Is society’s attitude towards obesity a problem? Yes, I believe so.
Is it more dangerous than obesity itself? Hard to tell, despite the scenarios depicted and the numbers crunched in the OPs.
<slight hijack> In my job as a lung cancer doctor, I deal constantly with patients who are smokers or “in the process of trying to quit” when I first see them. Because there is evidence that people who continue to smoke during treatment have a significantly lower success rate, I feel morally obligated to inform the patient up front why I think it is important they quit as soon as possible and tell them what sort of help is available. You can feel the embarassment and defensiveness in the room when I initiate this discussion, no matter how quickly I indicate that this is not about assigning blame but about trying to give the patient the best possible chance of success with treatment. <end of slight hijack>
So, getting back to obesity & attitudes: So just like with smokers who get lung cancer, obese patients who start to develop related health problems will understandably feel defensive or nervous about interacting with health professionals. The health professional hopefully will put the focus less on dropping weight and more on improving lifestyle.
OTOH, health professionals are only human, and it is hard not to share the societal attitude that fat = lazy or undisciplined, especially when it is our job to help patients take care of themselves and so often they admit that they haven’t been willing or able to follow the advice given.
Wow Wesley, congratulations on your assessments of the situation - you’ve obviously thought long and hard about this societal issue, and you’ve addressed it with both intelligence and compassion for those who are physically and psychologically suffering from the problems that arise from obesity.
Is society’s attitude to obesity more dangerous than obesity itself?
This is an extremely complex question. From what I see and read, I don’t think that medical science fully understands all the ins and outs of the problem as it affects individuals - genetically, psychiatrically, biochemically, hormonally, anthropologically, and so on. I also think that there is a lot of misinformation and misunderstanding being perpetrated upon the public with regard to diet, body size and health - non-scientifically trained journalists picking up on experimental studies without understanding the statistical siginificance (if any) of said study, and so on - so the public has a whole set of ideas in its collective mind about the obese.
And then, of course, obesity is a very visible condition - you can’t hide it, unlike say being a smoker, or having diabetes, or having bipolar disorder, when you’re in public. So then people have every opportunity to judge you for it based on their preconceptions.
I think that an overweight person who exercises and eats well is going to be healthier than a thin person who eats crap and doesn’t exercise. But if you see a fat person, you won’t know by looking at them that they actually lead a healthy lifestyle, and people judge by appearances, so…
Where did you 2% get from? If you are deducing this from your links, then you’ll have to clue me in to how your deriving this percentage.
I’ve already pointed out the flaw in concluding that the desire to stay thin has anything to do with smoking initiation among youth, just on the basis of the data you cited. There are confounders that need to be controlled for before you conclude anything substantial about any association. Another confounder to think about is the fact that white kids are significantly more likely to smoke than black kids. Whites are also more likely to report feeling pressure to attain a skinny physique than are blacks. What does this tell us? If the smoking you linked to did not control for race, then the results may be confounded. These are the kinds of questions that need to be considered before drawing any conclusions from correlational studies.
Smoking cessation is a different issue than smoking initiation. Who knows how many don’t quit because they are afraid of getting fat? It may be a lot of people, but that cite is not the kind of evidence we need to reach that conclusion. A simply survey asking people why they don’t quit (and why they started, for that matter) will get you the kind of answers you want.
Just looked at the smoking initation study again and it looks like they did control for race/ethnicity. So at least we know the results of the study weren’t confounded by ethnic differences. The abstract didn’t mention anything about adjusting for socioeconomic level, though. That’s another potential confounder, which might even be more important than race.
Did you include the gains earned from prevention in your analysis? The war on obesity also includes arming the public with the tools to prevent unhealthy weight gain. Keeping weight off is a lot easier than losing it. How many people have managed to stay a healthy size because of society’s increasing emphasis on our weight problem? These people should also be included in your total of lives saved as well.
It may seem like I’m being overargumentative, Wesley. But I’m just posing questions to you that any public health scientist would.
