Overweight diabetes patients outlive slim ones

[haidut]

In another confirmation of the "obesity paradox", this study found that overweight diabetes patients outlived slim diabetes patients, and had a lower risk of co-morbidities in general.

http://www.reuters.com/article/2015/05/ ... Z220150504

"...Patients with type-2 diabetes who are overweight but not obese outlive diabetics of normal weight, scientists reported on Monday, in another example of the "obesity paradox." Although public health officials issue dire warnings about the consequences of overweight, and employers are pressuring workers to slim down via "wellness programs," the relationship between weight and longevity is paradoxical: Studies show that although obesity increases the risk of developing cardiovascular disease (CVD), overweight patients with CVD live longer than patients of normal weight.

 

[Blossom]

 

[Westside PUFAs]

"Underweight diabetics had the highest risk of dying during the study, with nearly three times the mortality of normal-weight patients. Overweight patients had the best survival, being 13 percent less likely to die than normal-weight or obese diabetics."

13 percent? Not much.

Also,

"(Overweight is defined as a body mass index of 25 to 29.9, which would be 146 to 174 pounds for someone 5 feet 4 inches. Normal weight means a BMI of 18.5 to 24.9, or 108 to 145 pounds at that height.)"

I've been in the overweight, not obese, range. There is a difference between overweight and obese.

"Although overweight and obese patients had an increased risk of heart attacks and strokes, they were more likely to stay alive than normal-weight diabetics, the researchers reported in Annals of Internal Medicine."

Who wants to "just stay alive?" And also gamble with heart attack or stroke?

I'd like to see some info on lean people with T2D if you have any.

 

[tara]

"Who wants to "just stay alive?" And also gamble with heart attack or stroke?

Not just you, but why do people write off the relevance of mortality stats wrt health?
Are you assuming that the leaner folk all died unexpectedly, quickly and peacefully in their sleep (or while playing squash or something), whereas the fat ones suffered lingering deaths?
Is there any evidence that the lean diabetics/CVD patients etc have a shorter or less unpleasant lead up to death than fat ones?
Unless there is evidence to the contrary, I would have guessed that fat and lean people would have similar probabilities of spending their last year or five in whatever specified state of functioning and/or distress. And that a subset with higher mortality would also have worse health from a functional point of view.

 

[tara]

Who wants to "just stay alive?" And also gamble with heart attack or stroke?

Being alive is to gamble with dying. Heart attacks and strokes are major causes of death whether one is lean or fat. Personally, I pick being alive over being dead already.

 

[Westside PUFAs]

tara,

People like you (I'm not saying that in a mean tone, like "stupid people like you!, sometimes it's hard to tell someones tone through typed words), I'm simply saying that there are people here on RPF, and anywhere/everywhere for that matter, who hold your view on body fat. That's fine. That's your prerogative. I'm not trying to convince you that you need to lose your body fat. I'm just sharing my experiences with the negative effects that I have experienced from body fat. Of course I could die right now. I could get in a car accident. I could get cancer from all of the cigarettes I smoked from the age of 12-14 and then again at 24-26, including the many years of secondhand smoke, or get cancer from the many dental x-rays I've gotten. Anything can happen. I'm not going to keep posting about this much longer. I'll move on eventually. But I just see so many people post so many problems and my first thought is, "how much oil and cream are they eating?" That's just how I am because to me, oil and cream (in any form) are the main problems. A little is fine. But I think a lot of people over do it and clog up their bloodstream with fat. Like one guy who said he had so many problems, then he posted his cronometer and his daily fat intake was something like 125 grams. Is he serious? He wonders why he has problems.

Diabetes is no joke. One of the mains reason I'm so passionate about low fat is because it is reversing my pre-diabetic symptoms. But ok, I get it, people don't wanna hear it. They don't want a solution. They just want to keep eating high fat foods because it's no fun giving them up. Fine.

If having the amount of body fat you have right now works for you, and you don't have any problems from it (or perceived problems), then theres nothing else to say.

I'll be moving on soon from any forums. Because I've found what works for me, so there is no point in staying on a forum when you've found a diet and lifestyle that works, and fits your own personal definition of the word "works." The time spent trying to convince a person that they should do this or that is better spent doing something else, because they probably aren't going to take your advice anyway.

