Health risks associated/caused by being overweight?

Factual Questions
1

I always assumed like most people that there were risks to being overweight:

http://www.cdc.gov/obesity/causes/health.html

Often when I’m on other sites (people who believe in health at any size), people tend to see this as just an example of the medical profession being biased and assuming it’s the fat causing when it could be other things. I.e., gynecological problems could be caused by people staying away from the doctor out of fear of being made fun of, sleep apnea can cause weight gain, and stress related problems could be caused by the stress of living in a culture where being fat isn’t as acceptable.

It kind of sounds like excuse after excuse to me but I don’t know enough to really say. Is there anything to the idea that these things have nothing to do with fat? Or are these people just deluding themselves?

2

I don’t have a decent answer to your question and I’m sure there will be some knowledgeable people along soon, but in the meantime, you might be interested in a blog I follow called Junkfood Science which looks at a lot of the fat issues that are potrayed in the media and gives a bit more in-depth analysis of what the research actaully found, which is sometimes in direct contrast to what gets reported.

Perhaps start with the Obesity Paradox article 1 Junkfood Science: “Obesity Paradox” #1

3

Too thin, too fat at increased death risk - Times of India It is unhealthy to be too fat or too thin. Skinny people are at risk for health problems too.

4

I don’t think anybody is seriously saying the fat is actually causing any of those things, or even being fat for that matter. Those things are correlated, but it’s hard to imagine that we’ve consistently proved that most of those things are caused by being overweight.

5

All I know is that when I weighed 50 lbs more than I do now my blood sugar was out of control due to insulin resistance caused by type II diabetes. Now that I am of “normal” weight and exercise reguarly I no longer need to take medication to help metabolize the carbs that I eat. Being overweight definitly causes complications to all of the conditions listed in the OP, it’s a proven scientific fact from my poll of one.:smiley:

6

as a diabetic i have to totally agree with this HOWEVER the word “causes” in the cdc link disturbs me. being overweight does not CAUSE type 2 diabetes.

7

Apparently, much of the bad effects associated with overweight is actually caused by the insulin and insulin-related growth factor produced by eating carbohydrates. Hormonally-dependent-cancer tumor cells (breast, endometrial, colon, etc.) have something like 20 times more insulin receptors than ordinary cells and their growth is fueled by the insulin and IGF. Or so I’ve read.

8

Actually, it does.

It may not be the singular or sine qua non cause of DM type II, but in the way you can meaningfully attribute the cause of DM type II to anything, obesity is causes one through ten.

9

It is a complex issue. For one thing, when people say there are 300k deaths a year to being obese, around 60%+ are due to cardiovascular disease. And obesity does raise risks for CVD by about 50% or so, but so do dozens of other things (poor social networks, poor sleeping habits, tons of stress, deficiencies in various vitamins and minerals, various independent levels of hormones and proteins, etc). So obesity can be blamed for hundreds of thousands of deaths a year because it slightly increases CVD deaths, but by that logic so can poor sleeping habits. I believe obesity raises CVD deaths by 50%, but poor sleep raises them by 100% or more.

At the same time, even if obesity is correlated, that does not mean losing weight is the best or only treatment. Long term obesity treatments fail miserably, and even if obesity does increase blood pressure then using anti-hypertensive medications will be far more effective than promoting long term weight loss because compliance will be far higher. If there are health risks, you have to look for the safest, cheapest intervention with the highest compliance levels. Long term weight loss isn’t it.

Certain disorders like sleep apnea, type II diabetes and joint dysfunction are strongly tied to obesity. When people have obesity surgery these disorders usually either go into remission or dramatically improve.

However even that is complex. Obesity surgery can pretty much cure type II diabetes (roughly 50-90% of people who have an obesity surgery no longer are considered diabetic within a few years) however they don’t know how big a role weight loss plays on it. I have seen a study where obesity surgery was performed on normal weight people who had type II diabetes, and despite losing little/no weight their diabetes cleared up. So the surgery could be working to treat diabetes by manipulating people’s endocrine systems.

