Obesity Paradox Illusion

Discussion in 'Articles & Scientific Studies' started by jaa, Feb 12, 2016.

  1. jaa

    jaa Member

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    Whole Health Source: Is the "Obesity Paradox" an Illusion?

    Stephan Guyenet has just wrote a post that makes some good arguments against the Obesity Paradox. He argues that the Obesity Paradox is the result of poor observational research methods that fails to account for disease causing people to go from overweight -> thin and fails to fully adjust for unhealthy habits, like smoking, that make people thin.


    He supports this with evidence from new research methods used that account for body weight history, and not body weight at time of diagnosis.

     
  2. Giraffe

    Giraffe Member

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    As far as I know diabetes type 1 leads to rapid weight loss. Why would diabetes type 2 lead to weight loss?
     
  3. tara

    tara Member

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    I think there's a good point there about epidemiological studies having difficulty sorting out causal relationships.
    Which allows room for doubt about claims based on such studies in either the direction of fat causing or fat protecting from disease.
     
  4. Westside PUFAs

    Westside PUFAs Member

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    "The fundamental problem with the obesity paradox is that it's based almost entirely on observational evidence, meaning that it doesn't come from controlled experiments that are better at identifying cause-effect relationships."

    Exactly.
     
  5. tara

    tara Member

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    Related issues apply to the 'obesity epidemic' story.
     
  6. OP
    jaa

    jaa Member

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    [ moderator edit: threads merged ]

    Stephen Guyenet just posted two new studies over at his blog that suggest the obesity paradox is not really a paradox at all, and is mostly based on confounders such as smokers and people losing weight when ill. He touched on this earlier this year when Andrew Stokes used a maximum weight method to try to diminish the effect of these confounders, and found that people who stay lean over their lives are at the lowest risk for all cause mortality. I posted about this here.

    Whole Health Source: Two huge new studies further undermine the "obesity paradox"

    I suggest reading Stephen's brief summary of the two studies.

    tldr: Optimal BMI for healthy people seems to be ~20-22. Things don't start getting risky until you reach a BMI over ~27.
     
  7. ecstatichamster

    ecstatichamster Member

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    Yes but. Losing weight itself through dieting doesn't mean the risk factors are any lower. The same causes of obesity are probably still present. Losing weight by itself may be worse for mortality rates. This is what nobody seems to get.
     
  8. Tarmander

    Tarmander Member

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    Yeah it kind of messes up the causes and effects.

    Lean people have the least mortality long term...okay, so if I am fat, then get liposuction to get rid of all the fat, then I will be the same as those lean people right? No, you're just a skinny fat guy with more problems now with all those lipo scars.

    So say I am super fat and I go on an 800 calorie diet and lose it all and am lean, I am the same as all those naturally skinny people now right? Well no again, you are going to rebound hardcore and have all kinds of starvation issues.

    BMI is not a good indicator of health. It is a tool to study populations, to do statistical analysis with. If you walk into your doctors office, and your BMI is 27 and the doctor says hey you need to get your BMI down to 22...well you should run...none of the ways they are going to suggest to accomplish this goal are going to be healthy. The correct question is: why are the lean people healthier?
     
  9. Westside PUFAs

    Westside PUFAs Member

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  10. ecstatichamster

    ecstatichamster Member

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    Yes. And I'm still thinking lean people often have many metabolic problems.
     
  11. Peata

    Peata Member

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    :+1
     
  12. OP
    jaa

    jaa Member

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    Sure. But I think you're talking about the much smaller subset of overweight individuals who live a healthy life. Most do not. I'm also not convinced a decent percentage of that subset would not be better off with a little portion control and weight loss. Not starve yourself on kale shakes for bathing suit season portion control, more like cut back on the dense, somewhat void calories like sugar and coconut oil just a little.
     
  13. OP
    jaa

    jaa Member

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    While I agree, those are extreme examples.

    Conversely, if you walk into your doctors office at age 19 with a BMI of 27 and want to be healthier and your doctor looks at your diet and lifestyle and makes a few tweaks so that you're eating healthier food while eating ~100kcal less a day and getting good sleep and exercise and managing stress well, I would be very surprised if your BMI didn't get down near 22 over the next few years and you weren't healthier than your 27 BMI self.
     
  14. OP
    jaa

    jaa Member

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    Yeah there are a bunch of things that go awry when you start packing on the pounds that go away when you lose the weight. This is not to say people should starve themselves at risk of worse metabolic derangement, or that everyone's past history is irrelevant and everyone's ideal BMI is 22, just that if you are overweight tweaking your lifestyle in a way that gradually lowers your weight is probably for the best.
     
  15. Tarmander

    Tarmander Member

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    Pretty much in agreement. So is he healthier because his BMI came down from 27 to 22 or because he made lifestyle changes? If the doctor had instead offered him liposuction to get down to 22 BMI, would he be as healthy?
     
  16. OP
    jaa

    jaa Member

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    Purely speculative, but I think both. I think the loss of fat that is likely a PUFA warehouse waiting to get oxidized is a benefit in and of itself. And the lifestyle changes that lead to weight loss have health benefits grander than simply losing the stored fat.

    The process of liposuction may be a stressor that causes more harm than good, especially if the person getting one does not change their habits and just springs back to pre-lipo weight. That seems like the worst case scenario, and it may be better to just accept the weight. Conversely, if we can imagine a low-stress lipo-like procedure, it may be optimal for a person to undergo that surgery if they have a set of positive lifestyle changes they know they will implement and know will keep them at post lipo-like weight. This imaginary and idealized scenario would be very rare though, and for most people the process of stumbling through a number of strategies and keeping the useful ones as one gradually gets healthier is the best way to go.
     
  17. ecstatichamster

    ecstatichamster Member

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    Guyenets studies don't use all cause mortality as far as I can see. This is far more important than cardiovascular caused deaths.
     
  18. David PS

    David PS Member

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    A BMI over 27 is just a marker for living an unhealthy lifestyle. Liposuction to lower the BMI does not automatically change the underlying unhealthy lifestyle. Admittedly, if you lipo-away enough body fat you may make more likely that a person can walk continuously for 30 minutes; but there is no guarantee that extra walking will happen.

    Liposuction can remove excess fat tissue. But people with diabetes should not confuse it in any way with bariatric surgery or traditional weight loss. Bariatric surgery (surgically enforced fasting) and traditional weight loss both help to improve insulin resistance, lower cholesterol, and lower blood pressure. It seems that liposuction does not. see https://intensivedietarymanagement.com/bariatrics-surgically-enforced-fasting-t2d-6/
     
  19. Ahanu

    Ahanu Member

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    BMI is so old school
     
  20. PhilParma

    PhilParma Member

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