 

[Tom]

As regards BMI vs life expectancy in general, it is u-shaped, so optimal is perhaps around 25. But of course BMI is a questionable indicator as it does not take into account the body shape, the muscle mass etc. A bodybuilder could be obese, for example.



(From Lindeberg, S.: "Food and western disease" (2009))

On a side note I think Italians and americans eat about the same amunt of calories, but the average BMI of italians are around 25 on average compared to 29 for americans. Life expectancy in Italy is significantly higher (and one of the highest in the world). They do not exercise a lot, and generally look lean.

Let´s also remember the short life expectancy of diabetics.

 

[Tom]

One of the mains reason I'm so passionate about low fat is because it is reversing my pre-diabetic symptoms.

I would be interested to hear what the diet you follow that treats your pre-diabetes looks like. Do you eat a lot of starch or is it mostly fruits? Do you eat grains or white rice etc? How much percentage of energy from fats, carbs and protein?

 

[BobbyDukes]

tara,

People like you (I'm not saying that in a mean tone, like "stupid people like you!, sometimes it's hard to tell someones tone through typed words), I'm simply saying that there are people here on RPF, and anywhere/everywhere for that matter, who hold your view on body fat. That's fine. That's your prerogative. I'm not trying to convince you that you need to lose your body fat. I'm just sharing my experiences with the negative effects that I have experienced from body fat. Of course I could die right now. I could get in a car accident. I could get cancer from all of the cigarettes I smoked from the age of 12-14 and then again at 24-26, including the many years of secondhand smoke, or get cancer from the many dental x-rays I've gotten. Anything can happen. I'm not going to keep posting about this much longer. I'll move on eventually. But I just see so many people post so many problems and my first thought is, "how much oil and cream are they eating?" That's just how I am because to me, oil and cream (in any form) are the main problems. A little is fine. But I think a lot of people over do it and clog up their bloodstream with fat. Like one guy who said he had so many problems, then he posted his cronometer and his daily fat intake was something like 125 grams. Is he serious? He wonders why he has problems.

Diabetes is no joke. One of the mains reason I'm so passionate about low fat is because it is reversing my pre-diabetic symptoms. But ok, I get it, people don't wanna hear it. They don't want a solution. They just want to keep eating high fat foods because it's no fun giving them up. Fine.

If having the amount of body fat you have right now works for you, and you don't have any problems from it (or perceived problems), then theres nothing else to say.

I'll be moving on soon from any forums. Because I've found what works for me, so there is no point in staying on a forum when you've found a diet and lifestyle that works, and fits your own personal definition of the word "works." The time spent trying to convince a person that they should do this or that is better spent doing something else, because they probably aren't going to take your advice anyway.

Westside, like you, I respond so much better to a low fat diet.

The benefits of low fat, for me, are: more stamina, my libido returns (almost to the point of being sexually ravenous sometimes, haha) and better cognition.

The negatives are: food is boring, anxiety goes up,

Just wondering what you eat yourself, as a fellow 'low fatter'.

 

[jaa]

Not just you, but why do people write off the relevance of mortality stats wrt health?

I don't think I've ever written it off, but I think quality of life matters. And all else being equal, moving around as a lean person all day is more pleasant than moving around with excess weight. I'd rather 10 years as an overweight person than 5 years a lean person. But I might take 9 years as a lean person over 10 as an overweight individual. My measuring stick could be off as my strength, flexibility, and posture weren't as good when I was around 10lb heavier than I am now.

As for the study, that is interesting. I wonder if it' extrapolates to a healthy population or if it's more a function of the disease than anything else.

 

[Anonymous]

How did we survive for millions of years on this planet without skim milk, 0% Fage yogurt, egg whites and george foreman grills?!?! Why didn't we all just die off if saturated fat was clogging up our bloodstreams?!?! Trytophan is not abundant in many foods found in their organic state. Niether are polyunsaturated fats. Saturated fat is abundant, and i think ray even says that tropical fruits contain a minimal amount of saturated fats. saturated fat allows us to stay satiated so we don't need to eat every couple hours which is highly inconvenient. I feel MUCH better now that I'm slightly overweight. forget science, use common sense. look at foods as the exist in nature.