2% comes from the fact that 400,000 people die of lung cancer annually. If 2% of those smokers (8000 people a year) start smoking or refuse to quit over fear of getting fat than our fear of fat is automatically killing more people than the fat itself. Since one of the articles I listed showed girls highly concerned with thinness were 4x more likely to smoke (this is not a direct correlation, but there is some connection between the two) and that fear of getting fat is a major concern for people when it comes to quitting smoking it wouldn’t suprise me if that 2% figure is obtained in real life.
I know you’re not being argumentative, neither am I.
The problem you with the face is that most deaths only occur in the most obese 8% of the population. The new CDC study shows that 73% of deaths (82,066 out of 111,909) are tied to bodyweight are among those with a BMI of 35 or higher, and they are a tiny minority. So encouraging weight loss across the board makes no sense when its only the most obese 8% of the population that has any real health risks. And these health risks can probably be fixed more competently by encouraging healthy diet and exercise independent of whether they lead to any weight loss.
Also, preventing people from gaining weight keeps them out of the ‘overweight’ category (BMI 25-30) which according to the CDC study offers multiple health benefits. 86,095 lives are supposedly saved a year because someone has a BMI of 25-30 instead of 18-25. So by keeping people thin you are keeping them out of the 35+ BMI range, but also keeping them out of the 25-30 BMI range. So at the end of the day its probably not statistically relevant one way or the other.
The 2% figure also comes from the fact that only those with a BMI of 35 or higher seem to be at any health risk. Since 82,066 people a year with a BMI of 35 or higher die annually, and since our best non surgical interventions can only make 10% of people lose weight and keep it off then only 8,206 lives a year can be saved by the war on obesity, assuming we only target those with a BMI of 35 or higher for weight loss. That is also assuming that yo-yo dieting doesn’t cause unhealthiness, and that we’d have a compliance rate of 10% (long term success rates for weight loss vary from 2-15%, so I picked 10%). This also assumes that lowering BMI automatically gives the health benefits of having a lower BMI across the board in all areas (cardiovascular disease, cancer, diabetes, etc)
Its controversial at best to think losing weight will improve your health. You can read the book Big Fat Lies if you want more in depth science on the subject. There is an entire chapter on the subject of weight cycling (aka, losing weight and gaining it back which describes 95% of dieters). According to him and Paul Campos there are about 15 studies showing it is unhealthy to lose weight and about 3-4 showing it is healthy. So its really not known right now.
I really don’t know though. I do know some studies show weight loss increases death risks, some say it doesn’t. I honestly don’t know if any studies show that weight loss is actually beneficial in and of itself though. There may be some though, and it wouldn’t suprise me if there were. But as I said, its controversial and unreliable at best to assume that losing weight increases health at this point. There may be studies on people who had gastric bypass surgery which have been doen. I did find this though
“Short-term weight loss has been shown to have beneficial effects on diabetes and cardiovascular disease. To date, there have been no randomized trials on the benefits of long-term weight loss because of the difficulty of achieving and maintaining weight loss. The study has a budget of more than $180 million.”
That report by Gaesser ties into several studies showing losing weight is unhealthy. Gaesser wrote the book ‘big fat lies’ and has been researching the subject for decades.
Plus you have to consider that those in the 25-30 BMI range had lower mortality rates than those in the 18-25 range. So encouraging them to lose weight for health reasons alone makes no real sense. We should (if we are forced to encourage weight loss, which to me seems destructive) only encourage it in those with a BMI of 35 or higher.
There are some health benefits, as the article says diabetes and cardiovascular health improves. However, it is feasable that the health benefits are either wholly or in part due to the healthy habits picked up as a means of weight loss and not the weight loss itself. A recent study
If you read the book Chunk to Hunk Fred Anderson started the book with a BMI of about 51 (I think he was 5’11" and 371) and a blood sugar level of about 180mg/dl with two diabetes drugs. After he adopted a healthy eating pattern and started exercising his fasting blood sugar dropped to about 60-80mg/dl. However even though he lost a reasonably small amount of weight (BMI wise) his blood sugar dropped to 80 (even though he quit both of his diabetes drugs) when he was still about 330-350 pounds, with a BMI of about 47. So even with a BMI near 50 he got his diabetes under control via diet & exercise.
