Let’s say you take an x-ray of the skeleton of a 400 pound guy, and another one after he loses 250 pounds. Just by looking at the bones, would you be able to tell them apart? How about after someone dies. Can you look at their bones and determine that a person was overweight?
Um, you might be able to tell from the joints. My father was morbidly obese at the end, & he had horrible arthritis.
Is there anything to that old saw about being “big-boned”?
The size of people’s frames vary, of course. So, what weight may be overweight on one person isn’t on another. But as to “big boned” being an excuse for carrying too much weight, no. That doesn’t work. If you’re carrying too much weight for your height, you’re fat.
WAG: If one were to require all those being x-rayed to stand with their legs together and their hands at their side, you’d be able to see that the arms were closer to the ribs after the subject dropped some weight.
Bones grow in response to the loads placed on them (that’s why weight bearing exercises help ward off osteoporosis), so I’d hazard a guess and say that fat people really do have somewhat thicker bones than skinny people. After losing all of that weight, the bones would gradually get thinner. YMMV.
Yeah I can sit here and guess all day too. Anyone actually know what they are talking about?
You’re fat if you have excess fat on your body. Simple weight/height calculations don’t always work. But yeah, having “big bones” doesn’t create the 3 inch layer of fat under your skin.
No matter how much my dear ol’ mum tried to convince me otherwise. 
Bones cannot return to gracile after losing weight and taking a load off…the bone remains the same [although the density may modify, the framework of the bone will remain the same.]
I asked my sister in law once - she is a forensic anthropologist and used to work on the body farm. I was curious about why my grandmother ws like a twig. I swear, she looked like a good brisk wind would blow her away! Monica pointed out that my grandmother did no physical labor in her life and did have very tiny gracile bones where I did hard physical labor as a teen and 20 year old, and have large pretty dense bones as a result, and the only change that would happen would for me to lose density and get osteoporosis.
On the plus side, when I had my parathyroid kiss off for an indeterminate number of years, despite my bones leaching enough calcium into my blood stream [11.9 :eek: ] I was still pretty well off … only really effect was breaking bones in my foot doing a misstep in the driveway [which is what got me to a doctor and diagnosed.]
Radiology guy here.
If you take a standard X-Ray, you can see the bones well, but you also see shadows of soft tissues, fat, liver, spleen, bowel gas, boobs. As you get more experience you can tell how old they are. At some point you get a gestalt, where you walk by someones monitor (we use computerized imaging) and your first response is, “whoa, she’s hot”, despite the fact that it’s an X-Ray image. So you can kind of tell that they’re fat because the fat is represented on the image. There are also technique factors, in that a bigger person absorbs more X-rays and produces a different image.
With respect to bones and such, you will often see a normal sized skeleton within a morbidly obese patient, the classic ‘fat person with a skinny person inside’. A person with a normal skeleton and normal physique looks proportionate. A tall person with a big skeleton and an appropriate BMI also looks proportionate. I’ve never seen anyone who was ‘big boned’, - that is a disproportionately large skeleton for their height making them appear fat, when in fact it was the skeleton. I’ve seen tons of normal skeletons within very overweight people.
The comment about degenerative changes in the knees, hips, spine is correct. You do notice more osteoarthritis if the person is obese.
Obviously genetic disorders, acondroplasia and acromegaly aside, we’re talking normal overweight people
Yes they do change. I weighed 415lbs all through out high school. In 1998 I started on Phentermine and lost 250lbs. When I was finally down to a “normal size” my cervical spine was growing outward due to my large belly pulling down on my chest/neck area in the front of my body. When I was fat, I was always hunched forward/leaning forward, this drastically changed the shape of my back.
Also my knees had also started to “knock” due to the pressure of my body growing down on top of them, in turn, pushing them inward towards each other.
Man, where’s Gary Larson when you need him… 
but that is not a change in size … that is a change in morphology. You can get changes in your c/spine morphology for a lot of reasons. You can get the same hunching from carrying heavy loads like a woodmans hod [that huge basket for small pieces of wood that is like a giant wicker backpack] that forces you to hunch forward. Knocknees can be caused by a lot of things as well - such as carrying heavy weights [also like a woodmans hod.]
