thunder lips, if you Google flegal bmi smoking , you will see that the studies she included controlled for smoking in some way, but there is controversy about whether it was done well. When never smokers healthy people (exclude those who did in first four years) are looked at separately lower bmi, the paradox goes away. Another researcher split normal weight people into two groups (stable normal and people who used to be overweight or obese) the stable normals also lived longer than the weight losers. This is because many of the weight losers are already sick and that is why they lost weight.

Strategist says

People weren't so fat 50 years ago. Why are so many kids so overweight today? It's the sodas, burgers, fries, and donuts.

curious2 says

This. I have seen many "greatest generation" lean guys continue working into their 80s and 90s, while fat boomers suffer expensive medical problems and in some instances die younger than their parents did.

Yes, the outliers of that generation were alive and lean. There were plenty of big fat Sicilian guys who dropped dead of a heart attack at 45 in the 1960s, Spaghetti fork in hand. Fortunately in those days, people had kids young so their children were pretty much grown up by then. tPeople born in 1920 didn't live to see 65 on average.

Cheap generic water pills and blood pressure pills, and the widespread use of Heart Bypasses is a big factor in later generations' survival.

curious2 says

Also a really significant number of kids are overmedicated, including anti-psychotics prescribed to children as young as three, thanks to CHIP and other government programs that have made prescriptions increasingly profitable. (See also here, though it's behind a paywall.) The children of poor families are at worst risk of these "benefits" because the parents tend to lack the education to say no. Also the corn subsidies have the effect of reducing the prices of the most unhealthy processed foods. Also the advertising of junk food and fast food shifts demand away from healthy food and towards foods that are engineered specifically to maximize consumption; for example, an apple is better in every way than a bag of Skittles, but kids willingly pay more for the Skittles, "as seen on TV."

Thus "Diet Snacks" which are almost always Corn-Soy based and Insulin Spiking. I've seen people consume 300 Calorie bags of these while on the Treadmill going at an Old Lady's pace, sporting a sizable paunch and no muscle mass and seem to lose not one pound. Day after day. They are convinced they are making super healthy habits.

And the snack food/fitness industry is happy to have them on the low-fat snack endless treadmill hamster wheel. $$$ every month.

The walking probably isn't hurting them any, though they would get more cardio exercise in half the time if they sped up the walking 200%.

I would like to see some comments on the fact of the Obesity Paradox, that being overweight is marginally better for your health against the most common causes of death (and contributing syndromes like diabetes), than being average/lean.

Ironman says

Oh no... looks like you're screwed...

You missed the point about most people who lose weight do it because they are sick, or don't keep it off. I do think that the dangers of being fat are cumulative. You can't be fat all of your life, lose weight, and then be fine. Like smoking or working in a coal mine, quitting helps, but doesn't undo all of the damage.

YesYNot says

You missed the point about most people who lose weight do it because they are sick, or don't keep it off. I do think that the dangers of being fat are cumulative. You can't be fat all of your life, lose weight, and then be fine. Like smoking or working in a coal mine, quitting helps, but doesn't undo all of the damage.

This. Also there is the Loose Skin problem, somebody Class II Obese or even Class I if they have bad genetics, who goes down substantially to a healthy weight, can end up with pounds and pounds of loose skin. And often look better fat than with folds of loose skin dangling from their body.

Ironman says

Are you saying that these babes are hot?

Imagine them if the bellies didn't stick out, but the skin folds hung down like curtains.

This chef lost 150lb via dieting, and he's not an old geezer. Without surgery, his 10lb of loose skin ain't going nowhere.

Here's a link of a guy who also lost 100lb. His loose skin that formerly held his belly fat now folds over his nuts almost down to his knees. I won't put it up as to spoil anybody's lunch.
http://www.sciencephoto.com/media/522413/view

well, the MSM and those shows on television with females hosts all promote girls as being heavy hefty honeys like the one on sports illustrated. then they turn around and skinny shame other females for being too skinny. what a bunch of HIPPO Hippocrits.

I guess since most girls can't be thin anymore just give in and make them fell comfortable being fat pits! like the cuties in the profile just above this. They are GORGEOUS!

oh, and when the four ladies (i think they are human) kids grow up and see this pick they reply will probably be, "you were so thin mommy" oh my lord !!

YesYNot says

So, it's not a yoyo thing.

Ironman says

I don't think yo-yoing up and down from diet to diet is good for you overall. That puts stress on your body and your systems can't stabilize. That's what you've done.