This is the study often cited that 5-7% of weight loss can decrease diabetes risk by 58%. However the subjects had a high BMI to start (I can’t find the statistics, but Paul Campos said their BMI before the study was 34 on average). Their 5-7% weight loss only dropped their BMI to 33 so in a way it shows that weight is not coorelated with lowering diabetes risk nearly as much as healthy diet and exercise, since the subjects in both situations (Fred Anderson’s situation and the subject I just listed) since people drastically dropped their risks while still being signifigantly overweight.
To truly test the idea you’d have to have 2 groups of people, one who lost a small amount of weight through healthy eating and exercise and one that lost a small amount of weight through eating pizza, nachos, pepsi, etc and not exercising (but still cutting out 300 or so calories a day to cause weight loss) and comparing the cardiovascular and diabetes risks in both groups to find if the weight loss itself was what improved their health and not healthy habits.
On top of that you have to consider that the study I listed above (however it was just one study, there may be contradictory studies) showed that individuals who feel healthy eating and exercise are tools for weight loss (which is what alot of doctors recommend to their patients for diabetes, to eat healthy & exercise with the expressed goal of losing weight) cuts compliance rates from 92% down to 58%, and results in no changes in activity levels compared to those who are taught healthy eating and exercise are good goals in and of themselves who quadruple exercise rates.
The current attitude results in stories like this one, where weight loss is indicated when it is clearly not appropriate. Pregnant women should not be told to lose 8 k. Losing weight is associated with passing ketones, and that has been associated with various birth defects. Also there have been studies that show long term lower health for babies whose mothers did not gain weight in the last trimester, regarless of their weight going into the their trimester.
The current Scientific American has an article about obesity. One of the things it highlights is the poor construction of most of these studies. It has bothered me for a long time that weight studies always seem to control with a group of people who just happen to weigh what they think is a better weight than the experimental group. A better control would be a group that managed to lose weight. Or maybe also compare a control group that stayed fat and ate a better diet and exercised. They just are not testing for if weight loss would help; they are testing for if being thin all along would be better.
The recent mypyramid nastiness from the CDC once again made me wonder if this whole emphasis is not only desire for profit and power, but also misogyny. There are controls for sex, activity, and age. It does not have a control for pregnancy or breastfeeding. It certainly would not have added much more complication to the calculation. I know from experience, that at the end of pregnancy I needed 2300 calories to gain weight as recommended. It would have allotted me 1800. Surely the CDC is aware of both pregnancy and breastfeeding and understand that they alter caloric need.
Wes, you are wrong when you say that only those with BMI over 35 are at health risk. BMI’s over 30 are significantly worse off in mortality rate than those 25 to 30. And morbidity (association with diabetes, htn, etc.) has a linear association, even if it is treated well enough that it does not effect mortality rates.
That out of the way, I mainly agree with you. The focus really should be on the kinds and amounts of foods we eat and the excercise we engage in, not on the scale. BMI is a cheap screening tool, and in this case, you get what you pay for. The numbers were chosen because they were easy to remember cut-off points.
But obesity interfers with the ability and willingness to engage in excercise. It interfers with quality of life for many. And few who regularly engage in regular moderate to intense excercise and who eat a diet full of whole grain foods, fruits, veggies, and lean protein sources will be obese … have BMI’s 25 to 30 sure, but not over 30. So if nothing else, it is a marker that lifestyles may need to change.
I don’t know for sure about the mortality risks of those about 30. The new CDC report says only those with a BMI of 35 or higher are at any real risk of dying, people in the 25-35 range don’t seem to have very high mortality risks just due to their weight.
I suppose its fair to say that those who eat a healthy diet and exercise will be less likely to have an extremely high BMI, but a good amount of lowering of the BMI in someone who takes up a new lifestyle may indicate an overly restrictive diet or a ‘forced’ exercise regimin, which will cut compliance rates. Plus as the two studies I listed show (the one about cutting diabetes risk by 58% and the one in my OP about treating diet & exercise as ways to lose weight vs goals themselves) showed either no weight loss or only a 5-7% weight loss. However how intensely they changed their lives is not known, but an overly restrictive diet change that leads to alot of weight loss will probably cut compliance rates.
