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Unraveling BMI, Overweight, and Health

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Old 10-22-2008, 12:50 PM   #16
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One factor that may be involved in the higher mortality rate of lower BMI individuals is that some of these people are putting their bodies through tremendous stress to remain there if the natural , healthy, genetic "set point" of their body was intended to be a bit higher. This stress may take an effect on the body in the form of a lowered immune system. Even if it is through a good diet (at a low caloric level), and intense exercise, this can take it's toll over the long run.
I think there's something to be said for toll taken by the the mental stress in addition to the physical stress that an individual might also go through if they're trying to maintain a lower weight that their body just doesn't seem to want to be at. e.g. If someone in Amanda's position was trying to get to that BMI of 22. We all know that Amanda eats very healthily and exercises quite a bit. Trying to cut enough calories and increase exercise to lose a lot more weight would be very stressful, and I doubt that would be very good for her either.

Sorry to use you as an example Amanda. I go through the same thing - even when I'm at the top of my goal weight (not that I'm exactly there right now ) I still weigh more than someone of my height "should" weigh. I have to remind myself constantly that if I did weigh 125 pounds, I would literally be eating next to nothing, most likely have to let myself drop a lot of my muscle, and it just wouldn't be sustainable. I'd rather be on the high end of "normal" weight and be able to stay at one weight than yo-yoing all over - much better for my sanity, frankly.

Also, I wholeheartedly agree with what's already been said about how BMI doesn't take muscle mass or body structure into account, etc.
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Old 10-22-2008, 01:15 PM   #17
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Julie - it has been shown in experimental and non-experimental settings that obese men who are put on very low calorie diets (so..separating the "weight loss" from the "healthy lifestyle changes" as much as possible) have higher rates of heart failure than those men had they never tried to lose weight.

He also references longitudinal research going on at the Cooper institute - the report from 1993 indicates that men who are in the overweight BMI range, and who lose 5% of their body weight, have a 200-300% greater chance of dying from cardiovascular disease than overweight men who maintained stable weights.

The Blair Study at the Cooper institute is actually fascinating. He's been tracking fitness level, weight, and health of 70,000 people for over two decades, including regular stress tests, body fat percentages, etc. What he's found is that fitness is correlated to health, but that BMI isn't. Among other findings, he's seen that moderately active obese individuals (BMI above 30) have half the mortality of sedentary individuals of ideal weight. Now, that isn't all that surprising. But what IS surprising is that the ideal-weight, moderately active individuals have statistically indistinguishable mortality rates from the obese (not just overweight, obese), moderately active individuals.

He's also spending a considerable amount of time talking about the "who has an interest in telling America that even moderate overweight is a dangerous medical condition that must be treated"...and talks about what a boon it is for the medical and pharmaceutical industries, not to mention the diet industry, to have a "disease" to treat that never kills the patient and for which there is no real cure. Most diseases either kill the patient if treatment doesn't work (ending that source of revenue) or cure the patient (ending that source of revenue). Obesity is the ultimate profit-maker, at least right now...his argument is that inactivity and poor diet (not obesity) actually are the predictors of mortality, so obesity itself rarely kills you, and it can't be effectively treated. So there's a permanent patient pool for you to treat.

I know I'm rambling on and on about this book. But it was really challenging to some of my very core beliefs about fitness and weight loss (lower in your "normal" BMI range is better, getting out of "overweight" is better, etc). I will say he's only looking at MORTALITY, and obviously extreme obesity has not only higher risks of mortality, but also can cause quality of life issues that won't show up on mortality measurements, but

For what it's worth, he also is drawing some very interesting arguments that, as humans, are structure has always revolved around having some group(s) of people organized as "superior" and some as "inferior" - people to strive to be and people to not want to be/associate with. Essentially, the unspoken caste system. As we've decided that such exclusion of groups based on ethnicity, gender, etc. was unacceptable, people have started making fun of/excluding all sorts of people based on weight, because that is still acceptable, and thought to be entirely within personal control (so therefore, it's an OK thing to discriminate on).

I love hearing others thoughts on this. I am feeling almost weirded out and defensive at this book, because its so deeply challenging things I've "known" about weight.
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Old 10-22-2008, 01:23 PM   #18
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I think there is so much that the scientific community is learning about weight, weight loss, the health of the formerly obese, and how the formerly obese differ from the never-obese.
I think this is so key.