I have no reason to lie. I've spent 95% of my life in the normal weight range and very active. I spent a couple of years working too hard and being 10 lbs overweight. I changed my diet once and returned to my normal weight (bmi between 22 and 24). That's not yoyoing or going from diet to diet. It's a rational person's response to aging and life changes.

thunderlips11 says

Do Obesity Stats control for an aging population? In 1970, most of the population in US/Europe was under 40.

I think thunderlips brought up a key point here. If a chart of mortality=f(BMI) contains only one curve that covers all ages, then clearly part of the excess mortality at higher BMI must in reality be an age effect and not a BMI effect (because BMI tends to increase wih age, the higher-BMI persons in the sample tend also to be older and have higher mortality for that reason, and not just because of more fat on their bodies).

YesYNot says

You keep saying this, but: ( plots of mortality=f(BMI), and healthcarespending=f(BMI) follow ).

Your example of invoking healthcarespending=f(BMI), which is your 2nd plot, is a particularly clear example of not understanding the difference between correlation and causation. Your claim is that high BMI is unhealthy, because, look!, high BMI correlates with higher healthcare spending per person. You are completely ignoring that high BMI also has a positive correlation with age. There is a large statistical causation between age and healthcare spending, There is almost certainly also a causation between high BMI and higher healthcare consumption, but it is completely wrong to attribute the full healthcare consumption rise just to the BMI. This is what thunderlips has been trying to tell you.

By other applications of the same flawed logic, higher BMI also causes forgetfullness, thinning hair, glaucoma, Alzheimer's, racism, xenophobia, favorable views of torture, and (you guessed it) voting Republican.

thunderlips11 says

I gave three photos of 5'10" guys who are well into the "Overweight" range, and aren't bodybuilding or Olympic Weightlifting contestants by a long shot, just fit.

Average Joe at 5'10" or 5'9" and 190lb has a little pudge, you could pinch an inch. But healthwise, Joe presents negligible cost or mortality risk to society or himself even if he wasn't built.

Agree. Also, BMI is a very bad predictor of body fat percentage, which is the much more interesting indicator of overweight. If a male has a half-decent amount of muscle, the BMI quickly gets quite high even for persons with moderate body fat. Myself, I can easily get classified into the "obese" BMI range unless I insist on taking off my shoes and most of my clothes when weighing in at the doctor's office. While I'm hardly a sylph and should lose 20 lbs, I'm not "obese" either.

This whole weighing/BMI thing is a bit of peeve of mine, because if Obamacare ever gets repealed I will have to watch like a hawk on the weigh-ins or else my insurance cost would double.

justme says

Your interpretation of healthcarespending=f(BMI), which is your 2nd plot, is a particularly clear example of not understanding the difference between correlation and causation. ...

Health care costs are higher for overweight people within age brackets. It is true that overall, middle age people are fatter and sicker than younger people, and it is also true that both age and weight influence cost. However, it is also true that overweight middle age people are more expensive than normal weight middle age people. If you follow the link, you will see that the health is better and cost is lower within each age group for normal weight people.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637212/

Excess body weight increases the burden of age-associated chronic diseases and their associated health care expenditures
Vincenzo Atella,1,2 Joanna Kopinska,1 Gerardo Medea,3 Federico Belotti,1 Valeria Tosti,4 Andrea Piano Mortari,1 Claudio Cricelli, MD,3 and Luigi Fontana4,5,6
Author information â–º Article notes â–º Copyright and License information â–º
Go to:
Abstract
Aging and excessive adiposity are both associated with an increased risk of developing multiple chronic diseases, which drive ever increasing health costs. The main aim of this study was to determine the net (non‐estimated) health costs of excessive adiposity and associated age‐related chronic diseases. We used a prevalence‐based approach that combines accurate data from the Health Search CSD‐LPD, an observational dataset with patient records collected by Italian general practitioners and up‐to‐date health care expenditures data from the SiSSI Project. In this very large study, 557,145 men and women older than 18 years were observed at different points in time between 2004 and 2010. The proportion of younger and older adults reporting no chronic disease decreased with increasing BMI. After adjustment for age, sex, geographic residence, and GPs heterogeneity, a strong J‐shaped association was found between BMI and total health care costs, more pronounced in middle‐aged and older adults. Relative to normal weight, in the 45‐64 age group, the per‐capita total cost was 10% higher in overweight individuals, and 27 to 68% greater in patients with obesity and very severe obesity, respectively. The association between BMI and diabetes, hypertension and cardiovascular disease largely explained these elevated costs.

justme says

thunderlips11 says

Do Obesity Stats control for an aging population? In 1970, most of the population in US/Europe was under 40.