Obesity does interfere with quality of life, but that is because obesity is condemned. It seems that condemning obesity in and of itself is a bad idea medically and socially. Its role in preventing exercise is also due in part to our attitudes towards obesity, not the obesity itself.
And those options can be exercised in addition to an active weight loss program. Any good doctor will provide input on effective diets and exercise routines. Most don’t just tell people to lose weight. You are arguing that doctors do things that I doubt most would do. Even those that may not provide adequate assistance aren’t necessarily doing anything wrong. If you expect doctors to act like your friend and psychologist then you are bound to be disappointed. Most doctors aren’t going to thoroughly explore the reasons many people overeat. It’s just not practical. It’s not about the food for many overweight people. It’s also not a doctor’s job to try to find whatever issue that person is having beyond giving them sound medical advice. Eat less, exercise more is pretty sound advice.
Who is bypassing all other solutions? Overweight people with a variety of ailments are given drugs, surgery, etc. in addition to advice to lose weight. Plus, you can’t separate weight loss and exercise in the manner that you did. Exercising means you will either lose weight or not gain weight (at the same rate)if you maintain the same diet. I don’t understand your beef with doctors giving people sound, succinct advice. Yes, fat people don’t follow it, most others don’t either. That’s my real problem with your argument. While it’s hard to lose weight based on your statistics, it’s apparently also hard to take a pill(s) everyday correctly (according to statistics alone). Allow me to quote this article:
Apparently, people don’t listen to doctors across the board. At least 66% of people don’t take medicines prescribed by their doctors correctly. Should we change the way we prescribe medicines to people? If only 33% of people can follow the simple directions on a prescription bottle, I consider the percentage of people that can do something as difficult as losing weight encouraging.
The belief that you can get people who don’t care a great deal about their physical health, to care, by shifting societal attitudes about their affliction is unsubstantiated at best. Smoking being an example of something that does not follow your hypothesized model.
Encouraging smoking? Don’t you think many people are using that as an excuse. Many studies have shown that quitting smoking is often as hard as quitting illegal drugs. Would you believe a cokehead who said he didn’t quit because he was afraid of gaining weight? I’m not saying there aren’t people who feel this way, just that many of them are fooling themselves.
I think that 2% is unproven and highly speculative. Besides, to gain a full understanding of the effects our attitude toward obesity has, we would have to know many things we don’t know. First, does treating obesity the way we do prevent people from being fat, and if so, how many? Second, does it prevent overweight people from becoming obese, and if so, how many? Third, how does it effect obese people? Does it make them gain weight, maintain weight, or lose weight? Many of these things would be hard to determine. Your proposed shift may result in less of a stigma attached to being overweight, and more people being fat. One reason why I think it’s good to have some stigma attached, is that most people maintain an acceptable weight by eating well and exercising. One’s weight has a strong correlation to one’s overall physical health (at least that which you can control) and their attitudes toward food and exercise.
Come on Wesley. I would never suggest that obese people are less intelligent or motivated, which is what you seem to be implying. I’m sure they are as intellectually gifted as everyone else. My contention was that many (a disproportionate amount) are lazy. They are disinclined to activity or physical exertion. How many (true) obese athletes are there? Most people gain weight because of lack of exercise and poor diet. That doesn’t make them bad people worthy of scorn, but let’s be honest.
I’m sure many of the 66% of people who don’t correctly take their medicine are doctors and politicians. Any rational person recognizes the logical fallacy that “you have to be something to speak on it”. A fat doctor is just as capable of giving you good health advice.
Restrictive and controlling are in the eyes of the beholder. Usually, they are applied to things you don’t want to do. Healthy eating and exercise lead to weight loss the majority of the time. Pretending as if they are unrelated is dangerous. There is clearly a cause/effect relationship there.