Somewhere on the national geographic page I think is an article on looking at the skeletons found in Pompeii and Herculaneum and determining social class and professions based on bone structure and stress modifications. Fascinating [IIRC they determined that one woman was a prostitute because of disease lesions on her pelvic bones and another was a bricklayer becaus eof the deformation from carrying a brick hod on one shoulder]
We seem to have differing results from our experts. Radiology guy says “no change”, forensic anthropologist says “some change.”
Malienation and Aruvqan are right, I don’t disagree with them at all.
My comment was more addressing: “do you see a different skeleton inside a fat person”, and Siam Sam’s “are there big-boned people”.
The other stuff is pretty much lumped under the degenerative stuff that I mentioned, when I said “The comment about degenerative changes in the knees, hips, spine is correct. You do notice more osteoarthritis if the person is obese.” I should also have mentioned that bones that carry more load are going to be denser, and look more sclerotic on imaging. However, this will go away with time, as Malienation pointed out
Summary: Fat people look fat on X-ray. Formerly fat, now skinny people may have degenerative changes due to carrying a larger mass, and for a while would have denser bones, but this would be very nonspecific, you’d be WAG-ing if you said “Based on these images, I know the patient as recently lost 200 pounds”. Unless you saw a stomach band on the x-ray, or a radioopaque Jenny Craig logo on their underpants. (do they sell those?)
Final verdict- radiology guy: some change, nonspecific.
I’m thinking the Herculaneum hooker likely had an infective process like Reiter’s syndrome. I’m also thinking Herculaneum Hooker has potential as a band name
Thanks everyone. Your responses were very interesting.
The authors of this study of medieval monks’ skeletons apparently were confident in ascribing features of the skeletons to obesity.
i think Jenny Craig would sell anything, I would not be at all surprised if some now came out on the market 
I tried finding it and realized that I probably read it in an actual Nat Geo magazine, as my parents have the full run from 1949 to this month…and for a while until the house burned I used to delve into them for amusement when visiting home…since I am off for 2 weeks I might have a go at seeing if I can find an index online and find the article in question, I would guess an 80s vintage issue=)
<and my pseudogout has caused joint changes in my foot that even I can see now=( >
Yes, but there are several differences between the medieval monk question and a radiology report:
- clinical information
- the hypothesis was “were these monks fat?”
- historical menu data “monks ate like pigs”
- These are monks, not hod carriers or peasants, in whom the degenerative changes would be ascribed to work, not weight.
In the context of these things, yes you can come down harder, and tie in DISH.
DISH is usually idiopathic, there isn’t a firm 1:1 correspondence with obesity. Even in a person with degenerative changes and DISH, without a good clinical story, I wouldn’t call 'formerly obese, now skinny" as in the OP. I’d be more inclined to go with ‘hard life, ideopathic dish’
It the clinical note read “Patient claims to have been medieval monk and lost weight. Is this correct?” You’d say, “changes compatible with provided history”
You might have this kind of clinical information in a radiology request, more likely not, especially since the clinical question would be “was this person fat”, an issue more usually addressed by asking the patient.
- No medical-legal issue with dead monks
- If I say “this person has liver disease, (or atrophic changes in the brain), which due to alcoholism” I’ve opened myself up to a complaint to the board about how I called granma an alkie. Instead I say "which may be due to a myriad of causes, including Wilsons disease, hepatitis, yadayadayada…and alcohol…yadayadayada…
-Even people who are obviously obese on imaging, to the point that the images are degraded and nondiagnostic, that is, their body absorbs all the photons, or soundwaves (in ultrasound), you couch it in a single sentence of doctor talk: “This examination was suboptimal due to the patient’s body habitus”. Could mean that they’re too skinny, but it don’t.
The monks, however, are dead. Call them fat egg-eating alcoholics. No one will care*.
*please don’t haunt me.