There was a study recently that caused a lot of controversy. The CDC studied it and found that while an extra 112,000 people a year died due to obesity (BMI of 30+), around 86,000 avoided death because of the health protective benefits of being overweight (BMI 25-29.9). Paul Campos talks about this in his book ‘the obesity myth’ (renamed the diet myth) that being slightly overweight (but not obese) could actually be the ideal weight for health.

http://healthfullife.umdnj.edu/archives/weight_archive.htm

I think a huge objection the health at any size movement (which I would consider myself a member of) has against the obesity wars are based on a few things that should be considered in any argument about obesity:

  1. Intolerance of obesity causes psychological harm to people (depression, anxiety, low self worth, alienation). Fear of getting fat is also a major reason people take up smoking and refuse to quit. At the same time, the medical community seems so obsessed about this issue that other important health issues do not get the airtime they deserve because we are so busy talking about this endlessly.

For example, there are endless stories and studies on obesity being correlated with CVD or Alzheimer’s, but having good oral hygiene and flossing can decrease your risk of CVD and Alzheimer’s. The argument is that poor oral hygiene can lead to bacteria and inflammatory chemicals in the mouth leaking into the bloodstream where they damage the brain and cardiovascular system.

http://www.healthnews.uc.edu/publications/findings/?/6737/6795/

But how many people know this? Since the majority of health info the public is given is about obesity, useful info like this never gets any airtime. The media and medical community are so obsessed with obesity that nothing else of importance is discussed wrt health.

So if we are going to talk about the health risk of obesity, we should also talk about the health risks of intolerance to obesity (psychological problems, smoking, obsessing over this issue taking sparse airtime and attention away from other health issues, obsessing over treatment of obesity takes time and attention away from more effective interventions for CVD, cancer, diabetes, etc). Many of us who share these attitudes feel the medical community has been hijacked and used as a tool to promote fashion. If we weren’t a society that was socially terrified of bodyfat, this issue wouldn’t be nearly as big as it is now. Poverty has tons of health problems associated with it. If there were a nation made up solely of the characters in the movie American Psycho, people with a visceral fear of poverty, then the medical community would probably devote 50%+ of all their airtime and public service announcements to combating poverty. Instead we are a society terrified of obesity, and as a result that is all we hear about.

  1. Even if obesity in and of itself is a risk factor for various health problems, there is no effective cure. Polypharmacy is iffy, and surgery kindof works but not everyone wants surgery and it is not a guaranteed cure (I think the long term success rate is 50% or so, I’m not sure). It would be far easier to address these health problems by treating them in ways that do not involve weight loss. If obesity increases your risk of type II diabetes, then eating more soluble fiber, getting more magnesium and vitamin D, basic exercise and eating breakfast each day (all of which can lower your rates but will not dramatically change your BMI) would be more effective and have higher compliance rates than long term massive weight loss (which has a compliance rate of lower than 5%).

This is probably more of a debate issue. But to answer your question

“Is obesity an independent health risk”

The answer is long and preachy. But here you go:
Your weight can have health risks, but they are mostly exaggerated because we live in a society that latches onto any excuse we can find to demonize bodyfat. Even when weight is a factor in health, so are about 100 other things in life (social life, stress, oral health, nutritional status, environmental toxins, etc). Being extremely thin is unhealthy, and being slightly overweight can have health benefits. Either way, we don’t know how to make people lose large amounts of weight and stabilize at those new bodyweights with current technology (short of surgery). So saying obesity is a health risk is meaningless if we can’t change it.

Even if/when obesity does have health risks, since we have no truly effective interventions for it we should focus on ways to improve health that have higher rates of compliance (medications, basic lifestyle changes, etc).

10

You probably won’t get a decent distillation of thousands of articles on the topic here.

Lumping all fat people into a single group is problematic; some fat people don’t have morbidity-causing conditions typically associated with obesity, and they are going to do just fine.

In short, it is possible to be fat and pretty healthy, with a good chance at a long life.
You can also be skinny and about to crump.

You can have some diseases (diabetes, hypertension…) which are associated with a truncated life span, and the control of which will lengthen lifespan and diminish morbidity. In obese folks, losing fat has been shown to improve those conditions.

But if your particular genes allow you to be fat–not morbidly obese, but just good old fashioned plump–then you are one of those lucky ones who gets to be fat and healthy. And there is such a group.

I have a sibling who is quite fat. All of his physiologic paramaters are normal. It’s not likely making him less fat will improve his longevity.

I’m not so sure about the notion in the OP link that fat people, on average, live longer. Here’s a link to an (older, but probably still accurate) article suggesting that various studies which suggest that do not take into account certain variables.