First, let’s get one thing straight, OBESITY IS A BAD THING! There is no argument about that. While you see our attitudes causing people to not lose weight, I think of it as 8,206 individuals deciding to do what’s necessary to become healthy. Also, as I mentioned before, our attitudes certainly prevent plenty of people from becoming overweight/obese.
Re-read my last post on this.
This doesn’t really mean anything. Do normal sized mice have the same MSH-Diabetes relationships. This study only proves what has been known for a while, that genes and hormone levels can predispose or elevate one’s disease risk.
Where is the problem here. The “lazy” Pima are fatter and have more diabetics than the “hard-working” ones. That’s what we would expect. Of course, it appears that the Pima genes pre-dispose them to some things, but that doesn’t mean the physical activity has no effect. I’m not arguing that fat people become fat, and have the accompanying problems, solely because of their diet and lifestyle. There are many factors that people probably give short shrift to.
First, it is not clear that shifting attitudes would improve the situation any. It may result in more obese people. The rest of the conclusions you’ve drawn are unsubstantiated for many of the reasons I’ve already discussed.
It’s not the best WE can do, it’s the best THEY (each individual) can do. As I stated before, 10% is not out of line with the percentages of people that are able to follow other medical advice, or modify other dangerous behaviors. It may, in fact, be the most we can hope for.
If your hypothesis were true, smoking rates should be astronomical. Smokers are regularly demonized. They are basically extorted out of money and forced to isolate themselves while smoking. Now, some are even being fired because they smoke. All of this regulation and castigation should, according to your model, cause more people to smoke, and make it harder for smokers to quit. However, it has not. The more we demonize it, the less people smoke.
Another example is pornography. As society has becomes more tolerant of pornography, more of it has been sold and produced. It has become a 10 billion dollar industry because of society’s acceptance of it. To quote this CBS article:
Because society is more accepting of porn, more people buy and use it.
However, one could argue that the growth in the volume of illegal child pornography would lead one to believe that society has become more tolerant of it (which I doubt it has). My point being that you can’t necessarily attribute the incidence of something in society with societal attitudes. It’s much more complex than that. To reduce such a complex manner in the way that you have is misguided, and to suggest that our attitudes are worse than obesity itself is dangerous.
I can’t back up the idea that physicians ignore other medical interventions in favor of ‘lose weight’, it is just an assumption at this point.
Your argument that obesity is dangerous makes little sense to me though.
According to the new CDC statistics 82,066 of the 111,909 people who died of being overweight had a BMI of 35 or higher. That leaves 29,843 who had a BMI of 25-35 who died as a result of their bodweight. However having a BMI of 25-30 saves 86,095 lives a year according to the study, so add all those numbers together.
Consider that only 8% of the population has a BMI of over 35, and that about 67% of the american population is considered overweight or obese. Since only those 8% of the american population (or 12% of those considered overweight or obese, aka 8/67) have a BMI of 35 or higher and that those in the 25-35 BMI category have lower mortality ratings than those in the 18-25 BMI range that means that 88% of people labeled overweight or obese have lower mortality risks due to their weight than those in the ideal 18.5-25 range
So why is obesity dangerous if 88% of overweight/obese people have lower mortality risks than those in the ideal BMI range that we are supposed to encourage people to have a BMI in? Only the most obese 8% of the population is at any legitimiate health risk, but so is the most thin 10% of the population too. Being overly thin is tied into osteoperosis, anemia, certain cancers and cardiovascular damage, its common sense that the heaviest or thinnest minority of the population may have health risks due to their weight. If we did have a ‘healthy’ BMI range it would probably and should probably be from 18.5-35, anything below 18.5 and above 35 would be considered risky with everthing in between largely irrelevant to health. Even if we did promote weight loss in those with a BMI of 35 or higher this again also assumes that losing weight isn’t unhealthy, that doing it promotes health, and that we know how to do it, and each of those claims is controversial at best.
