Are all obese people hypothyroid?

[Waremu]

Re: The effect of vitamin A supplementation on thyroid function in premenopausal women.

Regarding the study, does it mention the start and end months, and approximate location? If not, and depending on when and where, seasonal effects could be a possible confounder?

obese/hypothyroid (if someone is obese they are hypothyroid)

Do we know this? It may be common, but I'm not sure that I've seen it demonstrated that it always applies. Some obese people seem to be metabolically reasonably healthy.

Yes, I think the evidence concerning the main factors behind efficient metabolism and the very strong association between obesity and inefficient metabolism is well established.

Obesity is a sign of a stressed metabolism, so how could obese people be "reasonably healthy?" Because a "disease" has not yet manifested itself yet? Of course that in of itself is impossible, since obese people in general do not efficiently utilize insulin or other important hormones which are involved in the regulation of blood sugar, etc. The main underlying mechanisms that contribute to or cause obesity are all conducive to disease, not good health. Obesity in of itself is a hallmark sign of biological stressors which drive metabolism. So I do not believe someone can truly be "healthy" and be obese. That would be like saying someone can be in a true starvation state where their body is catabolizing itself (organs, muscle, etc.) and because they have no "known disease" yet they are therefore "healthy." On the other hand, it does not mean an obese person cannot become healthy either.

 

[tara]

Re: The effect of vitamin A supplementation on thyroid function in premenopausal women.

Regarding the study, does it mention the start and end months, and approximate location? If not, and depending on when and where, seasonal effects could be a possible confounder?

obese/hypothyroid (if someone is obese they are hypothyroid)

Do we know this? It may be common, but I'm not sure that I've seen it demonstrated that it always applies. Some obese people seem to be metabolically reasonably healthy.

Yes, I think the evidence concerning the main factors behind efficient metabolism and the very strong association between obesity and inefficient metabolism is well established.

Obesity is a sign of a stressed metabolism, so how could obese people be "reasonably healthy?" Because a "disease" has not yet manifested itself yet? Of course that in of itself is impossible, since obese people in general do not efficiently utilize insulin or other important hormones which are involved in the regulation of blood sugar, etc. The main underlying mechanisms that contribute to or cause obesity are all conducive to disease, not good health. Obesity in of itself is a hallmark sign of biological stressors which drive metabolism. So I do not believe someone can be "healthy" and be obese. That would be like saying someone can be in a true starvation state where their body is catabolizing itself (organs, muscle, etc.) and because they have no "known disease" yet they are therefore "healthy."

I am quite willing to believe that obesity can sometimes be the result of ill health. (There is evidence that it may sometimes be protective against some metabolic disturbances.)

My memory of the mortality-BMI graph is that the trough in the graph sits around BMI 27 (near the middle of the 'overweight' range), and that it is fairly flat (ie close to the minimum) from the top half of the "normal/ideal" BMI range and up into the lower end of the 'obese' BMI range. I've looked for this graph again, and haven't found it - if I find it again I'll link to it somewhere so I don't lose it. :) I think it is quite possible that optimal BMI and adiposity can vary amongst healthy individuals, including into the so-called 'obese' range. I'm pretty sure there are people in the 'obese' range who show metabolic markers for reasonable metabolic health, eg good body temps, good insulin sensitivity, etc, on par with healthy people in the 'ideal' or 'overweight' ranges.

It's possible we have different definitions of obesity, and that that has something to do with our different views. The above paragraph refers to standard public BMI ranges. But if you define obesity in some other way, eg 'excess' adiposity, where 'excess' means more than is healthy for the individual, then your argument is probably true, but may be a bit circular. How would you know what was excessive?

You present some logic in support of your assertion, but I'm not aware of empirical evidence that shows that all or even most people in the 'obese' range are less healthy than people in the 'overweight' or ''normal' weight ranges.

Every healthy person will probably eventually have one or more diseases that is not yet manifest. Not to say that some states aren't closer to manifesting symptoms.

The view I've expressed here is mine, not necessarily Peat's.

 

[Waremu]

Re: The effect of vitamin A supplementation on thyroid function in premenopausal women.

Regarding the study, does it mention the start and end months, and approximate location? If not, and depending on when and where, seasonal effects could be a possible confounder?

obese/hypothyroid (if someone is obese they are hypothyroid)

Do we know this? It may be common, but I'm not sure that I've seen it demonstrated that it always applies. Some obese people seem to be metabolically reasonably healthy.

Yes, I think the evidence concerning the main factors behind efficient metabolism and the very strong association between obesity and inefficient metabolism is well established.

Obesity is a sign of a stressed metabolism, so how could obese people be "reasonably healthy?" Because a "disease" has not yet manifested itself yet? Of course that in of itself is impossible, since obese people in general do not efficiently utilize insulin or other important hormones which are involved in the regulation of blood sugar, etc. The main underlying mechanisms that contribute to or cause obesity are all conducive to disease, not good health. Obesity in of itself is a hallmark sign of biological stressors which drive metabolism. So I do not believe someone can be "healthy" and be obese. That would be like saying someone can be in a true starvation state where their body is catabolizing itself (organs, muscle, etc.) and because they have no "known disease" yet they are therefore "healthy."

I am quite willing to believe that obesity can sometimes be the result of ill health. (There is evidence that it may sometimes be protective against some metabolic disturbances.)

My memory of the mortality-BMI graph is that the trough in the graph sits around BMI 27 (near the middle of the 'overweight' range), and that it is fairly flat (ie close to the minimum) from the top half of the "normal/ideal" BMI range and up into the lower end of the 'obese' BMI range. I've looked for this graph again, and haven't found it - if I find it again I'll link to it somewhere so I don't lose it. :) I think it is quite possible that optimal BMI and adiposity can vary amongst healthy individuals, including into the so-called 'obese' range. I'm pretty sure there are people in the 'obese' range who show metabolic markers for reasonable metabolic health, eg good body temps, good insulin sensitivity, etc, on par with healthy people in the 'ideal' or 'overweight' ranges.

It's possible we have different definitions of obesity, and that that has something to do with our different views. The above paragraph refers to standard public BMI ranges. But if you define obesity in some other way, eg 'excess' adiposity, where 'excess' means more than is healthy for the individual, then your argument is probably true, but may be a bit circular. How would you know what was excessive?

You present some logic in support of your assertion, but I'm not aware of empirical evidence that shows that all or even most people in the 'obese' range are less healthy than people in the 'overweight' or ''normal' weight ranges.

Every healthy person will probably eventually have one or more diseases that is not yet manifest. Not to say that some states aren't closer to manifesting symptoms.

The view I've expressed here is mine, not necessarily Peat's.

Well, the BMI in of itself is not a good indicator to determine who is and isn't obese, by medical standards. In fact, a body builder could be found to be obese if one were to use the BMI system strictly without looking at the person or measuring LBM to BF percentage and ratio. But of course, if we look at their LBM and BF percentage and see them literally, one could not conclude that they were "obese."

When we look at some of the main causes of obesity, it points to biological stressors. I do not believe it is possible to find a single obese person who has: optimized insulin sensitivity, low estrogen, low prolactin, optimal TSH and T4 and T3 output (including uptake); low NO tissue saturation, low FFA, etc., as these things are what cause and contribute to obesity. There is no way someone can convince me that being 100 pounds or so overweight is "healthy." The weight alone that is put on an obese persons organs and joints is not healthy. Obese people often cannot do a decent level of exercise without being either winded or close to winded. This is not normal, nor is it healthy. I think it is well established that the vast majority of people who are tested and are obese have some kind of health condition or disease. If someone is obese and claims to be "healthy", then I would like to look at their blood work, hormonal profile included.

Also, the mortality rate in relation to obesity is not the main determining factor for health. Someone could live fairly long obese, but that doesn't make them "healthy." That would be like saying someone who is sick and in bed on life support at the age of 97 is healthy. Yes, they lived a long time by todays standards, but they're also spending their last years in bed, sick, on a bunch of drugs like a vegetable. People live longer, but people also "die" longer. Dying longer is not synonymous with good health.

Despite how the medical system defines health (simply the absence of disease), health correctly defined is not only the absence of disease, but also when the organism is operating at it's optimal or ideal state so that it can handle stress the most efficiently, with the least damage. If someone is in an ideal state of health, then they shouldn't be moving towards disease. If someone is in a state of bad health, they should be moving further from disease and closer to what should be an optimal state of health.

 

[tara]

Re: The effect of vitamin A supplementation on thyroid function in premenopausal women.

Warning: this is an off-topic and prolix tangent to the thread - do skip it if you like. (Thanks such, for extending my vocab today. :))

Well, the BMI in of itself is not a good indicator to determine who is and isn't obese, by medical standards. In fact, a body builder could be found to be obese if one were to use the BMI system strictly without looking at the person or measuring LBM to BF percentage and ratio. But of course, if we look at their LBM and BF percentage and see them literally, one could not conclude that they were "obese."

I agree both that BMI does not represent LBM:BF and that it therefore does not always match common perceptions of obesity.
But my points also apply to any set ranges of BF percentage.

When we look at some of the main causes of obesity, it points to biological stressors.

I agree that there do seem to be a number of factors that can cause excessive biological stress and increased fat for many people, and that these factors can undermine health. They may include, amongst others, mitochondrial inhibition by PUFAs, phytoestrogens and other environmental poisons, malnourishment, and severe life stresses. What I am not convinced about is that all fat people are fat from these causes. I think it is possible (likely) that some people have a natural set point in the 'obese' range under reasonably optimal conditions. I have not yet seen any evidence to counter that.
I am also aware of biological stresses that can lead people to be underweight compared to their optimum. (Severe under-eating is one of them - I think we'd agree about that.) Statistically, the mortality rates for BMI 17.5 (the bottom of the 'ideal' BMI range, depending on which version you look at) are similar to those at BMI 35 (well into the 'obese' range). Most people are not optimally healthy in the bottom half of the 'ideal' BMI range. But I don't conclude that no-one can be naturally thin and healthy at BMI 19, any more than I conclude that no-one can be naturally round and healthy at BMI 33 (even if they are not a body-builder or similar).

I do not believe it is possible to find a single obese person who has: optimized insulin sensitivity, low estrogen, low prolactin, optimal TSH and T4 and T3 output (including uptake); low NO tissue saturation, low FFA, etc., as these things are what cause and contribute to obesity. There is no way someone can convince me that being 100 pounds or so overweight is "healthy."

Are you saying your opinion is fixed and evidence to the contrary would be irrelevant? And all the onus is on other people to find the evidence to disprove your assertion?
Also, the question may already be begged by describing someone as 'overweight'. If it means more-than-optimal-for-them-adiposity, then it is self-evident that it is not the most healthy for that individual. If they are healthy, then by this definition they would not be overweight. Or by what standard do you distinguish overweight? Are we talking about an arbitrary larger-than-currently-fashionable-fat-ratio?

The weight alone that is put on an obese persons organs and joints is not healthy.

My understanding is that while large weight can be hard on joints, greater fat is statistically protective against osteoroporosis. Not sure if this is via load-bearing stimulus or other mechanisms. I know both lean and fat people with severe joint issues, and lean and fat people with reasonably healthy joints.
Some people spend lots of time and money adding to the weights borne by their joints. Some people here do it, too. Many of them think this is supportive of their health.
Fat around the vital organs provides valuable insulation, helping maintain core temperatures under stressful conditions. It is usually more saturated than more superficial fat, and may be protective against reduced metabolism compared with not having it. I'm not saying there can't be any downsides to fat around the organs, but it's not all bad. Sure beats not having any for swimming at our local beach.

Obese people often cannot do a decent level of exercise without being either winded or close to winded.