“The presence of these biases leads to a systematic underestimate of the impact of obesity on premature mortality” http://jama.ama-assn.org/cgi/content/abstract/257/3/353

11

Your weight according to the BMI doesn’t mean much for the individual. But there are definitely risk factors associated with being underweight, ‘ideal’ weight, overweight, obese, and morbidly obese. This doesn’t mean you can look at any given person and make assumptions about their health based on what their body looks like. There are people out there who weigh 400 pound who have perfect lipid profiles and no health problems (I know one).

I am underweight and at last testing was found to be ‘optimal’ in everything. I never even get colds. But plenty of skinny people I know are sickly… mostly because they don’t eat well and exercise IMO.

Now, body fat percentage means quite a bit. However BMI doesn’t accurately predict this. Mine was found to be 19% both when I was 90 lbs, and 102 lbs (15 BMI, 17 BMI). A quite ‘fat’ person can have 22% bodyfat, a very slim one 34% bodyfat.

This is known as the ‘skinny fat’ phenomenon. IMO all this focus on BMI gives naturally thin people an excuse to neglect their nutrition and general health, because we assume people that looks slender are ‘healthy’.

12

The link you posted says no such thing. it was a study on using surgical weight loss for glycaemic control. nowhere does it say that being overweight causes you to be insulin resistant.

13

The problem is that being “overweight” is not really a scientific term. As BMI indicates only height and weight, it is not always a good indicator of the amount of fat in your body or your health.

There is some science to indicate that being slightly (just a few pounds) overweight may have health benefits and likely does not increase your risk of heart disease, and that weight alone is not a good indicator of overall health. In other words, having a bit of excess body fat alone may not be health problem if you are not affected by other symptoms (e.g. blood sugar issues, problem cholesterol levels, snoring, hypertension). Your doctor should give you more information about what BMI is healthy for you, especially if you are one of the outliers (e.g. being of Asian descent means that a ‘normal’ BMI may still indicate you are overweight, being very muscular generally means your BMI will be off, etc.).

Of course, that doesn’t mean that true obesity, in particular morbid obesity, isn’t very bad for your health. Severe obesity (40+ BMI) lowers life expectancy by about 20 years in men and about 5 years in women (congrats, ladies). Obesity has been shown to increase your risk of many ailments, including cardiovascular disease, diabetes, and cancer in some cases.

If you would like to know of your risks, it is best to contact a doctor. Chances are, a full physical is going to tell you a lot more about your individual health needs than just going by the scale.

14

To add a little bit of information here…

The medical culture is very anti-obesity and for good reason. Significant obesity has a number of significant health risks. If you go to the doctor with a cough and you smoke, the doctor will say something. Likewise, if you go to the doctor with chest pain or sleep apnea and you’re significantly overweight, the doctor can and should advise you to lose weight.

Sadly, doctors are people just like everybody else. I have personally encountered, and have heard from others, of shockingly rude doctors who were unwilling to provide ANY treatment to someone other than just to lose weight (unassisted). For example, I know someone who is about 10-15 pounds overweight, is already on calorie restriction and working with a personal trainer, and was turned away for any treatment of her back pain by one doctor. Said doctor was contemptuous of her for being overweight to begin with and told her she was stupid for even thinking there could be any cause of her back pain other than her weight. Another doctor actually helped her. In short, there are just some bad, unempathetic doctors in the world. If your doctor is one of those, find a new doctor.

Don’t get me wrong: a lot of people can be very healthy and be visibly fat. As I said, being fat alone is not a perfect indicator. If you eat right and work out six times a week but are 50 pounds overweight, you may very well be more healthy than the guy who is perfect BMI but never exercises and lives on Cheetos. Doctors sometimes forget that. Unfortunately there are a lot of big people who are in denial, too. If you are very overweight, you shouldn’t wait until you’re actually diagnosed with heart disease or you wear out your knees, and you shouldn’t ignore the risks.

15

The literature describing a link between obesity and type II diabetes is such an extensive one that I’m not going to bother recapitulating it here. It’s in plenty of textbooks, and here’s but one example:

From Robbins and Cotran Pathologic Basis of Disease, Professional Edition , 8th ed (2009):

The more compelling causational experimental evidence relating to directionality (is type II DM the cause or effect of obesity?) is more recent but plentiful.

To sum up, not only is obesity very strongly associated with diabetes, when obese people stop consuming so many calories, the diabetes goes away.

To get back to the OP, if you could solve the problem of people being overweight, you could solve the majority of the dreadful consequences of diabetes, and for some people, those consequences are indeed dreadful.

Strokes, blindness, kidney failure, heart attacks, limb amputations, neuropathy, etc.