Your article about patient compliance was interesting, however that is the same point I was making. By teaching weight loss doctors manage to lower compliance with healthy diet and exercise regimes according to the study I listed above. I don’t see how what you said is different from what I said. If 66% of people don’t take their medicines, and promoting ‘X’ raised that level to 85% then many people would clamor to tell doctors to stop promoting ‘X’ since it lowers compliance rates. That seems to be what happens with obesity and weight loss. Promoting compliance with healthy medicine is good, that is what i’ve been saying all along and one of the main reasons why I don’t support the war on obesity.
As far as the smoking thing, as I said you only need 2% of the population to start smoking or refuse to stop to nullify the mortality benefits of the war on obesity, assuming we fight the war on obesity the smartest way possible by only targeting those with a BMI of 35 or higher (which we aren’t). This also assumes again that losing weight doesn’t increase mortality, that we can do it in 10% of the population and that losing weight increases health, all of which are controversial assumptions.
If a girl highly concerned with thinness is 400% more likely to smoke than a girl who doesn’t care about thinness and you only need 2% of smokers to start or refuse to quit due to an obsession with thinness then why is that 2% remark so controversial?
Again, you only need 2% of the population to take up or refuse to quit to nullify the health benefits of the war on obesity.
I will agree that only a small minority of athletes have high bodyfat percentages. However most atheletes of that level devote huge chunks of their physical and mental energy into their chosen sport, putting in 15+ hours a week of training. That is not something most people care about when they have families, hobbies, friends, etc (although I admit you don’t need 15 hours a week to get thin and stay thin, 5-7 is probably enough). I have a friend in San Francisco and he is constantly suprised about how the radical left there will ally themselves with the islamist fascists in the area. The radical left promotes human rights, promotes democracy, dislikes racism, dislikes sexism, dislikes antisemitism and promotes seperation of church & state. However despite all that they ally with the radical islamists in the area to protest US military action even though the islamic fascists oppose all the values they believe in.
The same can be said about the attitude that if a person had a really healthy diet and exercised that they’d be thin. Its true, but its a level of self control that would require would cause all but the most extreme libertarian cringe if placed in a different context. It is suprising to me that people who would oppose ending social security, ending universal healthcare access, ending funding for education and ending the minimum wage are in favor of the idea that a fat person should devote huge chunks of their mental and physical energy into being thin and that if they don’t they are lazy. The reality is if people put 15% of their income into funds they woudn’t need social security. If people got jobs that payed more we wouldn’t need a minimum wage laws or any kind of universal access to healthcare. If people educated themselves on crime and defended themselves we wouldn’t need police. So I agree its possible, but the level of self control required would make all but the most radical libertarian uncomfortable if you placed that level of chronic self control and ‘personal responsibility’ in another context. If you read the book Chunk to Hunk I listed above, the only reason the author succeeded was because he had the mental discipline of a buddhist monk and used an endless amount of nouveau psychology tactics to change his value system. Its bothersome when people who live in a society of minimum wages, police presence to protect them from criminals, universal healthcare, education funding, etc complain about fat people being lazy for not losing weight and keeping it off when they/we are having our hands held everyday by the government.
The reality is there are only about 3 groups of people who can consistenly lose weight and keep it off. People who are genetically thin, people who live in environments that require large amounts of exercise and have a bland, low fat, high fiber diet, and people who have gastric bypass surgery. Consistently the only people who can lose weight and keep it off are those who have their free will on the issue taken away either by having genetics that don’t permit fatness, an environment that doesn’t permit fatness, or a digestive system that doesn’t permit fatness. However when a person’s genetics, environment and digestive system permit fatness then fatness occurs all across all class, gender and racial lines. Men can’t lose weight and keep it off, women can’t, the poor can’t, the wealthy can’t, high school dropouts can’t, people with doctorates can’t, blacks can’t, whites can’t, etc. Only those who have their free will taken away are consistenly able to stay thin.
As far as shifting attitudes, I don’t see why it would hurt. To assume that everyone would jump to a BMI of 35 is unrealistic since the body has homeostatis mechanisms. Some people who are overfed have their metabolisms speed up, some do not.