A great many people who are fatter than fashion dictates are discouraged from exercise by the threat or reality of ubiquitous and vicious anti-fat abuse when they do. I think this counts as a major confounder.
When I was leaner, I got puffed/slow/exhausted carrying a 20kg pack uphill. Was I more fit and healthy than someone who got similarly puffed while carrying 20 - 30kg more of body weight (including more fat) instead of a pack? I think such a judgement would be a bit arbitrary.
I have had at least one yoga teacher who I think would have been classed as obese by either BMI or fat-mass standards. It didn't stop her being able to a lot of things that most 'ideal' or 'overweight' people couldn't do. Given that she also regularly practiced pranayama, I wouldn't be at all surprised if her general metabolic health by the measures you propose was better than average. I can't prove it though.
I'm not saying all obese people are healthy, just that some probably are.

This is not normal, nor is it healthy.

By normal, do you mean common (in which case I'd say it is pretty normal) or ideal?

I think it is well established that the vast majority of people who are tested and are obese have some kind of health condition or disease.

Do you have evidence for this? Or only if obesity itself is counted as a disease? It is common for people who are judged to be overweight to have any health issue they present attributed to their fat, often with little evidence. They often get worse treatment by the medical establishment than leaner people, and this may be another important confounder.

If someone is obese and claims to be "healthy", then I would like to look at their blood work, hormonal profile included.

The metabolic markers for health are only meaningful to the extent that they really do relate to long good health, rather than fashion. I expect we would agree that there has been confusion about this wrt cholesterol levels, for instance. This is why I think mortality is a relevant parameter.

The stress imposed by the rest of society on people who are fatter than average is severe. As we know, stress of all kinds is deleterious to health. There is some evidence that at least some of the ill health associated with fat is caused by the societal oppression, rather than the fat itself. Some of this oppression takes its toll psychologically, and some may well have physical mechanisms, such as discouragement from exercise and pressure to undernourish oneself, or submit to dangerous drugs or surgery, etc.
A decent study to demonstrate your point would be difficult, given that it would be pretty hard to control for the confounding factors mentioned above - how would you distinguish the direct effects of obesity in humans from the effects of the other stresses imposed on people with more than average fat?

Also, the mortality rate in relation to obesity is not the main determining factor for health. Someone could live fairly long obese, but that doesn't make them "healthy." That would be like saying someone who is sick and in bed on life support at the age of 97 is healthy. Yes, they lived a long time by today's standards, but they're also spending their last years in bed, sick, on a bunch of drugs like a vegetable. People live longer, but people also "die" longer. Dying longer is not synonymous with good health.

It's true that health is more than just having a heartbeat. Do you mean that people in some arbitrary 'ideal' weight range die quickly when their health deteriorates, whereas fatter people die more slowly? I don't know if that's true in general. It does seem to be true for some metabolic conditions though. I think it's established (called the 'obesity paradox') that obese people are more likely to survive a heart attack, for instance. I tend to think of such survival as a good thing.

Despite how the medical system defines health (simply the absence of disease), health correctly defined is not only the absence of disease, but also when the organism is operating at it's optimal or ideal state so that it can handle stress the most efficiently, with the least damage. If someone is in an ideal state of health, then they shouldn't be moving towards disease. If someone is in a state of bad health, they should be moving further from disease and closer to what should be an optimal state of health.

I agree that good health is more than just the absence of diagnosed disease, and that ideally we would all want to be in, or moving towards optimal health. You generally have to be pretty far away from good health to get a diagnosis from a dr. But statistically, such diagnoses are still relevant.
In practice so far immortality has not been achieved, and probably all of us are generally moving towards ageing and death, hopefully not too fast. To me, much as I would like for me and my loved ones to be in ongoing ideal health, the reality is that very few people probably match your high standards, and I think the relative health of the rest of us is important too.

 

[Waremu]

Re: The effect of vitamin A supplementation on thyroid function in premenopausal women.

Warning: this is an off-topic and prolix tangent to the thread - do skip it if you like. (Thanks such, for extending my vocab today. :))
I agree both that BMI does not represent LBM:BF and that it therefore does not always match common perceptions of obesity.
But my points also apply to any set ranges of BF percentage.

Yes, but obese people with a higher will generally have more BF than obese people with a lessor BMI, since obese people in general do not have a high LBM to BF ratio.

The problem is, by medical definition, there is a vast difference between being over weight and obese.

Doctors usually define “overweight” as a condition in which a person’s weight is 10%-20% higher than “normal,” as defined by a standard height/weight chart, or as a body mass index (BMI) of 25 to 30.

Obesity is usually defined as a condition in which a person’s weight is 20% or more above normal weight or as a BMI of 30 or more. “Morbid obesity” means a person is either 50%-100% over normal weight, more than 100 pounds over normal weight, or sufficiently overweight to severely interfere with health or normal functioning.

An argument can be made for what the set BF percentage should be, but you cannot compare the body fat percentage of someone who is overweight to someone who is obese and use that to justify questioning the set body fat percentage of an obese person, as they have drastically more body fat.

I agree that there do seem to be a number of factors that can cause excessive biological stress and increased fat for many people, and that these factors can undermine health. They may include, amongst others, mitochondrial inhibition by PUFAs, phytoestrogens and other environmental poisons, malnourishment, and severe life stresses. What I am not convinced about is that all fat people are fat from these causes. I think it is possible (likely) that some people have a natural set point in the 'obese' range under reasonably optimal conditions.

If all obese people were not obese because of these biological stressors, then how come we cannot find a single obese person who is not in a biological state of stress? How come we cannot find a single obese person who has low estrogen, low prolactin, low serotonin, fast digestion, proper thyroid function? If obesity is a hallmark sign of the biological state of stress, like many other diseases, then surely one cannot argue that obesity is healthy when it resembles something that is a state of biological stress, or is the result of biological stress.

I have not yet seen any evidence to counter that.

The fact that obesity is highly correlated with the biological stressed state is enough evidence. Furthermore, the mechanism that we know of which lead to or cause obesity are mainly those of biological stress.

I am also aware of biological stresses that can lead people to be underweight compared to their optimum. (Severe under-eating is one of them - I think we'd agree about that.)

Correct. And being severely underweight is also unhealthy. It's just a different manifestation of being unhealthy than obesity is. But both states are unhealthy.

Statistically, the mortality rates for BMI 17.5 (the bottom of the 'ideal' BMI range, depending on which version you look at) are similar to those at BMI 35 (well into the 'obese' range). Most people are not optimally healthy in the bottom half of the 'ideal' BMI range. But I don't conclude that no-one can be naturally thin and healthy at BMI 19, any more than I conclude that no-one can be naturally round and healthy at BMI 33 (even if they are not a body-builder or similar).

Again, as I explained earlier, the mortality rate is not the proper definition of health. Just because you live a little longer than someone else does not necessarily mean you are healthier than they are. Obese people have more "safeguards" to deal with stress than underweight people do, quite possibly. For example, if obese people store more PUFA instead of burning it as fast as a non-obese person may, then that could actually mean that the thinner person could see disease quicker due to the mitochondrial damage that ensues. But does that mean the obese person is still healthy? No, of course not.

So that could be one factor in relation to the mortality rate. As far as those not being "as healthy" in the bottom half of the "ideal" BMI range, that is up for debate. What the medical profession tests for and defines as "healthy" is largely wrong and misleading. According to their definition, they did not check both the obese and non-obese subjects with a proper assessment of their complete blood work, etc., so that is largely misleading.

I do not believe it is possible to find a single obese person who has: optimized insulin sensitivity, low estrogen, low prolactin, optimal TSH and T4 and T3 output (including uptake); low NO tissue saturation, low FFA, etc., as these things are what cause and contribute to obesity. There is no way someone can convince me that being 100 pounds or so overweight is "healthy."

Are you saying your opinion is fixed and evidence to the contrary would be irrelevant? And all the onus is on other people to find the evidence to disprove your assertion?

I simply said that there is no evidence of obese people with normal levels of the mentioned blood tests/hormonal profiles. This is because obesity is the result of out of control blood tests which indicate biological stress. If there is evidence of healthy obese people, then why have we not yet seen it? It's a logical conclusion.

Also, the question may already be begged by describing someone as 'overweight'. If it means more-than-optimal-for-them-adiposity, then it is self-evident that it is not the most healthy for that individual. If they are healthy, then by this definition they would not be overweight. Or by what standard do you distinguish overweight? Are we talking about an arbitrary larger-than-currently-fashionable-fat-ratio?

We are talking about obese people, NOT overweight people. You seem to keep going back and fourth between the two. I am talking and have been talking about obese people. I think the standard which they use to determine obesity is fairly correct, though not perfect. More fat mass is associated with more biological stress. For example, obese people will generally have less insulin sensitivity than people who are at a fairly healthy weight. Obese carry more weight which puts more stress on organs. Almost all obese people are type 2 diabetic or "borderline" diabetic. More weight is associated with disease. This is well established. Therefore, the more overweight a person is, the less likely they are to be healthy. When a person shies away not too far from the medical definition of being overweight or becomes obese, very often they begin to see all kinds of health problems. Therefore, the way we determine the obesity level is fairly accurate. This is of course backed up by the fact that no one can find a handful of obese people who are healthy.



I agree with Dr. Peat when he says good health is associated with a fast metabolic rate. Obese people do not have fast metabolic rates, so that in of itself is contrary to the statement that obese people can be healthy.

My understanding is that while large weight can be hard on joints, greater fat is statistically protective against osteoroporosis. Not sure if this is via load-bearing stimulus or other mechanisms. I know both lean and fat people with severe joint issues, and lean and fat people with reasonably healthy joints.
Some people spend lots of time and money adding to the weights borne by their joints. Some people here do it, too. Many of them think this is supportive of their health.
Fat around the vital organs provides valuable insulation, helping maintain core temperatures under stressful conditions. It is usually more saturated than more superficial fat, and may be protective against reduced metabolism compared with not having it. I'm not saying there can't be any downsides to fat around the organs, but it's not all bad. Sure beats not having any for swimming at our local beach.

Yes, fat can be protective, but that doesn't mean being fat is healthy. Yes, though fat can be protective in some cases, there are still trade-offs. We simply cannot ignore one risk that is brought about by something just because that something offers a potential benefit in another area. Sometimes there will be some benefits to the mechanisms put into place by stress itself as a means to cope with stress, but that does not mean that that condition or state is still healthy. Same goes with obesity.

Obesity is highly associated with Osteoarthritis, which is a common joint problem of the knees, hips, and lower back. The condition occurs if the tissue that protects the joints wears away. Extra weight can put more pressure and wear on joints, causing pain. In fact, if we were to make a calculation, we can say that for every 10 pounds of extra weight you carry, an additional 30 to 60 pounds of force is placed on the knees with each step. That is simply not healthy.

A great many people who are fatter than fashion dictates are discouraged from exercise by the threat or reality of ubiquitous and vicious anti-fat abuse when they do.

Using the term "fatter than fashion dictates" is not a good assessment of things at all. That is extreme because fashion often sees anyone who is not a stick as being "fat." We aren't talking about fashions definition of what fat is; we are talking about obesity. Big difference.

When I was leaner, I got puffed/slow/exhausted carrying a 20kg pack uphill. Was I more fit and healthy than someone who got similarly puffed while carrying 20 - 30kg more of body weight (including more fat) instead of a pack? I think such a judgement would be a bit arbitrary.
I have had at least one yoga teacher who I think would have been classed as obese by either BMI or fat-mass standards. It didn't stop her being able to a lot of things that most 'ideal' or 'overweight' people couldn't do. Given that she also regularly practiced pranayama, I wouldn't be at all surprised if her general metabolic health by the measures you propose was better than average. I can't prove it though.
I'm not saying all obese people are healthy, just that some probably are.