 

[Dean]

As someone essentially living on non-fat milk powder and 0% Fage, I get the point about naturalness. It's something that I think about quite a bit. I think though that most of us have spent our lives ( or at least part) eating unnatural, especially in terms of PUFA. So, restricting fat as a means of depleting PUFA stores makes sense. Yeah, over the long term, I hope I'll be able to drink whole milk and be more natural with my diet. I have to admit though, I have always found dairy fat to be especially fattening.

There are other reasons to restrict fat and be concerned with carrying extra weight over the long term though, other than pure aesthetics or trying to fit into a statistical norm. Examples in my case would be--reducing stress on joints, impaired pancreas function, and animal fats causing hemorrhoids to flare up. I'm sure there are many other reasons someone might opt for long term or permanent fat restriction over natural purity in diet.

 

[tara]

Hi Westside PUFAs,
Of course you don't have to engage further in this discussion when you have better things to do.

I've had a number of people attribute views to me that I don't hold and that I don't think I have expressed (though it could be that I've not expressed myself clearly). Since you didn't seem to respond to any of my points, I still don't know why/where we differ.

I'm still curious about why you think meat fat is no problem. Is it only because you don't think people eat as much of it, or is it because you think similar quantities of beef or mutton fat have less harmful impact than milk fat? How does this fit with the higher PUFA in meat fat?

I still don't know why people keep writing off mortality studies as irrelevant when it comes to people who are obese. Is there any reason to think that the thin people in the study quoted in the original post suffered less before they died than the rounder ones? I know some diabetics, and being blind or losing limbs doesn't look like much fun to me while lean either.

I did not argue for a high fat diet in general. I simply reported what I am currently doing, and noted that I seemed to be a contradiction to what I think might have been your assumption that people eat less meat fat than milk fat.

I think it is quite likely that a low fat diet can be helpful in many situations, including against diabetic tendencies.

I am not happy with the state of my own health, and aim to keep experimenting, as and when I have the inspiration and energy for it. It wouldn't surprise me if lowering fat intake at some stage could be helpful to me, if I can find ways to make it work for me in other respects.

It is obvious by reading a few posts here that milk fat does not automatically turn into additional body fat for everybody - even if it were true for many people, that seems to be an unwarranted simplification.

 

[oxidation_is_normal]

And those fat people have less stress because they've never been asked out... So they're even
Honestly, this is an odd fascination (same disease, slightly less symptoms; size of fatty tissue). It seems the only people take away from this is temporary rationalization - no useful actionable behaviors.

 

[cantstoppeating]

These findings aren't a way to rationalise being overweight or obese, or that it's healthy to be overweight or obese.

These findings show that when something in you body is not working, being overweight or obese can be protective. That's it.

We're trying to fix whatever isn't working so that our body doesn't need to resort to storing excess fat (PUFA or saturated) as a protective measure.

 

[charlie]

These findings aren't a way to rationalise being overweight or obese, or that it's healthy to be overweight or obese.

These findings show that when something in you body is not working, being overweight or obese can be protective. That's it.

We're trying to fix whatever isn't working so that our body doesn't need to resort to storing excess fat (PUFA or saturated) as a protective measure.

:1

Well said.

 

[tara]

These findings aren't a way to rationalise being overweight or obese, or that it's healthy to be overweight or obese.

These findings show that when something in you body is not working, being overweight or obese can be protective. That's it.

We're trying to fix whatever isn't working so that our body doesn't need to resort to storing excess fat (PUFA or saturated) as a protective measure.

I agree.

It does not show that being 'overweight' (either over whatever is one's personal optimal weight, or much over the statistically median weight) is healthy, except insofar as it may be protective when there is something else amiss.

It does suggest that there may be negative consequences of prescribing weight loss by undereating (or overexercising) as an appropriate treatment for diabetes etc. Finding ways to improve general metabolism, as many of us here are trying to do, is likely to result in fat loss for some people who are over their optimal adiposity.