Plus there is a group called ‘overcoming overeating’ that is comprised of women who used to diet constantly and who gave up overeating and focused on just allowing themselves to eat what they want. Their BMIs did not all shoot up dramatically, according to Laura Fraser (who wrote about them in her book ‘losing it’) about 1/3 lost some weight, 1/3 stayed the same and about 1/3 gained weight. Considering that about 67% of the population is already overweight or obese why would it get worse? And why would it matter if health risks don’t seem to occur unless your BMI is 35 or higher (meaning you are about 100 pounds overweight)? Do you really believe that huge chunks of the public have the genetic susceptibility to have 120 pounds of bodyfat?
And again, compliance rates with healthy diet & exercise are low, but our obsession with thinness seems to make them even lower. Which is one of my main arguments for not obsessing on thinness. And again, as far as smoking, smoking is an actual health risk. Obesity is not a health risk until you get to be about 100 lbs heavier than average. So there is no real medical reason to support the war on obesity since most people aren’t genetically able to become 100 lbs overweight and stay there. Overfeeding studies show forcing people to become heavier than they naturally would be is as hard as forcing them to be thinner than they naturally would be.
Do you trust CDC Director Dr. Julie Gerberding who said, “there’s absolutely no question that obesity is a major public health concern of this country”. There is really no debate on that point in the scientific community. How dangerous it is is an ongoing debate, but not whether it’s dangerous.
All of those 111,909 deaths were for people with a BMI of 30 or above. Of those, 82,066 were extremely obese (BMI over 35). That leaves 29,843 with BMI between 30-35, not 25-35. Big difference. Plus, the health benefits are for people who are modestly overweight (25-29.9), not obese. We are talking about obesity, not being modestly overweight. Doctors don’t tell people who are modestly overweight to diet unless they have personal concerns.
Where are you getting these statistics? Besides, you fudged your numbers. If 8% of people have a BMI of 35 or above, that makes them extremely obese. The obesity cutoff is 30, not 35. The 67% you mention is of people who are overweight (25-29.9), people who are obese (30-35), and people who are extremely obese (35+). You are lumping in people who are overweight with people who are obese. That isn’t statistically accurate. The health benefits only apply to those who are modestly overweight (25-29.9), not those who are obese. Again, this thread is about obesity, not being slightly overweight. I want a cite on your last statement. I would bet that that is not true. Every cite I have found has said that overweight (25-29.9) fair better than underweight people (below 19), but not people of normal weight.
Once again, you can’t lump obesity with overweight. You are also forgetting that the guy with a BMI of 33 is well on his way to being extremely obese. Doctors also speak to people about being underweight, but that is not nearly as common.
First, you assume the successful patients, or those who lost weight by viewing it positively, did so because of something their doctor said. Second, your opinion of how doctors treat obesity is really far off the mark.
Why do you keep repeating this statistic. You admit the smoking thing is tenuous, yet you keep stating it as fact. Roughly 10% of obese people manage to lose weight permanently (right). That doesn’t mean 90% of people go on to die form their obesity. The picture isn’t that bleak. Plenty of them die of everyday things. Obesity doesn’t kill 100% of the people who don’t lose weight, it increases their risks of dying. The reason why we don’t wait until people have a BMI of 35+ is that we practice preventative medicine. We wait until someone is in the danger zone to act?
Also, the number of tobacco deaths is grossly inflated in the same ways the obesity statistics were.
You are combining two sets of data into one. Two percent of people who don’t smoke equals (in the US) (smoking data PDF)
[300 million- # number of people who smoke (21.6% of 300m)] x .02 =
4.7 million people.
Two percent of smokers equals
(21.6% of 300m) x .02 =
1.3 million people.
Keep in mind that the WHO estimate the number of smokers at 45 million and not the 64.8 million I used. That would skew the number even more in my direction.
Is there a point to all this?
Because it’s hard work. Nobody will argue that it isn’t hard, that’s why an attitude shift won’t really do much.
No but people at 33 might hit 35 and people at 29 might slide to 33. Either way, there is no real way to tell what the effect will be.
It’s not susceptibility that accounts for people being over 100 pounds overweight. You have to eat insane amounts of food to gain that much weight.