Things change practically overnight with regard to what is healthy and what isn't. And the numbers that they say today are a "healthy range" might change next week.

I think that being healthy is more than just your BMI or your weight or your blood pressure or your cholesterol or any one number. We have to take a more holistic approach to being healthy and I do think when we get into talking about the difference between a BMI of 22 and a BMI of 26, there is "wiggle room" for that healthy approach.

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Old 10-22-2008, 01:44 PM   #19
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his argument is that inactivity and poor diet (not obesity) actually are the predictors of mortality, so obesity itself rarely kills you, and it can't be effectively treated
This is a compelling argument and if it is true then my DH and I are okay. Neither of us has been classified as obese (only overweight) and we've always had a healthy diet. We're both active as well, although I have to admit we've become more active lately, but have never been completely sedentary. I hope this means we'll live long and prosper!
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Old 10-22-2008, 01:46 PM   #20
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Hm. Manda - you and I posted at the same time, so I missed some of your followup thoughts.

One thing I want to comment on is this:
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.his argument is that inactivity and poor diet (not obesity) actually are the predictors of mortality, so obesity itself rarely kills you, and it can't be effectively treated.
I think that's playing semantic games, personally. Which came first, the chicken or the egg? You know?

Also as you said, he's focusing on mortality only. I think taking that narrow a view discounts the other issues/concerns about being overweight - at all ranges. It's possible to be unhealthy without being mortally so.

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Old 10-22-2008, 01:55 PM   #21
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Definitely with you on the mortality thing, and I mentioned it in my above post. But does moderate OVERWEIGHT (again, not morbid obesity) in active people have that much of an impact on quality of life?

I'm not so sure that the "chicken or the egg" argument applies, either, for moderate overweight.

I am very active and have a diet that meets my nutrient requirements, consists of mostly whole foods, etc. I'm also medically defined as overweight. That won't change unless I get more active (we're at 8 hours a week here. There isn't a ton of room for upward progress) or reduce my intake, which will make it hard to meet nutrient requirements. Its not like I'm still losing weight, so I can't say my weight will naturally settle at something defined as "healthy" if I'm just patient.

My brain is still working on wrapping around all of his arguments.
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Old 10-22-2008, 02:08 PM   #22
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One more reason why I think unraveling the "Obesity vs. poor diet/low fitness level as risk factor" distinction is that it affects treatment recommendations.

Lets say that we have found that obesity in and of itself is a risk factor, and reducing obesity in and of itself reduces disease risk. The treatment recommendation would be, then, "lose weight, no matter what it takes, because it will make you healthier"

If the obesity itself is merely another symptom of poor fitness and eating habits, but not dangerous in and of itself except at major outliers, the treatment recommendation would instead be "make lifestyle changes to improve your fitness and diet. This might make you lose weight or it may not, but your risks will be reduced regardless".
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Old 10-22-2008, 02:08 PM   #23
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I think I might have to hit the library today and see if I can find a copy of the book. I'm intrigued now!

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Old 10-22-2008, 02:14 PM   #24
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I think there is an issue for mildly to moderately "overweight" individuals who eat a healthy balanced diet and are physically active, and yet are still socially stigmatized for not being slim (and the discrimination justified by unsubstantiated claims of fat being "unhealthy").

I don't think it's entirely a chicken and egg argument, because I do believe there are people who despite very good diet and health are still overweight (and a few perhaps even obese) by the BMI standards.

Now I think there probably are limits, but where they are, I'm not sure. Does anyone "naturally" weight over 300 lbs, I tend not to think so. However, could a woman of 5'7" naturally and in good health weigh 170? I wouldn't discount the possibility, and yet that woman would still be considered fat enough for many to ridicule.

I also think that looking at lifestyle rather than weight, has advantages. Many, many who have tried to lose weight, find the lack of progress (on the scale) devastating. It can be so discouraging that it seems hopeless and just not worth the effort. However, stressing lifestyle OVER weight, tells a person, "even if the scale isn't moving, you are making progress and there is good reason to keep the lifestyle changes even if the scale isn't rewarding you for doing so." Also, stressing lifestyle over the number on the scale, removes at least some of the reward for the crazy, unhealthy and even hazardous people can be tempted to lose weight, because success is promised quickly.