I am talking about someone who is too out of breath to do an exercise, I am not talking about someone simply puffing" for air while exercising. I am an athlete and I have trained with people my entire life. There is absolutely no way anyone can prove to me or tell me that the average obese person is more fit than the average thin person who does not even exercise. I worked with all kinds of people and in every single case, obese and even people who were well overweight we not even able to do the most basic exercises for more than 20 minutes. This is far from natural. Thousands of years ago, in nature, just to survive and provide for yourself, there is no way one would be able to make it if they were too obese to hunt their prey. That fact alone should be a strong indicator that obesity is not and cannot be synonymous with health. If someone is too out of breath to do a constant exercise for 20-30 min, then there is something wrong with that. There are thin people who never exercise either and would be puffing for air do to some basics, but they would adapt much quicker to that exercise than an obese person would; also, there is all that weight on the joints during exercise, which I doubt is healthy.

This is not normal, nor is it healthy.

By normal, do you mean common (in which case I'd say it is pretty normal) or ideal?

I think it is well established that the vast majority of people who are tested and are obese have some kind of health condition or disease.

Do you have evidence for this? Or only if obesity itself is counted as a disease? It is common for people who are judged to be overweight to have any health issue they present attributed to their fat, often with little evidence. They often get worse treatment by the medical establishment than leaner people, and this may be another important confounder.

Yes, because the biological mechanisms that cause obesity are the same ones that cause disease. Therefore, in order for someone to be obese, they must have some kind of risk due to these biological stressors. That is like saying you can go from point A to point Z without actually beginning point Z.

And why isn't there a single shred of medical evidence that shows a single obese person who does not have high estrogen, serotonin, or low thyroid? Because there isn't a single obese person that lacks these stressors because the reason why the are obese is due to these stressors.

If someone is obese and claims to be "healthy", then I would like to look at their blood work, hormonal profile included.

The metabolic markers for health are only meaningful to the extent that they really do relate to long good health, rather than fashion. I expect we would agree that there has been confusion about this wrt cholesterol levels, for instance. This is why I think mortality is a relevant parameter.

No, I think Ray Peat has summed this up well enough already. This has nothing to do with "fashion", as you, for some reason, keep pointing out. Again, we are talking about obesity, not being fat according to a fashion agencies definition, which is crazy to begin with. The fact is, we have enough evidence established to have a good idea of what is and isn't good when it comes to hormone levels, etc. And not a single obese person can show blood work that has all these stressors at bay, as that is the reason why the became obese to begin with. A slow metabolism is synonymous with obesity and it is also synonymous (but not limited to) with biological stressors.

The stress imposed by the rest of society on people who are fatter than average is severe. As we know, stress of all kinds is deleterious to health. There is some evidence that at least some of the ill health associated with fat is caused by the societal oppression, rather than the fat itself. Some of this oppression takes its toll psychologically, and some may well have physical mechanisms, such as discouragement from exercise and pressure to undernourish oneself, or submit to dangerous drugs or surgery, etc.
A decent study to demonstrate your point would be difficult, given that it would be pretty hard to control for the confounding factors mentioned above - how would you distinguish the direct effects of obesity in humans from the effects of the other stresses imposed on people with more than average fat?

The fundamentals (obesity in relation to stress and slow metabolism) are there, so it doesn't matter whether we have a "study" to confirm what we already know scientifically. That's the thing, stress is not just associated with obesity, it is associated with a number of health conditions, therefore the question as to how we distinguish the stressors of obesity to those imposed on "average" people doesn't matter. Obesity is just the manifestation of a poor state of health, but not the only manifestation. Some people can be very thin and have high estrogen, for example. However, at the same time, I am willing to bet that the average thin person who is in bad health could probably recover from their poor state of health somewhat quicker than an obese person could.

Also, the mortality rate in relation to obesity is not the main determining factor for health. Someone could live fairly long obese, but that doesn't make them "healthy." That would be like saying someone who is sick and in bed on life support at the age of 97 is healthy. Yes, they lived a long time by today's standards, but they're also spending their last years in bed, sick, on a bunch of drugs like a vegetable. People live longer, but people also "die" longer. Dying longer is not synonymous with good health.

It's true that health is more than just having a heartbeat. Do you mean that people in some arbitrary 'ideal' weight range die quickly when their health deteriorates, whereas fatter people die more slowly? I don't know if that's true in general. It does seem to be true for some metabolic conditions though. I think it's established (called the 'obesity paradox') that obese people are more likely to survive a heart attack, for instance. I tend to think of such survival as a good thing.

My point is that health is not just defined by how long you live, but also the absence of disease and the proper biological adaptations to be able to handle stress. For example, someone with HIV who is on medication outlives someone who went into a diabetic coma and died. The person with HIV had more longevity, but does that mean that they were healthier? Not necessarily, since they are dependent on medication to live and if the stopped it, would die.

I think it is safe to say that obese people, because of their potential greater state of poor health, have more "safeguards" than someone who might be very thin and suffer from a certain horrible disease, when it comes to longevity. For example, if an obese person stores more PUFA than a thin person who burns PUFA and is underweight and very stressed and doesn't eat much burns, then perhaps that could be one example of why they might outlive that thin person who doesn't eat much and suffers mitochondrial damage due to burning more PUFA, etc. There are more factors to health than simple longevity. Health is a state, longevity isn't.

I agree that good health is more than just the absence of diagnosed disease, and that ideally we would all want to be in, or moving towards optimal health. You generally have to be pretty far away from good health to get a diagnosis from a dr. But statistically, such diagnoses are still relevant.
In practice so far immortality has not been achieved, and probably all of us are generally moving towards ageing and death, hopefully not too fast. To me, much as I would like for me and my loved ones to be in ongoing ideal health, the reality is that very few people probably match your high standards, and I think the relative health of the rest of us is important too.

I simply agree with Dr. Peat that fast metabolism is synonymous with good health and slow metabolism is synonymous with disease, including obesity, which is the result of a slow metabolic rate. I don't think this has anything to do with having "high standards."

 

[tara]

Further prolixity.

Yes, but obese people with a higher will generally have more BF than obese people with a lessor BMI, since obese people in general do not have a high LBM to BF ratio.

The problem is, by medical definition, there is a vast difference between being over weight and obese.

Doctors usually define “overweight” as a condition in which a person’s weight is 10%-20% higher than “normal,” as defined by a standard height/weight chart, or as a body mass index (BMI) of 25 to 30.

Obesity is usually defined as a condition in which a person’s weight is 20% or more above normal weight or as a BMI of 30 or more. “Morbid obesity” means a person is either 50%-100% over normal weight, more than 100 pounds over normal weight, or sufficiently overweight to severely interfere with health or normal functioning.

An argument can be made for what the set BF percentage should be, but you cannot compare the body fat percentage of someone who is overweight to someone who is obese and use that to justify questioning the set body fat percentage of an obese person, as they have drastically more body fat.

I understand that the term obese is commonly used to mean BMI 30 or higher, and this is what I meant by it. My point does not change. I understand that the common definition of 'overweight' is BMI 25-30. 'Drastically' is an emotive term. 'Normal' in this contex means BMI 17.5/18. -24.99, a range near the bottom end of the range that can sustain human life, and I'm not sure that it even contains the median BMI. I guess it is 'normal' in the sense of conforming to norms and rules of society. For some people, but I suspect not everybody, it is also normal in the sense of being consistent with good health. There is some evidence that this range has been defined by parties with interests in the weight-loss and dieting industries. It strikes my that comparing anyone who is not in this range with phrases like x amount above 'normal' weight in the context of health introduces bias regardless of the facts of their health. (I don't imagine you think 'normal' is generally an argument about what is good or right for everybody? It is normal (ie ordinary, common) here to eat a lot of bread and PUFA.)

I agree that there do seem to be a number of factors that can cause excessive biological stress and increased fat for many people, and that these factors can undermine health. They may include, amongst others, mitochondrial inhibition by PUFAs, phytoestrogens and other environmental poisons, malnourishment, and severe life stresses. What I am not convinced about is that all fat people are fat from these causes. I think it is possible (likely) that some people have a natural set point in the 'obese' range under reasonably optimal conditions.

If all obese people were not obese because of these biological stressors, then how come we cannot find a single obese person who is not in a biological state of stress? How come we cannot find a single obese person who has low estrogen, low prolactin, low serotonin, fast digestion, proper thyroid function?

You keep asserting this. Do you have evidence? How hard have you looked for counter-evidence? My understanding was that if you took a large sample of people in the obese BMI range 30 - 35, you'd get a statistically significant higher proportion showing imbalances in a number of markers of health, including any that you consider relevant, than in a similar sample in 'overweight' or 'normal' BMI ranges. But not that they all would. Are you aware of relevant studies that would confirm or deny this? My understanding is that natural healthy weights/BMIs vary on a normal distribution, for most people this lies in the 'normal' or 'overweight' ranges, and for a smaller number it lies in the 'obese' range.

If obesity is a hallmark sign of the biological state of stress, like many other diseases, then surely one cannot argue that obesity is healthy when it resembles something that is a state of biological stress, or is the result of biological stress.

I do not argue that all obesity is healthy. I argue that being in the 'obese' range may be the optimal healthy weight for some minority of people (just as being under BMI 20 may be the optimal healthy weight for some minority of people).
I think you are arguing that if it looks like something that can happen under stress conditions, it must have been caused by those stress conditions? If so, there is a leap (gap) in logic there that I don't accept as conclusive.

I have not yet seen any evidence to counter that.

The fact that obesity is highly correlated with the biological stressed state is enough evidence. Furthermore, the mechanism that we know of which lead to or cause obesity are mainly those of biological stress.

I do not accept that correlation proves causation. That an unhealthy mechanism can lead to obesity does not prove that all people who are obese are unhealthy. All sorts of unfortunate conclusions and remedies can be and have been drawn in medicine on the basis of this kind of flawed logic.

I am also aware of biological stresses that can lead people to be underweight compared to their optimum. (Severe under-eating is one of them - I think we'd agree about that.)

Correct. And being severely underweight is also unhealthy. It's just a different manifestation of being unhealthy than obesity is. But both states are unhealthy.

Statistically, the mortality rates for BMI 17.5 (the bottom of the 'ideal' BMI range, depending on which version you look at) are similar to those at BMI 35 (well into the 'obese' range). Most people are not optimally healthy in the bottom half of the 'ideal' BMI range. But I don't conclude that no-one can be naturally thin and healthy at BMI 19, any more than I conclude that no-one can be naturally round and healthy at BMI 33 (even if they are not a body-builder or similar).

Again, as I explained earlier, the mortality rate is not the proper definition of health. Just because you live a little longer than someone else does not necessarily mean you are healthier than they are.

Obese people have more "safeguards" to deal with stress than underweight people do, quite possibly. For example, if obese people store more PUFA instead of burning it as fast as a non-obese person may, then that could actually mean that the thinner person could see disease quicker due to the mitochondrial damage that ensues. But does that mean the obese person is still healthy? No, of course not.

I understood your earlier explanation, but I disagreed with some of it. I agree that mortality rate does not define health. However, I think it is a relevant indicator. Having a heartbeat is not sufficient to be considered healthy, but it is necessary. No heartbeat=the extreme end of unhealthy. I'm trying to picture how it could be otherwise, in a statistically relevant way. If the mortality rate of the 'healthy' people was lower than the mortality rate of the 'unhealthy' people, which I think would satisfy your argument, then I and probably others would question your definition of 'healthy'. Unless there are significant confounders, like sending all the healthy ones off to war, or some such.
I have to say, in your example, it's not obvious whether the thin person or the fat person is healthier. If the thin one died of the symptoms before the fat one, then I might say the fat one was healthier, on the basis that they were better able to adapt to the stresses placed on them. But if your point is that neither of them were fully healthy, I'd agree.