Moderate occasional smoking is not a significant heath risk. It’s frequent smokers who are at highest risk, just as severely obese people are. Where is the cite for that last claim.
Brick is correct Wes. Your numbers are just wrong.
“Extremely obese” (BMI > 35) is very bad. They are a fairly small percentage of the total population yet represent a huge share of the mortality associated with excess weight.
“Obese” (BMI 30 tp 34.9) is also asociated with significant mortality and morbidity. Less than previously estimated but significant. This group is a greater percentage of the population than the extremely obese (about 20%) yet have less impact on the mortality rates.
So-called “overweight” (BMI 25 to 29.9) is associated with an increase in some morbidities (diabetes, htn, etc.) but a decrease in overall mortality. Subtract out the decrese in mortality associated with being “overweight” and you reduce the impact of “overweight and obese” on mortality rates dramatically. They represent about half of the US population. I would posit that they should be called “normal”.
Decreased quality of life asociated with obesity is not just the result of prejudicial views by society. The obese inordinately suffer from sleep apnea, osteoarthritis, gallstones, nonfatal heart attacks, congestive heart failure, diabetes, dyslipidemias, hypertension. They are at increased risk for various cancers too.
Some doctors do indeed focus on the scale and weight loss per se rather than lifestyle changes. Most do not. No one focuses on weight loss alone and ignores other interventions. In point of fact one explanation for the decreased mortality in the so-called “overweight” group is that they are being very well treated for their increased morbidity: they take their statins and oral hypoglycemics and antihypertensives as prescribed. So well that they are better off than if they were never labelled with a problem in the first place.
There is no doubt that a sedentary lifestyle full of processed food with its fats and simple carbs and with the obesity that often goes along with it is very bad for America’s health. The false labelling of normal as “overweight” has not helped address this issue.
Reading more of what you have posted gets me more rankled. And you started off so well.
Well I’ve lost about 20% of my body weight and I am not genetically thin (and have the siblings to prove it), am not required to excercise by any one but myself, and I eat anything but blandly. I do excercise a good deal. I do eat high fiber with lots of lean protein, whole grain, veggies and fruit, but no one would taste my cooking and call it bland. Spices are healthy you know … garlic, tumeric … all good for you.
So Ultra, should I be more GDish and just say “cite, please”?
There are dozens of randomized controlled trials (citations available if you insist) on the efficacy of various diets. Policy guidelines prefer “Low Calorie Diets” (LCD) preferably including excercise to increase fitness (the evidence that excercise increases weight loss turns out to be scanty although few studies measure body composition as an end-point) and “lower fat” primarily based on its calorie reduction effect. Personal experience testifies to the fact that low calorie does not mean bland. But tasty low calorie food does require that you do more than rip open a bag or buy from the kiosk or nuke a package.
There are many individuals who make up large populations who are not obese and who are not “genetically thin”, not required to perform large amounts of excercise, and who are not the result of surgical intervention. That particular statement sounds more like fatalistic excuse-making than “data” about populations.
As Brickbacon said, “it’s hard work” to maintain the lifestyle choices of a healthy diet and excercise.* But it is not the case that “only those who have their free will taken away are consistently able to stay thin”, on the contrary, it is only by the application of free will that individuals can resist the inate predisposition to eat past the point of saitity and to resist eating the easily available processed crap, it is only by use of free will that one can drag ones lazy ass out of bed to bike to work instead of driving or to fit in a swim or just to decide to take the stairs today or park a bit farther out from the office when you do not have to.
And making everyone thin is not one of the goals anyway. Treating real obesity is. Improving quality of life is. It was sloppy thinking that lumped BMI’s of 25 to 29.9 in with obesity as “a problem” and it is equally sloppy thinking that continues to lump them and the apparent low mortality of that population with obesity as evidence that obesity aint so bad afterall.
*Truth be told it is starting it that is the hardest part. Once you are in the groove maintaining it has inertia. Like all habits, the more you do it the more engrained it becomes. Its the making it a habit that is the work.
