How does being overweight kill, and why can't I eat more donuts?

Factual Questions
1

I had a health screening yesterday for stroke and heart disease. The screening data included testst for blood glucose, total lipids (HDL LDL and total cholesterol) , and blood pressure. There was also a questionaire to gather some personal and family history of heart disease, smoking, dibetes, etc… The end result of the screening is to give you a percentage of risk for a stroke or heart attack in the next ten years.

I have some factors counting against me, and they always will as they are beyond my control. For instance, my mother died of heart disease, and as a former smoker I will always be more at risk than someone who’s never smoked. (all other things being equal).

On the tests where my behavior could actually affect the results, I did very well. My cholesterol results were especially good - a total cholesterol of 149, and when I saw that, I said something like, “Ooh, I can afford more donuts in the morning”. leading to a protracted discussion with the nurse interpreting the results for me. I explained to her that though I’ve been a junk food junkie all my life, I’ve always had very low cholesterol. Seriously, huge amounts of dairy, peanut butter, fatty meats, cookies, cupcakes, candy – that’s been my diet by and large. I am fortunate in the sense that my body seems able to cope very well with cholesterol busting.

So if eating more donuts does not incur a penalty of increassing my cholesterol, then I can have as many as I want and have no more risk then eating no donuts, At least that was my position. I was surprised that body weight was not a factor in this risk calculation, because it really would have weakened my arguement if it was a factor.

Her arguement was that even if I was right about not affacting my cholesterol, donuts add nothing in the way of nutritional value and aren’t worth the energy spent eating them. What I took from this is that she was implying that donuts were to my diet as a carbon monoxide leak to the air quality in a car. It just slowly and painlessly replaces the good stuff until you’re seriously debilitated or dead.

2

The short answer is we really don’t know how being overweight kills. But there’s been some recent research published that says it’s something emitted by the fat itself that causes problems.

Check out the whole article.

It’s not just high cholesterol and heart disease that kills overweight people. excess fat is also linked to diabetes, strokes, cancer (particularly pancreatic), and other diseases.

And evidence is also clear that being of a normal or even lower than normal weight is the healthiest option in terms of both longevity and quality of life. So it’s important to avoid excess weight (and therefore excess calories). Also, there are many healthy and vital compounds in food that scientists are still identifying. (which is why people kibble is as yet impractical) And even if scientists aren’t sure what the nutrients are, they’re pretty sure they ain’t hiding in the Krispy Kremes…

3

Note the idea that “diabetes is caused by being fat” is a myth.

4

That link has absolutely no references attached and counters everything I’ve ever read on Type II diabetes.

It’s the “chicken-and-the-egg”. Does someone get fat because of insulin resistance or does the fat cause the insulin resistance?

source page

It is true that not every obese individual develops Type II diabetes and that certain individuals and ethnic groups seem to have a greater likelyhood of getting it. That doesn’t mean that the obesity doesn’t contribute to the development of the disease. Type II diabetes can be prevented with the right lifestyle adjustments.

source page

5

I thought I’d point out some stuff that I read recently in the book “The Obesity Myth” by Paul Campos. His premise is that health correlates extremely well to excercise, lack of smoking, and eating a healthy, balanced diet. It does NOT however correlate to weight as an independent variable. Interesting book, worth a read anyway in my opinion.

Anyway I thought I’d offer it to counter some of what was said in this thread.

6

My absolutely unsupported theory is that in a lot of cases, overweight is a symptom, not a cause. Or maybe just wishful thinking…

7

Actually, only a smallish % of obese dudes get diabetes. There is a HUGE difference bewteen “the obesity contributes to the development of the disease” and “obesity causes diabetes”. I think the best wording is that “obesity acts as a trigger in those susceptible”. Obesity does not CAUSE diabetes anymore than exposure to cold wet weather causes a cold or flu.

8

I thought by now the total cholesterol reading was meaningless, only the ratio of good cholesterol to bad cholesterol could really answer the question if you could afford one more donut.

9

Boyo, I am not a nutritionist or a doctor. But I would think that if you are in good general health and getting exercise that you should be able to enjoy a Krispy Kreme donut every morning for the rest of your life – especially with those beautiful cholesterol numbers and no weight problems.

The nurse seems to have forgotten about the pleasures of moderation.

10

Ooh! Can I nominate this for the most ignorant response to a GQ this year? telerama. com?

“*Type 2 diabetes is most common in people over age 40. However, the number of children diagnosed with this disease is increasing. People who develop type 2 diabetes are often are overweight and not physically active. *”
This from WebMD, but if I had the time I could post a hundred others.

This assertion is equivalent to the smoking lobby claiming that not all lung cancers are caused by smoking. True, but misleading. Being overveight greatly increses your chances of getting diabetes. It is not a random selection.