So that could be one factor in relation to the mortality rate. As far as those not being "as healthy" in the bottom half of the "ideal" BMI range, that is up for debate. What the medical profession tests for and defines as "healthy" is largely wrong and misleading. According to their definition, they did not check both the obese and non-obese subjects with a proper assessment of their complete blood work, etc., so that is largely misleading.

I do not believe it is possible to find a single obese person who has: optimized insulin sensitivity, low estrogen, low prolactin, optimal TSH and T4 and T3 output (including uptake); low NO tissue saturation, low FFA, etc., as these things are what cause and contribute to obesity. There is no way someone can convince me that being 100 pounds or so overweight is "healthy."

I don't have the resources to test this.
I guess it would take a study that measures all those parameters for many people in the 'obese' BMI range, and assesses people as healthy if they fall within a specified reasonable healthy range. Perhaps you would also want to assess them on the basis of symptoms and/or ability to carry out some functions in their lives. For real rigour, you might want to reassess 10 years down the line. In order to rule out some of the other reasonable contenders, you'd have to have reasonable subsamples that were eating a diet not comprised of mostly PUFA and starch, but eating a reasonable balanced diet (but not calorie restricted, since that would be another confounder), and getting some regular exercise - not necessarily a huge amount, but at least of the order of a half hour brisk walk a day (since this is within cooey of the trough in exercise/mortality graphs). And then the hard part would be finding a subsample that was not subjected to anti-fat social stigma. Where are you going to find them? I think it will have to be an international study.

Are you saying your opinion is fixed and evidence to the contrary would be irrelevant? And all the onus is on other people to find the evidence to disprove your assertion?

I simply said that there is no evidence of obese people with normal levels of the mentioned blood tests/hormonal profiles. This is because obesity is the result of out of control blood tests which indicate biological stress. If there is evidence of healthy obese people, then why have we not yet seen it? It's a logical conclusion.

I can imagine that out of control blood tests could cause a fair amount of biological stress <shudders>.

Actually, you made a couple of emphatic statements about your beliefs, and about it not being possible for them to change. You have said there is no evidence, but I do not know how hard or relevantly you have looked for evidence. It is easy to find no evidence if you do not look. Anecdotal evidence about the fitness of people you have trained in a particular set of physical exercises doesn't strike me as strong evidence that there are no obese people anywhere who are healthy.
I know obese people who seem ton the face of it to be reasonably healthy.

Also, the question may already be begged by describing someone as 'overweight'. If it means more-than-optimal-for-them-adiposity, then it is self-evident that it is not the most healthy for that individual. If they are healthy, then by this definition they would not be overweight. Or by what standard do you distinguish overweight? Are we talking about an arbitrary larger-than-currently-fashionable-fat-ratio?

We are talking about obese people, NOT overweight people. You seem to keep going back and fourth between the two. I am talking and have been talking about obese people. I think the standard which they use to determine obesity is fairly correct, though not perfect. More fat mass is associated with more biological stress. For example, obese people will generally have less insulin sensitivity than people who are at a fairly healthy weight. Obese carry more weight which puts more stress on organs. Almost all obese people are type 2 diabetic or "borderline" diabetic. More weight is associated with disease. This is well established. Therefore, the more overweight a person is, the less likely they are to be healthy. When a person shies away not too far from the medical definition of being overweight or becomes obese, very often they begin to see all kinds of health problems. Therefore, the way we determine the obesity level is fairly accurate. This is of course backed up by the fact that no one can find a handful of obese people who are healthy.
The reason I used the word 'overweight' in this paragraph was because I was referring to your phrase ''100 or more pounds overweight'. I'll rephrase to reduce my contribution to this confusion:

Also, the question may already be begged by describing someone as '100 or more pounds overweight'. If it means 100 or more pounds more-than-optimal-for-them-adiposity, then it is self-evident that it is not the most healthy for that individual. If they are healthy, then by this definition they would not be overweight by any number of pounds. Or by what standard do you distinguish 100 or more pounds overweight? Are we talking about 100 or more pounds larger-than-the-arbitrary-currently-fashionable-fat-ratio?

I now understand that in this example your definition is probably '100 or more pounds greater than the top of the 'normal' BMI range', and that we were and are both talking about someone who would be classed as 'obese'.
I guess you are aware that the 100 pounds reference is hyperbole, too? Not that it isn't in the obese range, and not that my points couldn't apply to at least a few people in that range, but you are talking about ALL obese people. For fairly tall woman like me, the difference between the top of 'normal' and the bottom of 'obese' is about 16kg (less than 36 pounds). For someone shorter, the kilo/pound difference is less. And of course it wouldn't all be fat.

I agree with Dr. Peat when he says good health is associated with a fast metabolic rate. Obese people do not have fast metabolic rates, so that in of itself is contrary to the statement that obese people can be healthy.

I also think it likely that Dr Peat is right about fastish metabolic rate being good for maintaining health.
Do you mean that you believe there are no euthyroid obese people, using some standards such as eg not supplementing thyroid, TSH <1, base temps averaging close to 37 deg C? I understand that statistically, on average, obese people may be more likely to be hypothyroid. My expectation would be that some are euthyroid.

My understanding is that while large weight can be hard on joints, greater fat is statistically protective against osteoporosis. Not sure if this is via load-bearing stimulus or other mechanisms. I know both lean and fat people with severe joint issues, and lean and fat people with reasonably healthy joints.
Some people spend lots of time and money adding to the weights borne by their joints. Some people here do it, too. Many of them think this is supportive of their health.
Fat around the vital organs provides valuable insulation, helping maintain core temperatures under stressful conditions. It is usually more saturated than more superficial fat, and may be protective against reduced metabolism compared with not having it. I'm not saying there can't be any downsides to fat around the organs, but it's not all bad. Sure beats not having any for swimming at our local beach.

Yes, fat can be protective, but that doesn't mean being fat is healthy. Yes, though fat can be protective in some cases, there are still trade-offs. We simply cannot ignore one risk that is brought about by something just because that something offers a potential benefit in another area. Sometimes there will be some benefits to the mechanisms put into place by stress itself as a means to cope with stress, but that does not mean that that condition or state is still healthy. Same goes with obesity.

There are trade-offs in many things. Sometimes being fatter is healthier than being thinner. (I think we would agree about this.) Same goes with leanness.
You seem to be using data about correlation and risk to support a much stronger conjecture about all individuals. This seems a bit like the kind of logic that got us widespread statins. People with high cholesterol are at higher risk of heart attacks (true). Therefore all people with high cholesterol are unhealthy (not true).
I could use similar logic to say that we know that:
- Severe undereating can make people unhealthily underweight, and that
- many people at BMI 18 would be unhealthy because of undereating.
- There are a number of serious health risks associated with severe undereating, and
- quite a bit is known about the mechanisms.
- They include suppression of metabolism.
- The increased mortality rates at this weight are comparable to the increased mortality rates of people at the lower end of the obese range.
- But it's not just mortality that is an issue - real health symptoms show, too, like exhaustion, cold hands and feet, and a whole lot of stress effects.
If I was to use the kind of logic you use, I would leap from there to saying that there cannot be a healthy thin person at BMI 18, no one like that will have good blood tests. All thin people are hypothyroid and unhealthy. I don't think that would be logical, supported by the evidence, or true. I believe that some people can be thin and healthy. But that seems to be the kind of logic I think you are using.

Obesity is highly associated with Osteoarthritis, which is a common joint problem of the knees, hips, and lower back. The condition occurs if the tissue that protects the joints wears away. Extra weight can put more pressure and wear on joints, causing pain. In fact, if we were to make a calculation, we can say that for every 10 pounds of extra weight you carry, an additional 30 to 60 pounds of force is placed on the knees with each step. That is simply not healthy.

A great many people who are fatter than fashion dictates are discouraged from exercise by the threat or reality of ubiquitous and vicious anti-fat abuse when they do.

Using the term "fatter than fashion dictates" is not a good assessment of things at all. That is extreme because fashion often sees anyone who is not a stick as being "fat." We aren't talking about fashions definition of what fat is; we are talking about obesity. Big difference.

My point is the same, only more so, for people catergorised as obese than people who are around the top of 'normal'. The sensure aimed at people who are way outside the bounds of fashion by being obese is vicious. It is sometimes just patronising, but it is also often extremely abusive. There are a number of serious barriers to obese people taking good care of their health that leaner people do not have to deal with every day. This includes getting a reasonable amount of exercise to support good health. Obese people are more likely to be healthy if they get a reasonable amount of exercise, even (and in some cases especially) if it does not result in weight loss. But there are severe barriers to this, mostly in the form of societal attitudes. So it would be reasonable to expect that this societal oppression would result in statistically worse health, even if the physical fat itself was not a key part of the mechanism (just an excuse for abuse). There have been studies that demonstrate this - eg that fat oppression is harder on the health of fat young women than the fat itself is.

When I was leaner, I got puffed/slow/exhausted carrying a 20kg pack uphill. Was I more fit and healthy than someone who got similarly puffed while carrying 20 - 30kg more of body weight (including more fat) instead of a pack? I think such a judgement would be a bit arbitrary.
I have had at least one yoga teacher who I think would have been classed as obese by either BMI or fat-mass standards. It didn't stop her being able to a lot of things that most 'ideal' or 'overweight' people couldn't do. Given that she also regularly practiced pranayama, I wouldn't be at all surprised if her general metabolic health by the measures you propose was better than average. I can't prove it though.
I'm not saying all obese people are healthy, just that some probably are.

I am talking about someone who is too out of breath to do an exercise, I am not talking about someone simply puffing" for air while exercising. I am an athlete and I have trained with people my entire life. There is absolutely no way anyone can prove to me or tell me that the average obese person is more fit than the average thin person who does not even exercise. I worked with all kinds of people and in every single case, obese and even people who were well overweight we not even able to do the most basic exercises for more than 20 minutes. This is far from natural. Thousands of years ago, in nature, just to survive and provide for yourself, there is no way one would be able to make it if they were too obese to hunt their prey. That fact alone should be a strong indicator that obesity is not and cannot be synonymous with health. If someone is too out of breath to do a constant exercise for 20-30 min, then there is something wrong with that. There are thin people who never exercise either and would be puffing for air do to some basics, but they would adapt much quicker to that exercise than an obese person would; also, there is all that weight on the joints during exercise, which I doubt is healthy.

I'm sure you can find someone. What I don't think you can find is everyone. I have never said that the average obese person is more fit than the average thin one, whether or not they exercise. Straw man. (But if the average obese person exercises moderately and regularly, there is a good chance they will be both fitter and healthier than if they don't. Hence my point about discouraging social attitudes affecting health.) Your contention further up was that no-one can find even a handful of healthy obese people. What I have said is that I believe some obese people are/can be healthy, and that I have known obese people who were fit and strong and agile. I didn't say they were average, just that they exist.

We do not live thousands of years ago. The demands on us now are different. We don't necessarily all have to be able to do all the things our ancestors did to be healthy. Survival over the last few hundred years in civilisation has probably had more to do with resistance to infectious diseases than to the athletic abilities required to hunt prey.

This is not normal, nor is it healthy.

By normal, do you mean common (in which case I'd say it is pretty normal) or ideal?

I think it is well established that the vast majority of people who are tested and are obese have some kind of health condition or disease.

Do you have evidence for this? Or only if obesity itself is counted as a disease? It is common for people who are judged to be overweight to have any health issue they present attributed to their fat, often with little evidence. They often get worse treatment by the medical establishment than leaner people, and this may be another important confounder.