I think thunderlips brought up a key point here. If a chart of mortality=f(BMI) contains only one curve that covers all ages, then clearly part of the excess mortality at higher BMI must in reality be an age effect and not a BMI effect (because BMI tends to increase wih age, the higher-BMI persons in the sample tend also to be older and have higher mortality for that reason, and not just because of more fat on their bodies).

This is not how any of the research works. There are loads of studies that correct for age, physical activity, alcohol intake, smoking, etc. Nobody is holding up correlations that do not adjust for age. The issue is that with enough data, it is easy to correct for things that don't correlate strongly, but it is hard to adjust for things that do correlate strongly (like smoking and weight). So, people get different results when they regress all data and correct for smoking (Flegal) than when they just regress data after excluding everyone who smoked or was sick when the study began.

What is not correlated with age is the percent of the country that is obese. But it has grown so much that it doesn't really matter. You don't go from 10% obese to 30% obese just because the baby boom is at peak fat years (late middle age).

www.youtube.com/embed/RBKM3b7phJc

Ironman says

Yep, it's actually the majority of the Gen Xers that are the most obese, not the baby boomers:

While your chart is helpful, your analysis is off as usual. Boomers are 50-70 at the moment. They represent more than 1/3 of the 40-60 group. Plus, the 60+ group is thinner in part b/c the fatter oldsters have died off and the surviving ones are shrinking with age.

Ironman says

When you have a population of teenagers (who should be in the best condition of their lives), and just about 20% of them are considered OBESE (not just overweight), tell me what does that do for the future of healthcare in the country.

Health care and the military. What's a bigger long term threat to US military power, ISIS or running out of fit people to serve in the military?

YesYNot says

Health care costs are higher for overweight people within age brackets. It is true that overall, middle age people are fatter and sicker than younger people, and it is also true that both age and weight influence cost. However, it is also true that overweight middle age people are more expensive than normal weight middle age people. If you follow the link, you will see that the health is better and cost is lower within each age group for normal weight people.

Overweight or Obese? Again, the Obesity Paradox shows that Overweight (25-30BMI) is healthier than average, with better health outcomes from the major causes of death like heart disease and cancer.

YesYNot says

This is not how any of the research works. There are loads of studies that correct for age, physical activity, alcohol intake, smoking, etc. Nobody is holding up correlations that do not adjust for age. The issue is that with enough data, it is easy to correct for things that don't correlate strongly, but it is hard to adjust for things that do correlate strongly (like smoking and weight). So, people get different results when they regress all data and correct for smoking (Flegal) than when they just regress data after excluding everyone who smoked or was sick when the study began.

Which ones do and which don't? Did the EU study correct for Age?

Even in Europe it's not at all unusual to see Overweight-Obesity Class I people over 55.

thunderlips11 says

Which ones do and which don't? Did the EU study correct for Age?

If you read through some of the abstracts and summaries I pasted in this post http://patrick.net/?p=1290424&c=1277827#comment-1277827, you will see that many do correct for age. I believe the rest do too, but I didn't look for that when copying results.

As far as the EU study goes, I assume you are talking about the cost study. This article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637212/) was written by the same person who wrote the article with the cost/bmi chart. If you follow the link, you will see that overweight is more expensive and has more disease than normal bmi in each of the age groups.

thunderlips11 says

Overweight or Obese?

Overweight is more expensive than normal bmi. Just look at the link in my last post.

YesYNot says

Overweight is more expensive than normal bmi. Just look at the link in my last post.

Maybe - but chart is from Europe and it doesn't look like it's adjusted for age.

But overweight is healthier. Scientists and Mathematicians have spent more than a decade trying to debunk the research and have conducted hundreds of studies and many metastudies, and almost all of them confirms it, and those that don't generally find no difference in health outcomes.

thunderlips11 says

Again, the Obesity Paradox shows that Overweight (25-30BMI) is healthier than average, with better health outcomes from the major causes of death like heart disease and cancer.

Only if you include smokers and sick people.

YesYNot says

Only if you include smokers and sick people.

So average weight smokers are healthier than non-smoking overweight people?

Source controlled for age and addictions?

Obesity is out of control; why?

This is an easy one

Carbohydrates

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