11

Eat the doughnuts. Mmm, a glazed Krispy Kreme . . . I could so go for that. Is the extra 3 days of life you’ll save by not eating another doughnut for the rest of your life REALLY worth it?

12

re: the diabetes (II) and obesity link, I had always had the impression that the eating habits that cause diabetes generally cause obesity as well. Or simply put, in a large number of people that eat a whole lot of sugary foods that may increase insulin resistance, a high percentage of those people end up obese and with diabetes. Obesity doesn’t cause diabetes, it is just a byproduct of the same processes that cause diabetes, overeating lots of sugary foods coupled with little or no exercise (some of the time, there are exceptions of course).

I know two very skinny people with type II diabetes. They ate like crap, but something about them doesn’t store fat well. So while their insulin sensitivity dropped like a stone, they still did not gain any weight.

13

Lamar, not to get into a big flame war with you… :slight_smile: I’m actually a nice, reasonable guy…

But the thing is, I just read this book “The Obesity Myth”, where he debunks a lot of the “establishment” science regarding this and other ideas surrounding obesity. I thought the book was interesting since the author actually went back and read many of the scientific research and saw that it did not in fact support the conclusions being furthered by the media.

Essentially, the key point he makes is that, based on the available evidence, good health (things like longer life span, diabetes/heart disease. etc) are very strongly correlated with eating healthy food and excercising. HOWEVER, weight (specifically, Body Mass Index, a measure of weight/height radio) is not in itself an independent risk factor. That is, when you control for lifestyle (exercise, smoking, diet), you find that heavier people are as healthy or in many cases healthier that light or average people. Additionally, these healthy lifestyle aspects (eating good food, getting a moderate amount of exercise, etc) do not in fact usually cause people to lose weight, even though they do in fact cause health benefits.

I encourage you to read the book if you’re interested in a different perspective on this topic.

14

Are there any heavyweight centenarians? All the ones I have ever heard about were skinny and shorter of stature? If weight were not a factor for longevity, don’t you think there would be an equal number of skinny and overweight centenarians?

15

In general, be very wary of anyone who:

  1. In a pop-science book
  2. “debunks” mainstream science
  3. in a manner that tells people what they want to hear.

That’s not how science works; from a scientific perspective, he debunked nuthin’. The Obesity Myth is therefore not particularly relevant in a scientific conversation about nutrition.

Now, if you want to show us the specific scientific research that appeared in peer-reviewed publications that appears to contradict “the conclusions furthered by the media,” please do so. Until then, I’m apt to consider this guy a hack author out for a quick buck.

Daniel

16

As an economist, I’d be very interested in seeing his regression model and results. My first question would be what is the dependent variable he is using as a proxy for “health”? You can do all sorts of funky things (and get all sorts of weird answers) just throwing data into a statistical package. Is this a peer reviewed work?

17

There was a report in 1998 in the New England Journal of medicine saying the ties between obesity and bad health were tenous. I think its because people assume bad diet, lack of exericse and obesity are all the same thing and assume if people with bad diet and no exercise (who are more likely to be obese as a result) die it is due to the obesity itself. another stereotype that fat people all eat poor diets and never exercise probably helps move the idea along.

http://www.techcentralstation.com/073003C.html

"In an attempt to curtail the now rampant “fat kills” legend, New England Journal of Medicine (NEJM), editors Jerome Kassirer, M.D., and Marcia Angell, M.D. – with 36 scientific references backing them up – argued in two 1998 editions that scientific and medical research did not support the obesity-death link. “The data linking overweight and death, as well as the data showing the beneficial effects of weight loss, are limited, fragmentary, and often ambiguous. Most of the evidence is either indirect or derived from observational epidemiologic studies, many of which have serious methodological flaws. … [T]hat [300,000] figure is by no means well established. Not only is it derived from weak or incomplete data, but it is called into question by the methodologic difficulties of determining which of many factors contribute to premature death. … Calculations of attributable risk are fraught with problems … when several known factors [physical inactivity, low fitness levels, poor diet, risky weight loss practices, and less-than-adequate access to health care, to name a few] are taken into account, it is even possible that they account for more than 100 percent of deaths – a nonsensical result.”

For going against what had become politically correct, the editors were crucified in the media, by obesity researchers, and even former U.S. Surgeon General C. Everett Koop.

Drs. McGinnis and Foege were so concerned that their study results were being misinterpreted they even wrote a letter in NEJM on April 16, 1998, but they, too, were ignored by the media and most of their peers.

Researchers and public officials were increasingly reporting not just that 300,000 deaths were linked to obesity, but suddenly caused by obesity, too. Most, like a study published in JAMA, Oct. 27, 1999, didn’t actually specify what obese people were dying from. But as the author, David Allison, Ph.D., noted, “our calculations assume that all excess mortality in obese people is due to their obesity.”

The “fat kills 300,000” myth was born."