Yes, because the biological mechanisms that cause obesity are the same ones that cause disease. Therefore, in order for someone to be obese, they must have some kind of risk due to these biological stressors. That is like saying you can go from point A to point Z without actually beginning point Z.

And why isn't there a single shred of medical evidence that shows a single obese person who does not have high estrogen, serotonin, or low thyroid? Because there isn't a single obese person that lacks these stressors because the reason why the are obese is due to these stressors.

You have made an assertion that it is not possible to be healthy and obese. I still do not see any strong evidence for this. You have stated that the evidence supports this, but then you refer to:
-risks and averages,
-your own anecdotal experience about fitness to perform particular physical exercises (yes, I count anecdotal evidence as data, but limited)
-the absence of any healthy obese people - this last just stated over and over again, with as far as I can see no support.
- a theory based on knowing that some people get obese from biological stressors that also cause ill health.

If someone is obese and claims to be "healthy", then I would like to look at their blood work, hormonal profile included.

The metabolic markers for health are only meaningful to the extent that they really do relate to long good health, rather than fashion. I expect we would agree that there has been confusion about this wrt cholesterol levels, for instance. This is why I think mortality is a relevant parameter.

No, I think Ray Peat has summed this up well enough already. This has nothing to do with "fashion", as you, for some reason, keep pointing out. Again, we are talking about obesity, not being fat according to a fashion agencies definition, which is crazy to begin with. The fact is, we have enough evidence established to have a good idea of what is and isn't good when it comes to hormone levels, etc.

I have not mentioned the extremely unhealthy subculture of fashion agencies anywhere. In my earlier reference to fashion, I was thinking more of everyday mainstream western cultural fashion wrt fat.

But my reference to fashion in this context was to medical fashion, eg the medical fashion of obsessing about low cholesterol levels without respect to other factors or consequences, or with the medical fashion of ignoring the hypothyroid condition of people who don't align with their numerical guidelines. I was agreeing with you that the currently medically fashionable ranges may not in all cases be the best guidelines for assessing health.

And not a single obese person can show blood work that has all these stressors at bay, as that is the reason why the became obese to begin with. A slow metabolism is synonymous with obesity and it is also synonymous (but not limited to) with biological stressors.

There you go again, with this certainty that there is not a single obese person who can fulfil your criteria. I can say with I think more justifiable confidence that there is no way you can know this (unless you circularly use obesity itself as a marker indicating ill health). At the most basic level, there is no way that all obese people have been tested, so the data is not available for you to assert something so definite.

The stress imposed by the rest of society on people who are fatter than average is severe. As we know, stress of all kinds is deleterious to health. There is some evidence that at least some of the ill health associated with fat is caused by the societal oppression, rather than the fat itself. Some of this oppression takes its toll psychologically, and some may well have physical mechanisms, such as discouragement from exercise and pressure to undernourish oneself, or submit to dangerous drugs or surgery, etc.
A decent study to demonstrate your point would be difficult, given that it would be pretty hard to control for the confounding factors mentioned above - how would you distinguish the direct effects of obesity in humans from the effects of the other stresses imposed on people with more than average fat?

The fundamentals (obesity in relation to stress and slow metabolism) are there, so it doesn't matter whether we have a "study" to confirm what we already know scientifically. That's the thing, stress is not just associated with obesity, it is associated with a number of health conditions, therefore the question as to how we distinguish the stressors of obesity to those imposed on "average" people doesn't matter. Obesity is just the manifestation of a poor state of health, but not the only manifestation. Some people can be very thin and have high estrogen, for example. However, at the same time, I am willing to bet that the average thin person who is in bad health could probably recover from their poor state of health somewhat quicker than an obese person could.

Here you are presenting some specific established general theory (which I agree applies in some/many cases), and assuming it applies to all cases. This is still not empirically supported, as far as I have seen so far. I'm fussy about that, I like my theories to at least be shown to be consistent with empirical evidence before I take them too seriously.

Actually, anorexia has much, much worse mortality rates than obesity does. And without assuming anyone had full anorexia, think of all the undereaters here whose depleted digestive systems won't allow them to nourish themselves adequately.

Also, the mortality rate in relation to obesity is not the main determining factor for health. Someone could live fairly long obese, but that doesn't make them "healthy." That would be like saying someone who is sick and in bed on life support at the age of 97 is healthy. Yes, they lived a long time by today's standards, but they're also spending their last years in bed, sick, on a bunch of drugs like a vegetable. People live longer, but people also "die" longer. Dying longer is not synonymous with good health.

It's true that health is more than just having a heartbeat. Do you mean that people in some arbitrary 'ideal' weight range die quickly when their health deteriorates, whereas fatter people die more slowly? I don't know if that's true in general. It does seem to be true for some metabolic conditions though. I think it's established (called the 'obesity paradox') that obese people are more likely to survive a heart attack, for instance. I tend to think of such survival as a good thing.

My point is that health is not just defined by how long you live, but also the absence of disease and the proper biological adaptations to be able to handle stress. For example, someone with HIV who is on medication outlives someone who went into a diabetic coma and died. The person with HIV had more longevity, but does that mean that they were healthier? Not necessarily, since they are dependent on medication to live and if the stopped it, would die.

I think it is safe to say that obese people, because of their potential greater state of poor health, have more "safeguards" than someone who might be very thin and suffer from a certain horrible disease, when it comes to longevity. For example, if an obese person stores more PUFA than a thin person who burns PUFA and is underweight and very stressed and doesn't eat much burns, then perhaps that could be one example of why they might outlive that thin person who doesn't eat much and suffers mitochondrial damage due to burning more PUFA, etc. There are more factors to health than simple longevity. Health is a state, longevity isn't.

I agree that good health is more than just the absence of diagnosed disease, and that ideally we would all want to be in, or moving towards optimal health. You generally have to be pretty far away from good health to get a diagnosis from a dr. But statistically, such diagnoses are still relevant.
In practice so far immortality has not been achieved, and probably all of us are generally moving towards ageing and death, hopefully not too fast. To me, much as I would like for me and my loved ones to be in ongoing ideal health, the reality is that very few people probably match your high standards, and I think the relative health of the rest of us is important too.

I simply agree with Dr. Peat that fast metabolism is synonymous with good health and slow metabolism is synonymous with disease, including obesity, which is the result of a slow metabolic rate. I don't think this has anything to do with having "high standards."

Your standards seem to be a specific set of biochemical markers, and the absence of ageing. Absence of ageing is not a realistic standard for most people. The biochemical markers may be. Especially if they align with evidence about actual health and longevity (I think both are important).
I don't think it is established that obesity is a disease, or that it is synonymous with hypothyroid function in all cases. I do accept that they sometimes/often go together.

 

[tara]

My understanding is that natural healthy weights/BMIs vary on a normal distribution, for most people this lies in the 'normal' or 'overweight' ranges, and for a smaller number it lies in the 'obese' range.

I take back the normal distribution part - I said it wrong. Normal distributions are symmetrical, and I don't believe healthy individual BMIs vary symmetrically. I think it is much more likely that someone can be healthy at 10 BMI points above the median than below. Depending on the sample, I think the median is somewhere between 24 and 27. 10 below is in serious danger. 10 above statistically has a slightly higher risk of some serious diseases, but may be fine for some people.

 

[Waremu]

I understand that the term obese is commonly used to mean BMI 30 or higher, and this is what I meant by it. My point does not change. I understand that the common definition of 'overweight' is BMI 25-30. 'Drastically' is an emotive term. 'Normal' in this contex means BMI 17.5/18. -24.99, a range near the bottom end of the range that can sustain human life, and I'm not sure that it even contains the median BMI. I guess it is 'normal' in the sense of conforming to norms and rules of society. For some people, but I suspect not everybody, it is also normal in the sense of being consistent with good health. There is some evidence that this range has been defined by parties with interests in the weight-loss and dieting industries. It strikes my that comparing anyone who is not in this range with phrases like x amount above 'normal' weight in the context of health introduces bias regardless of the facts of their health. (I don't imagine you think 'normal' is generally an argument about what is good or right for everybody? It is normal (ie ordinary, common) here to eat a lot of bread and PUFA.)

The problem is that people who are "obese" according to this higher end BMI have an excessive amount of body fat, which also fits the "definition" of obesity. So it isn't just as simple at looking at the BMI. Those who have a significant amount of body fat (as is the case of obese people) have slow metabolisms. Slow metabolisms, as Ray Peat points out, are the opposite of good health. Therefore, one cannot be obese and in good health. I think it is not "normal" to have a significant amount of body fat because that just shows that you are storing the food that you eat rather than burning it off, which again points to a slow metabolism. Some people say obese people just eat too much and that they do not have "slow metabolisms", yet that is not true because there are people their age who eat almost just as much and are not obese. So while obese people obviously eat more than what their body burns, it is because they have a slow metabolism and therefore it is not very hard to overeat. There is "normal" in the sense of what people and society do in general, regardless of it being healthy or not, and there is also "normal" as far as biology goes. It is not "normal" for our bodies to run off of stress hormones because of it's implications to bad health and because it is not the optimal way for the body to operate. A stress-driven metabolism is not "normal", while a metabolism that, for example, is not driven by stress hormones primarily is "normal."

I don't think you can compare what society sees as "normal" and what is biologically "normal" or "ideal" as far as our bodies are concerned. Society does things without much care about the possible negative outcomes, whereas the body is aware of stress and although it uses ways to deal with it, the body knows that those ways are not ideal. For example, it is not a normal biological function for the body to be in such a high estrogenic state and thus, the body takes many cautions to deal with it ---- all of which do not go hand in hand with optimal health in the long run.

I agree that there do seem to be a number of factors that can cause excessive biological stress and increased fat for many people, and that these factors can undermine health. They may include, amongst others, mitochondrial inhibition by PUFAs, phytoestrogens and other environmental poisons, malnourishment, and severe life stresses. What I am not convinced about is that all fat people are fat from these causes. I think it is possible (likely) that some people have a natural set point in the 'obese' range under reasonably optimal conditions.

You keep asserting this. Do you have evidence? How hard have you looked for counter-evidence? My understanding was that if you took a large sample of people in the obese BMI range 30 - 35, you'd get a statistically significant higher proportion showing imbalances in a number of markers of health, including any that you consider relevant, than in a similar sample in 'overweight' or 'normal' BMI ranges. But not that they all would. Are you aware of relevant studies that would confirm or deny this? My understanding is that natural healthy weights/BMIs vary on a normal distribution, for most people this lies in the 'normal' or 'overweight' ranges, and for a smaller number it lies in the 'obese' range.

Of course I do. The evidence is what we already know. What we know is that all of the known biochemical pathways that lead to obesity are stress-inducing pathways.

What evidence do you have that can prove a single pathway to obesity that is not is not a biological stressor?
You can't because there are none that we know of that exist. I am not just talking about BMI. I am talking about those who meet the medical definition of obesity other than what an BMI chart says. For example, if someone is 150 pounds overweight (most being fat mass), then there is no way that person isn't obese. They are obese, as evident by the significant amount of fat mass that is on them. And yes, please show me just one study where obese subjects were tested and had low estrogen, prolactin, low cortisol, low adrenaline, etc. You won't find any because it was through those biological pathways of stress that that they became obese. This is a logical statement made by those who understand what we do know about science right now.

I think you are arguing that if it looks like something that can happen under stress conditions, it must have been caused by those stress conditions? If so, there is a leap (gap) in logic there that I don't accept as conclusive.