It doesn't address one way or the other whether a minority of people may be at their optimal weight and/or healthy in the 'obese' category, because that's not what it is studying.

 

[tara]

And those fat people have less stress because they've never been asked out... So they're even

Aside from being obviously untrue, this looks like fat-shaming to me. Even when it's in the guise of 'it's just a joke', fat-shaming involves adding unnecessary stress to people's lives, which as I see it is not consistent with helping people figure out how to restore health. From my point of view, it's short on respect.

Honestly, this is an odd fascination (same disease, slightly less symptoms; size of fatty tissue). It seems the only people take away from this is temporary rationalization - no useful actionable behaviors.

'Rationalisation' seems to be an accusation often used when people do not want to address a rational argument that they disagree with by relevant evidence and logic of their own.

 

[oxidation_is_normal]

I don't see any rational disagreements with my "in-actionable behaviors" argument against studies like this in your post.

There is also truth to my generalization about personal issues caused by this visible symptom of a variety of causes (growth of adipose tissue).

Also, if you're going to claim something as general as "being fat is protective," then propose some mechanisms (and the storage/release of PUFA is not one that is congruent here).

Honestly, the reason why people (including researchers) are so fascinated by this single side-effect of underlying health issues (gratuitous adipose growth) is because it is one of the few very visible symptoms. If all symptoms were equally visible, then we wouldn't be so obsessed with this one.

 

[tara]

I don't see any rational disagreements with my "in-actionable behaviors" argument against studies like this in your post.

I think I see what you mean. How about this?: Taking a possible behavioural affecting decision to not force weight loss by undereating could be called inaction, but sometimes inaction is the appropriate 'first do no harm' behaviour.

There is also truth to my generalization about personal issues caused by this visible symptom of a variety of causes (growth of adipose tissue).

I agree that there are issues created by people's discrimination and other abuse aimed at people with larger body fat, and that this is a problem. I disagree about the generalisaton about fat people never getting asked out. At least where I live, as evidenced by people I know, and also by apparent couples I see when I go shopping, dancing, etc. I tend to see this as not just individual personal problems, but as a societal problem, the costs of which are borne disproportionately by fat people, but which also has negative effects on the health of many thin people.

Also, if you're going to claim something as general as "being fat is protective," then propose some mechanisms (and the storage/release of PUFA is not one that is congruent here).

By claiming that 'being fat is protective' in this context, I'm echoing the results of the empirical study posted and number of others - the 'obesity paradox' is as far as I know widely recognised. Are you saying that empirical data is irrelevant without a theoretical mechanism to explain it? I do like to understand mechanisms too, but I don't think it's correct to say the empirical data is invalid because it does not fit a particular theory.

If you are claiming that reality/the theory you think is relevant in this area does not match the apparent results of this empirical study, then what explanation do you propose for the discrepancy?

I can propose a possible mechanism consistent with this study result, but I can't demonstrate that it is the/a real one - there may be other mechanisms at play.
It could be that a statistically significant difference between thin and fat diabetics is that the fat ones are more likely to be eating to appetite, and the thin ones are more likely to be restricting their diet and eating less calories than they feel like. It could be that eating to appetite and allowing the body to find its own current set point (which for people with diabetic metabolism may be increased) is more supportive of metabolism than eating less calories and/or less carbs and/or less sugar than appetite suggests. Restricting calories and/or carbs seems to inherently cause a range of stress responses in the body, and these stress responses may predispose it to faster exhaustion of its adaptive reserves, hence higher mortality.
Peat has said that a craving for sugar usually means a need for sugar. Avoiding sugar and restricting calories despite cravings is what diabetics are frequently encouraged to do. Not meeting the bodies actual needs could plausibly lead to increased mortality.

Honestly, the reason why people (including researchers) are so fascinated by this single side-effect of underlying health issues (gratuitous adipose growth) is because it is one of the few very visible symptoms. If all symptoms were equally visible, then we wouldn't be so obsessed with this one.

Yes, I agree. Other visible difference are sometimes also targetted.
If we all had our BMR displayed on our foreheads it might put things in a different perspective (not that I'm suggesting this would be a good idea).