No, what I am saying is that obesity is made manifest through the biological stress-induced pathways that we have discovered. Thus, obesity and these stressors go hand in hand. For example, in order for someone to gain fat, leptin and insulin have to move in a certain direction because it is through some of these mechanisms that fat mass can be gained. Therefore, if someone has a significant amount of fat mass, then it is safe to assume that they do not have optimized insulin and leptin metabolism. So if the body uses certain pathways to achieve obesity, then it would not be very logical to say that they became obese without these pathways in which the body uses to store fat, etc. This is essentially what you are saying and it is not at all very conclusive with the science that we do have.

I do not accept that correlation proves causation. That an unhealthy mechanism can lead to obesity does not prove that all people who are obese are unhealthy. All sorts of unfortunate conclusions and remedies can be and have been drawn in medicine on the basis of this kind of flawed logic.

"Correlation does not prove causation." That is a very broad term and, in of itself, an empty statement. Why? Because correlation can either point to the cause or not point to the cause, depending on additional factors and evidence. So yes, correlation does in of itself does not prove causation, but when the correlations in of themselves are shown to be the actual biological pathways in which the disease is manifested, then correlations can indeed point to causation. This is precisely the case with obesity. The biological pathways in which obesity takes place are stress-induced pathways and therefore, if those pathways are correlated with obesity in of itself, then we can safely say that the correlation of those pathways with obesity can be responsible in some way for the disease.

I am also aware of biological stresses that can lead people to be underweight compared to their optimum. (Severe under-eating is one of them - I think we'd agree about that.)

Ray Peat has spoken about this and said that in some people who are estrogen dominant, they tend to be very thin with lack of muscle, and in many they tend to be fat. Biological stress is not only conditional to obesity. Biological stress manifests itself in a multitude of ways, most likely due to the genetic weaknesses of that person. So, for example, if someone is genetically predisposed to breast cancer, but not obesity, then chances are they may get cancer rather than become obese, etc. But while biological stress is not manifest in a single way, like cancer, it is still associated with obesity because through those pathways fat is stored in significant amounts, etc.

I understood your earlier explanation, but I disagreed with some of it. I agree that mortality rate does not define health. However, I think it is a relevant indicator. Having a heartbeat is not sufficient to be considered healthy, but it is necessary. No heartbeat=the extreme end of unhealthy. I'm trying to picture how it could be otherwise, in a statistically relevant way. If the mortality rate of the 'healthy' people was lower than the mortality rate of the 'unhealthy' people, which I think would satisfy your argument, then I and probably others would question your definition of 'healthy'. Unless there are significant confounders, like sending all the healthy ones off to war, or some such.
I have to say, in your example, it's not obvious whether the thin person or the fat person is healthier. If the thin one died of the symptoms before the fat one, then I might say the fat one was healthier, on the basis that they were better able to adapt to the stresses placed on them. But if your point is that neither of them were fully healthy, I'd agree.

Yes, it is a relevant factor. However, it is not the determining factor. If it were, then we would not see people who have disease outlive those who do not have disease. Health is the absence of disease and the optimal state at which the organism operates to combat stress. Yes, both the obese and fat person was never fully healthy, but we are not striving towards "somewhat healthy" or "more healthy." Most of us are striving towards ideal health. So I am simply talking about ideal health, not whether a thin person was a little healthier than an obese person. The mortality rate is simply the rate of longevity and longevity in of itself does not mean that one is in an ideal state of health. Also, as far as the mortality rate goes, many of those who were thin died from other things that were causes by biological stressors, just as obesity is. So all one is doing is comparing which state of health may be worse, but that does not mean either is healthy. For example, a group of thin people may have weaker immune systems and die of breast cancer. The obese people outlived them, but does that mean that obesity is then healthy because these obese people outlived cancer patients? No. Therefore, while the obese people who might be severe type 2 diabetics (most obese people probably have type 2 diabetes or borderline type 2) outlived the thin breast cancer patients, both were in a poor state of health, as type 2 diabetes causes millions of deaths There is a lot to the mortality rate and while it does play a role in health, it is not at all the proper tool to use to make a case for good health. Humans have adapted to stress in such a way that they can live a fairly long time while in a state of poor health (metabolism not functioning at an optimal level, the absence of disease, etc.).

I guess it would take a study that measures all those parameters for many people in the 'obese' BMI range, and assesses people as healthy if they fall within a specified reasonable healthy range. Perhaps you would also want to assess them on the basis of symptoms and/or ability to carry out some functions in their lives. For real rigour, you might want to reassess 10 years down the line. In order to rule out some of the other reasonable contenders, you'd have to have reasonable subsamples that were eating a diet not comprised of mostly PUFA and starch, but eating a reasonable balanced diet (but not calorie restricted, since that would be another confounder), and getting some regular exercise - not necessarily a huge amount, but at least of the order of a half hour brisk walk a day (since this is within cooey of the trough in exercise/mortality graphs). And then the hard part would be finding a subsample that was not subjected to anti-fat social stigma. Where are you going to find them? I think it will have to be an international study.

If someone is not functioning at an optimal level in the sense that it is a stress-driven metabolism, then they are not healthy, even before they actually get a disease, because they are simply in a state that is leading them to be at more risk for disease. This is how Ray Peat sees health. But again, I think it boils down to basic science concerning what we already know about metabolism. If people are truly obese (they have a significant amount of fat mass), then that condition was achieved through biological stress-induced pathways and therefore no study would need to be done to confirm whether obese people are healthy or not. Now, if you would want to see if those people have disease yet or not, then yes, some kind of international study would need to be conducted, but again, because they do not yet have disease does not necessarily make them healthy. For example, we know that estrogen feeds and is a cause of breast cancer. Because we know this, we do not need to do studies in every single breast cancer patient to see if they have high estrogen because we know that they will. Same goes for those who are obese in the sense of having a significant amount of fat mass on them.

Actually, you made a couple of emphatic statements about your beliefs, and about it not being possible for them to change. You have said there is no evidence, but I do not know how hard or relevantly you have looked for evidence. It is easy to find no evidence if you do not look. Anecdotal evidence about the fitness of people you have trained in a particular set of physical exercises doesn't strike me as strong evidence that there are no obese people anywhere who are healthy.
I know obese people who seem ton the face of it to be reasonably healthy.

There is no evidence that people can defy gravity (without technology) by floating around or flying in the air. Why? Because we have the laws of gravity, which dictate this. Therefore, we would not need to do studies on every single person to see if they can or can't defy gravity. Same goes with the well established mechanisms behind disease and obesity.

If disease is caused by biological stress, as Ray Peat says and has been well established, and if disease is manifested through those pathways, then the signs of a stressed metabolism will always be there. And since obesity is a sign of a slow, stressed metabolic rate, then those signs of biological stress will always be there. Obese people will always have these signs of stress because in order for them to become obese and put of significant weight, it had to have occurred through the known pathways. For example, with overweight people insulin "sensitivity" decreases. This is just one sign. Or, since adipose tissue and increased estrogen (circulation of pools of estrogens) often go hand in hand, we can safely say that estrogen increases when significant fat mass is gained. I don't think we again need to test every single obese person to see if they have some of these signs of a stressed metabolism when we already know that fat gain is achieved through stressors.

The reason I used the word 'overweight' in this paragraph was because I was referring to your phrase ''100 or more pounds overweight'. I'll rephrase to reduce my contribution to this confusion:

"I now understand that in this example your definition is probably '100 or more pounds greater than the top of the 'normal' BMI range', and that we were and are both talking about someone who would be classed as 'obese'. I guess you are aware that the 100 pounds reference is hyperbole, too? Not that it isn't in the obese range, and not that my points couldn't apply to at least a few people in that range, but you are talking about ALL obese people. For fairly tall woman like me, the difference between the top of 'normal' and the bottom of 'obese' is about 16kg (less than 36 pounds). For someone shorter, the kilo/pound difference is less. And of course it wouldn't all be fat."

I am not talking about someone who might fit an obituary number to be called obese and isn't. Some people again are tall and have more LBM and even then fat mass is distributed across their body in a way that it could not on someone who is short. Height factors into the overall calculation of the BMI so can't just say that anyone of ANY height who fits a number of the BMI scale is obese. There are other factors, of course. But again, the best way is to just say those who have a significant amount of fat weight for their height. Most people would agree that that is what obese really means.

I also think it likely that Dr Peat is right about fastish metabolic rate being good for maintaining health. Do you mean that you believe there are no euthyroid obese people, using some standards such as eg not supplementing thyroid, TSH <1, base temps averaging close to 37 deg C? I understand that statistically, on average, obese people may be more likely to be hypothyroid. My expectation would be that some are euthyroid.

Yes. Due to our understanding of the stress-inducing biological mechanisms that cause true obesity and slow metabolism, I do very much doubt that any obese people exist who have normal TSH, T3 T4, rT3, levels, a healthy pulse and body temperature, and low estrogen, cortisol, and prolactin. This is what I am saying: if we know that these signs are cause obesity is some way, then in reality, every true obese person should not have healthy blood work/low numbers of stressors, etc.

There are trade-offs in many things. Sometimes being fatter is healthier than being thinner. (I think we would agree about this.) Same goes with leanness.

Correct. But my focus isn't on what is healthier, but rather, what is healthy.

You seem to be using data about correlation and risk to support a much stronger conjecture about all individuals. This seems a bit like the kind of logic that got us widespread statins. People with high cholesterol are at higher risk of heart attacks (true). Therefore all people with high cholesterol are unhealthy (not true).

No, not exactly. Thyroid lowers cholesterol. Therefore, if someone has naturally high cholesterol, then it is often one of the hallmark signs that they are ALREADY unhealthy because they are hypothyroid and are not producing the steroidal hormones in the correct ratios. They may not have many health problems yet and are therefore "healthier" than those who have disease, but because one of the key metabolic factors that drive metabolism is broken, then they are in the middle of a cascade effect stress because their defense is down. Therefore, while not all people who have high cholesterol may not end up getting one specific disease (heart disease), they will likely get another disease (since hypothyroidism eventually leads to a complete metabolic breakdown that leads to other diseases and B) or, if someone wants to be technical, already have a disease called hypothyroidism. Therefore, we can safely assume that all hypothyroid people (when not trying to limit cholesterol through diet to artificially lower cholesterol levels) may not all get the same disease,

but they all have the same biological stressors that is the result of their hypothyroid condition

, and these stressors cause disease, therefore every hypothyroid person should test positive for these stressors.

That is not the same thing as saying A causes disease B and therefore all people should take drug C to prevent disease B. A eventually leads to many different diseases (as Ray says that all disease is a sign of a breakdown of the organism through stress), therefore people should fix A in order to prevent b, C, D, etc.

I could use similar logic to say that we know that:
- Severe undereating can make people unhealthily underweight, and that
- many people at BMI 18 would be unhealthy because of undereating.
- There are a number of serious health risks associated with severe undereating, and
- quite a bit is known about the mechanisms.
- They include suppression of metabolism.
- The increased mortality rates at this weight are comparable to the increased mortality rates of people at the lower end of the obese range.
- But it's not just mortality that is an issue - real health symptoms show, too, like exhaustion, cold hands and feet, and a whole lot of stress effects.
If I was to use the kind of logic you use, I would leap from there to saying that there cannot be a healthy thin person at BMI 18, no one like that will have good blood tests. All thin people are hypothyroid and unhealthy. I don't think that would be logical, supported by the evidence, or true. I believe that some people can be thin and healthy. But that seems to be the kind of logic I think you are using.

No, I think you entirely missed my logic. I never said that there isn't a healthy person at a specific number on the BMI index. I said that there are not any true obese people who do not have low stressors, since through these stressors they became obese. Your analogy of the person undereating with a BMI of 18 would have to include other factors, such as height for BMI, etc. However, if that person is very thin as the result of biological stressors, then we could say that she is thin because of those stressors, not that everyone who is that thin is in a state of stress because she is. But again, I do believe there is a fine line between what too fat or thin is for someone's height, etc. But again, please read my above statement before this one.

My point is the same, only more so, for people catergorised as obese than people who are around the top of 'normal'. The sensure aimed at people who are way outside the bounds of fashion by being obese is vicious. It is sometimes just patronising, but it is also often extremely abusive. There are a number of serious barriers to obese people taking good care of their health that leaner people do not have to deal with every day. This includes getting a reasonable amount of exercise to support good health. Obese people are more likely to be healthy if they get a reasonable amount of exercise, even (and in some cases especially) if it does not result in weight loss. But there are severe barriers to this, mostly in the form of societal attitudes. So it would be reasonable to expect that this societal oppression would result in statistically worse health, even if the physical fat itself was not a key part of the mechanism (just an excuse for abuse). There have been studies that demonstrate this - eg that fat oppression is harder on the health of fat young women than the fat itself is.

I never said anyone who is at a specific BMI number is obese, but generally,

most people who do fit the BMI index do have a great amount of fat mass and are therefore obese

. But again, other factors such as height play a role, so I never said to go strictly by the BMI chart. Now, if someone is truly obese then that is what they are. As a doctor, I would not avoid saying they are obese if they truly are, even if they are "offended" or they see it as being "patronizing." At the end of the day, I do not believe it is healthy to carry a significant amount of fat mass around, which is what obesity is. If someone is obese according to the BMI chart and does not have a significant amount of fat mass, then they are not obese. Perhaps they are just tall and have more LBM than others. But again, the fact is, most people who are on the upper end of the BMI chart do have a significant amount of fat mass on them so arguing the few who are not truly obese even thought he BMI says so, is just a numbers game.

I'm sure you can find someone. What I don't think you can find is everyone.

I don't think so. And even if someone who was obese was "more fit" than someone who is really skinny, it doesn't mean they are "fit" in general.

I have never said that the average obese person is more fit than the average thin one, whether or not they exercise.

I never said you said that. I was simply making a point.

Straw man. (But if the average obese person exercises moderately and regularly, there is a good chance they will be both fitter and healthier than if they don't. Hence my point about discouraging social attitudes affecting health.) Your contention further up was that no-one can find even a handful of healthy obese people. What I have said is that I believe some obese people are/can be healthy, and that I have known obese people who were fit and strong and agile. I didn't say they were average, just that they exist.

Well, if all obese people have a significant amount of fat mass, then that generally means that they have a slow metabolism, which would mean that they have a very stress-driven metabolism, which then means that, by Ray's definition, they are not healthy. So no, I disagree that any truly obese person exists who is healthy.

And no, not strawman. Just logic and science. In fact, if a thin person and an obese person who, say, carries 80 pounds of extra fat on them, did the same HITT workout for only 30 minutes, it is very logical to assume that the thin person would generally come out on top. Why?

Because that obese person has to exert much more energy to do the very same exercises that the thin person does.

Exerting more energy means one will suffer fatigue quicker. These are all facts.

So yes, I do highly doubt that obese people can be truly fit, since they are prone to more fatigue at a fast rate than those who do not carry an excessive amount of weight. This is also why you don't see obese pro-athletes who do various cardio-oriented sports, for example.

We do not live thousands of years ago. The demands on us now are different. We don't necessarily all have to be able to do all the things our ancestors did to be healthy. Survival over the last few hundred years in civilisation has probably had more to do with resistance to infectious diseases than to the athletic abilities required to hunt prey.

That is a weak argument. Many people have office jobs where they sit all day now. Therefore we don't have to worry about sitting all day either, right? The fact isn't whether we still hunt for food like our ancestors did hundreds of years ago, but that is the level of fitness that our bodies were naturally adapted to, therefore to go from that to not even close to that level of fitness for the average adult is problematic. The fact is, if having a significant amount of fat mass was ideal, then in nature we would have no problem seeing species who are obese. I think nature does a good job at helping us determine that obesity isn't very ideal.

By normal, do you mean common (in which case I'd say it is pretty normal) or ideal?

Biologically, normal as in ideal. For example, the normal or natural process of our bodies is to produce sufficient thyroid, but because of stress. That is a normal biological process that our bodies would normally engage in, when stress isn't out of control.

Do you have evidence for this? Or only if obesity itself is counted as a disease? It is common for people who are judged to be overweight to have any health issue they present attributed to their fat, often with little evidence. They often get worse treatment by the medical establishment than leaner people, and this may be another important confounder.

Are most obese people hypothyroid? If they were not hypothyroid, then they would not have a significant amount of fat weight. Therefore, the fact that almost all obese people may be hypothyroid in of itself means they have a health condition and is in of itself evidence. People who are "judged to be overweight", or people who ARE overweight? And yes, obesity is counted as a disease. I wouldn't say that their health issues are just or specifically always attributed to their fat, but rather, their significant fat mass is the result of a poor state of health do to s stress-driven metabolism in which other conditions or diseases can manifest alongside their obese state.

You have made an assertion that it is not possible to be healthy and obese. I still do not see any strong evidence for this. You have stated that the evidence supports this, but then you refer to:
-risks and averages,
-your own anecdotal experience about fitness to perform particular physical exercises (yes, I count anecdotal evidence as data, but limited)
-the absence of any healthy obese people - this last just stated over and over again, with as far as I can see no support.
- a theory based on knowing that some people get obese from biological stressors that also cause ill health.

So it is a "theory" that estrogen and low thyroid cause weight gain and that those are the same pathways that cause obesity?

This is well established by science. Obese people are unhealthy because they have slow metabolisms which in of itself is one of the main indicators of poor health. That's like says you need to see every person to demonstrate and prove that they cannot break the law of gravity. Obese people have slow metabolisms and a slow metabolic rate is caused by metabolic stress. Not just some theory, I am afraid.

I have not mentioned the extremely unhealthy subculture of fashion agencies anywhere. In my earlier reference to fashion, I was thinking more of everyday mainstream western cultural fashion wrt fat.
But my reference to fashion in this context was to medical fashion, eg the medical fashion of obsessing about low cholesterol levels without respect to other factors or consequences, or with the medical fashion of ignoring the hypothyroid condition of people who don't align with their numerical guidelines. I was agreeing with you that the currently medically fashionable ranges may not in all cases be the best guidelines for assessing health.

It would be best to be more direct when you use such a term as "fashion."

There you go again, with this certainty that there is not a single obese person who can fulfil your criteria. I can say with I think more justifiable confidence that there is no way you can know this (unless you circularly use obesity itself as a marker indicating ill health). At the most basic level, there is no way that all obese people have been tested, so the data is not available for you to assert something so definite.

My criteria? So it is possible to have a slow metabolism without the biological stressors of prolactin, estrogen, cortisol, inflammation, etc., in action? Because for you to say that it is my "criteria" that says it is impossible for obese people to be low in all of these, then you would have to show evidence that obesity occurs independent of these stressors. This assertion of yours goes against what Ray Peat says about obesity.
Again, if obesity is the cause of stress, then there is no way someone can have low stressors on their blood work. Never has happened and I do not believe it is possible based on the science we do have, not my "criteria." Again, not all obese people have to be tested. The pathways of stress are those that lead to or cause obesity so that is what is important.

in some/many cases), and assuming it applies to all cases. This is still not empirically supported, as far as I have seen so far. I'm fussy about that, I like my theories to at least be shown to be consistent with empirical evidence before I take them too seriously.

The empirical evidence is that obesity (slow metabolic rate) is stress induced, as research has shown for many decades now.

Actually, anorexia has much, much worse mortality rates than obesity does. And without assuming anyone had full anorexia, think of all the undereaters here whose depleted digestive systems won't allow them to nourish themselves adequately.

Of course it does ---- the body is eating itself alive. But why does that matter? Anorexia is unhealthy and stress-induced just like obesity is, so that is an apples and oranges comparison. We are talking about what healthy is and obesity, not worse health.

I simply agree with Dr. Peat that fast metabolism is synonymous with good health and slow metabolism is synonymous with disease, including obesity, which is the result of a slow metabolic rate. I don't think this has anything to do with having "high standards."

Yes, but obesity is an extreme case of low metabolism. And since a slow metabolic rate, as ray says is unhealthy, then so too is obesity unhealthy, which then means that true obese people cannot be healthy. If obesity is the result of slow metabolism, which is unhealthy and stress induced, then one cannot say that obese people are healthy and do not suffer from these stressors.

Your standards seem to be a specific set of biochemical markers, and the absence of ageing. Absence of ageing is not a realistic standard for most people. The biochemical markers may be. Especially if they align with evidence about actual health and longevity (I think both are important).
I don't think it is established that obesity is a disease, or that it is synonymous with hypothyroid function in all cases. I do accept that they sometimes/often go together.

No, aging is natural. Aging is not bad health. I do not think that someone who is aging is unhealthy or that it is not natural or ideal. I am simply talking about the optimal state at which an organism operates or lives. That optimal state means fast metabolism which is the only safeguard to stress. Slow metabolism means no defense to stress. With a fast metabolic rate, the body has more ammunition to fight against disease, whereas with a slow metabolic rate, the body has much less ammunition to fight disease. The biochemical markers are evident of good or poor health. For example, if estrogen directly causes and feeds breast cancer, then one cannot say that it is normal or possible to find a breast cancer patient with low estrogen, unless there are other alternative stressors which cause breast cancer (but then those two would be pinpointed and the same point would be made). If thyroid is the main or key regulator of metabolism and someone has a slow metabolism, then it evident by the low thyroid reading or high estrogen (which blocks thyroid) that we see. To say that biomarkers do not indicate the state of health is not at all correct. They are simply tokens that point to the substance of what is going on. And if someone has good health, then those biomarkers, which are complicit in poor health, should indicate that.

 

[tara]

@Waremu

You seem to switch back and forth from initially stating that all obese people are hypothyroid, which is what I was calling into question for lack of evidence. Initially you defined obese according to guidelines roughly along the lines of BMI over 30 (with the proviso that it's not accurate for people with higher lean mass ratio), which would include people who are not particularly muscled and have round bellies etc, who have maybe 20 - 30 pounds more fat than the median. Now you seem to be talking about people with 100 - 150 pounds of 'excess' fat. This doesn't necessarily change my points, they just refer to fewer people, who may be statistically harder to find.
You've also talked quite a bit about averages and risks, neither of which in themselves provide strong evidence that all obese individuals are unhealthy/hypothyroid.
You seem to have moved the goal posts rather a long way.

I agree with you that there are scientifically established pathways showing how metabolic stress can cause fat gain, sometimes a lot of fat gain, and this is often mediated, possibly along with other mechanisms, by low thyroid function/slow metabolism.

My problem is that you seem to keep asserting over and over that this is the only reason why anyone can have a large adipose organ. Ie. since you are not aware of any other mechanisms, there can't be any.

You have repeatedly argued that because you are not aware of x, therefore x cannot exist (where x=healthy obese people or lab reports within normal ranges for obese people).

What I would like to have taken into account, that I don't see here, is that there is naturally occurring variation in parameters like height, weight, and fat mass amongst healthy people. Most people under ideal conditions will be near the median. But quite a few will be further away from the median, and will be categorised as obese by whichever current standard measurable definition you want to choose, whether it's BMI, fat mass ratio, etc. A smaller number will be a long way away (in the direction of larger not smaller, of course, since much smaller = dead) - well into 'obese' range, whatever your measurable definition. (I don't accept a definition that defines obesity according to 'excess', because that begs the question, for reasons I've described.)

I have also described another possible mechanism that would explain some of the health problems associated with large adipose: fat oppression. Ie once someone is fat at least in western society (or very fat, or obese, or whatever term/definition you are interested in), they are going to to be subject to some horrible messages and treatment that has been shown to be very stressful and harmful to health.
I'm not saying this explains all the health problems experienced by all fat people. However, I think that both empirical studies and plausible causal mechanisms support it being a significant contributor to at least some of them. So for some people it is at least reasonably possible that the fat preceded the stress mechanisms and health issues, rather than being caused by it.

It is possible there could be other mechanisms, apart from healthy natural variations and hypothyroid metabolism that may or may not have been identified yet, too.

So now we have at least two plausible causes of large adipose, and at least two non-exclusive causal mechanisms to explain an association between large fat and some health issues. ( And have we not ruled out that there may be more of both.)

Therefore, we cannot on the basis of the evidence I am aware of or that you have pointed to so far, conclude that all large adiposity is caused by hypothyroid states or will always be accompanied by hypothyroid states.

 

[tara]

@ Waremu,
While I agree that a number of hormones have levels that indicate likelihood of better or worse health, to me they are not the same as health itself. Eg high cholesterol may be an indicator of high CVD risk. But if someone lives happily and actively into their late 90s with long term high cholesterol, it seems I would count that as a healthy old age and you would not.

 

[Waremu]

You seem to switch back and forth from initially stating that all obese people are hypothyroid, which is what I was calling into question for lack of evidence. Initially you defined obese according to guidelines roughly along the lines of BMI over 30 (with the proviso that it's not accurate for people with higher lean mass ratio), which would include people who are not particularly muscled and have round bellies etc, who have maybe 20 - 30 pounds more fat than the median. Now you seem to be talking about people with 100 - 150 pounds of 'excess' fat. This doesn't necessarily change my points, they just refer to fewer people, who may be statistically harder to find.

No, that is not true. When I originally mentioned obesity, it was not related to BMI. You originally brought up the BMI chart. I then said that there were cases where people who had high LBM (body builders) would be called obese according to the chart if we only followed the chart, but those cases are rare and doctors generally do not just look at the BMI chart. Most good doctors will also take into account their LBM to BFM ratio, etc., according to their height, etc.

My original comment was about obese people --- not the few people who are not truly obese. Obesity varies. Some people are far more obese than other people (hence my comment about 100 pounds or so of excess fat). But of course, generally speaking, someone who is overweight fat-wise ("overweight" does not always mean someone has excess fat, it can be a broad term concerning any kind of weight) is chubby or has a relative amount of excess fat, but not to the degree of an obese person. These people are considered lightly or moderately overweight fat--wise as they have a moderate amount of body fat. Anyone who has an far excessive amount of body fat is usually referred to as obese and most doctors and athletes will agree. My point does not change and it still stands. It doesn't matter whether someone has 80 pounds of excess fat
My original comment was relative to people who have an excessive amount of body fat. These people usually come to mind when people think of the disease obesity.

You've also talked quite a bit about averages and risks, neither of which in themselves provide strong evidence that all obese individuals are unhealthy/hypothyroid.
You seem to have moved the goal posts rather a long way.

You brought up the point of obese being healthy or not, so why would me mentioning some of the health risks associated with obesity "move the goal posts rather a long way?" The evidence is strong that those who have excessive amounts of fat long term usually suffer from all kinds of diseases, including diabetes, etc. These diseases are not limited to obesity, but are common among obese people.

I agree with you that there are scientifically established pathways showing how metabolic stress can cause fat gain, sometimes a lot of fat gain, and this is often mediated, possibly along with other mechanisms, by low thyroid function/slow metabolism.

My problem is that you seem to keep asserting over and over that this is the only reason why anyone can have a large adipose organ. Ie. since you are not aware of any other mechanisms, there can't be any.

Science changes on a weekly basis. What we know now we really didn't know all that well years later. But that isn't how science is practiced. Science is practiced with the expectations based on what we already know as a foundation and we work our way from there. Someone we make corrections, sometimes we do not. Since obesity has been studied, the evidence that has come out ever since has continuously shown the main pathways which lead to or cause obesity as being stress inducing pathways which are not optimal for a healthy and fast metabolism long-term. This alone is very significant. You can ignore that, but it does not change what the science is pointing to.

You have repeatedly argued that because you are not aware of x, therefore x cannot exist (where x=healthy obese people or lab reports within normal ranges for obese people).

As I said above, science is continually showing us that all the pathways to obesity thus far does not contribute to good overall health.

What I would like to have taken into account, that I don't see here, is that there is naturally occurring variation in parameters like height, weight, and fat mass amongst healthy people. Most people under ideal conditions will be near the median. But quite a few will be further away from the median, and will be categorised as obese by whichever current standard measurable definition you want to choose, whether it's BMI, fat mass ratio, etc. A smaller number will be a long way away (in the direction of larger not smaller, of course, since much smaller = dead) - well into 'obese' range, whatever your measurable definition. (I don't accept a definition that defines obesity according to 'excess', because that begs the question, for reasons I've described.)

Yes, there are naturally occurring variations such as height, LBM, etc., as I mentioned in my previous posts, but those variations themselves aren't too significant to sway a person away from being obese if they have a great amount of body fat. Things like height and LBM only contribute to a certain percentage and will not offset that person being obese if their body fat level is quite excessive. As ray Peat points out, excessive body fat is a sign of slow metabolism, which is a sign of bad health.

I have also described another possible mechanism that would explain some of the health problems associated with large adipose: fat oppression. Ie once someone is fat at least in western society (or very fat, or obese, or whatever term/definition you are interested in), they are going to to be subject to some horrible messages and treatment that has been shown to be very stressful and harmful to health.
I'm not saying this explains all the health problems experienced by all fat people. However, I think that both empirical studies and plausible causal mechanisms support it being a significant contributor to at least some of them. So for some people it is at least reasonably possible that the fat preceded the stress mechanisms and health issues, rather than being caused by it.

Yes, but that has to be put into perspective too. Almost everyone is singled out by society for some preconceived abnormality that they have. For example, if someone has a lisp, they can be made fun of and it can cause emotional issues to that person, but did those people making fun of them cause them to have a lisp? No. All it does is worsen the problems of an already-unhealthy person or someone who has some kind of "abnormality." Obese people are made fun off to a great degree after they are fat, not before they become fat (assuming they were not fat from childhood, as many are). So yes, fat people may undergo stress which will worse their already bad condition, but I don't think we can take that so far and say that is the reason why they have type two diabetes, which is a biochemical problem caused through metabolic stress. Many of the problems obese people suffer are directly related to their stress induced metabolic state and perhaps some of their emotional guilt or disorders are also the result of them knowing that they are not healthy and have an uncontrollable addiction to junk food (as is the case for some), etc.

It is possible there could be other mechanisms, apart from healthy natural variations and hypothyroid metabolism that may or may not have been identified yet, too.

There can be other mechanisms, such as the emotional ones you pointed out, but these would only worsen their problems. We are talking about the mechanisms that CAUSE obesity, not the ones which make already-obese people worse emotionally, etc.

So now we have at least two plausible causes of large adipose, and at least two non-exclusive causal mechanisms to explain an association between large fat and some health issues. ( And have we not ruled out that there may be more of both.)

I don't think those are two large plausible factors at all, as I have pointed out above. once again, those two factors not only take root often once that person is ALREADY fat, but they can also cause more health problems in an already obese person, therefore one cannot say those emotional issues caused their obesity. Causation and association are not always the same thing, remember.

Therefore, we cannot on the basis of the evidence I am aware of or that you have pointed to so far, conclude that all large adiposity is caused by hypothyroid states or will always be accompanied by hypothyroid states.

[/quote]

Obesity is caused by metabolic stress, which includes hypothyroidism is what I said. All the known biological pathways that cause obesity are metabolic stressors and the two points you make are not "evidence" that shows obesity is not always caused by these stressors.

 

[Waremu]

@ Waremu,
While I agree that a number of hormones have levels that indicate likelihood of better or worse health, to me they are not the same as health itself. Eg high cholesterol may be an indicator of high CVD risk. But if someone lives happily and actively into their late 90s with long term high cholesterol, it seems I would count that as a healthy old age and you would not.

Well, that may be the case for you, but there is enough information established by science to safely conclude that hormone levels are a great indicator of metabolic stress and this is further indicated by the roles of these metabolic stressors (stress hormones) which have specific mechanisms in causing metabolic stress. It's like evidence that is left at a crime see. These stress hormones are simply indicators to show us that the metabolism is stressed.

If someone lived until 90 being very obese and on all kinds of medication, then no, that would not be a healthy old age." They lived long, yes, but they died long. Many elderly people are on all kinds of medications and are vegetables and still live to be 87 or older. That does not at all mean they are healthy. With medical advancements, we still cannot "cure" disease, but we sure can make people live longer being sick.

 

[Such_Saturation]

With medical advancements, we still cannot "cure" disease at a profit, but we sure can make people live longer being sick at a profit.

There you go

 

[tara]

Despite how the medical system defines health (simply the absence of disease), health correctly defined is not only the absence of disease, but also when the organism is operating at it's optimal or ideal state so that it can handle stress the most efficiently, with the least damage. If someone is in an ideal state of health, then they shouldn't be moving towards disease. If someone is in a state of bad health, they should be moving further from disease and closer to what should be an optimal state of health.

This is the bit that seemed to me to rule out normal aging from your definition od good health. It seems likely to me that everyone has in their future terminal illness that they (we) are moving towards, unless we get run over by a bus or similar.

 

[Waremu]

Despite how the medical system defines health (simply the absence of disease), health correctly defined is not only the absence of disease, but also when the organism is operating at it's optimal or ideal state so that it can handle stress the most efficiently, with the least damage. If someone is in an ideal state of health, then they shouldn't be moving towards disease. If someone is in a state of bad health, they should be moving further from disease and closer to what should be an optimal state of health.

This is the bit that seemed to me to rule out normal aging from your definition od good health. It seems likely to me that everyone has in their future terminal illness that they (we) are moving towards, unless we get run over by a bus or similar.

Many people are moving toward terminal illness, but just because that is so or common doesn't mean they are exactly healthy just because they have not yet had an illness. And actually, if most people are hypothyroid, as Ray Peat says, and hypothyroidism is a disease, then technically, most people do have a disease (especially when you count other common diseases that are associated with the disease of hypothyroidism, such as diabetes, etc.). So then, by a strict medical definition of what health is, most people would not be healthy as they suffer from some kind of disease.

The way Ray Peat seems to define health is not only is there the absence of disease, but also, the organism is in the best state to fight stress (by having a fast metabolic rate, etc.). I tend to agree with him on that.

I think it is very possible for someone to age "gracefully" in that the only thing they are moving towards is ultimately death due to old age, which is natural and cannot be stopped. Anything that leads to premature death I believe is not natural because the life of the organism is being cut short rather than just "wearing out." And what cuts the life short? Biological stressors, etc., which have a chain reaction that inevitably lead to disease.

If the organism is worn down more through stress, it will usually have a shorter life. Most people are worn down by stress and end up dying before their time. Those who live fairly long and are in bad health usually live long because of the advent of modern medicine to keep them alive and sicker longer, for without that they would probably live a much shorter life.

Yes, the possibility or tendency to continually move towards disease is always there because stressors are constantly bombarding us on a daily basis. This is why maintenance (through diet, lifestyle choices, etc.) is required to be in a constant state of good/optimal health.

The old car analogy I think is very fitting. You maintain your car and therefore keep it "healthy" by it not breaking down and dying on you. Cars that are maintained well last much longer than cars that are not maintained properly. But stop the maintenance on that car and it will die out before it's time (that is, the factory life that car is supposed to have). Stop maintenance and one little thing will break and that will set off a chain reaction in the engine or transmission that will cause it to break down over time.