However, until weight isn't a vanity issue as well as a health issue, I don't think you will get rid of the unhealthy and even hazardous methods to lose weight, because a large number of people, women and girls especially would actually trade health for beauty. I know I would have, and probably did with the decades of crash dieting, because during most of that time I wanted the horrendously ugly stuff off my body as fast as I could, and I didn't care what it did to me, in order to do it.

Are my multiple health problems now a result of the weight, and lack of fitness - or the stresses of near constant yoyo dieting? Probably a mixture of the two. There is some compelling evidence that even for super morbidly obese people, those that never dieted tend to be healthier than those who've been on the diet rollercoaster repeatedly.

I think as long as the magic weight on the scale, or reflection in the mirror, is in itself the reward (and not at best one of several potential indicators of progress), there will be incentives to lose weight in an unhealthy and even hazardous methods, in exchange for the illusive promise of rapid weight loss.
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Old 10-22-2008, 02:49 PM   #25
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"make lifestyle changes to improve your fitness and diet. This might make you lose weight or it may not, but your risks will be reduced regardless".
__________________________________________________ ____________

Oddly enough, my first contact with this theory was in the 1990's from within the controversial "fat acceptance" movement, and it has revolutionized the way I look at myself. It inspired me to stop dieting and eat better and stay active. At the time I was at a very high weight (a little over 300 lbs, I believe), but I stopped gaining. I didn't lose, but I didn't gain either, and I wondered "geez, what would have happened if I'd learned this at 5 instead of 25". Then I herniated a disc in my back (forcing my frozen car door open on my way to the gym at 5:30 in the morning), and needed to lose weight to prepare for or prevent surgery (I was able to prevent the surgery). Of course, was it just the weight loss that prevented the need for the surgery (because that would be less weight the spine had to bear), or could it have also been the swimming 3 times a day? (Well at first only treading water, because while I had been swimming 25 to 30 laps every morning before work - yes at over 300 lbs - but after the injury only being vertical in the water was bearable at first

I do think the advantages of taking the pressure off "the number" far outweight the disadvantages. When I was in 8th grade, my pediatritian put me on a strong amphetemine diet pill for weight loss and bribed me with excuse from P.E. (though he said he expected me to exercise at home). By junior year, I was within five pounds of the 150 lb goal that the doctor had set for me. Well those kind of diet pills stop working after a while, so I wasn't taking the diet pills anymore and maintaining the 155 lbs was extremely difficult, so my weight wasn't budging. My doctor lowered my goal to 145. I don't know if he thought that lowering my goal would motivate me to work harder, but it had the opposite effect. Because 155 was so difficult to maintain, 145 seemed (every applicable swear word) impossible.

I was 16 or 17, so I'll cut myself a little slack here (though I've seen similar thinking in every weight loss group I've belonged to, even here), but since 145 seemed impossible, my response was to give up entirely (gaining all of the weight back plus an additional 25, as is so typical).

The "all or nothing" thinking is typical of weight loss. In fact, it's so typical, I'd argue that it's how we're taught by example to think and act where weight loss is concerned. A miss is as good as a mile, and if you're not at a healthy weight (and what we really mean is a beautiful weight) then you've failed. You're a worthless, ugly cow and you should be ashamed of yourself and filled with self-loathing. Why you're not even fit to breathe the same air as "normal" people.

Exagerating? Lord, I wish I was. Although, I think attitudes are changing somewhat, at least in the medical community. The beauty culture is as unreasonable as ever, but I think that's been the case since prehistoric times. When people endangered their lives (from the risk of infection) to beautify themselves with scarification and tatoos... and in the middle ages when women put caustic and poisonous substances on their faces and into their eyes in the name of beauty (and there's evidence that they weren't completely ignorant of the harmful and dangerous effects).

My current doctor is only the second doctor I've ever had to stress lifestyle over weight. The first was a rheumatologist (with a horrible bedside manner, but that's another story) treating my fibromyalgia, who said that if I just lost weight (without exercise) I'd look better, but probably would not feel much better. While if I exercised regularly, whether or not I lost weight, the statistics predicted that I'd have fewer fibro symptoms.

My current doctor, when I asked him for a goal slip for my TOPS group, asked me what I wanted my goal to be, and I suggested 200 lbs (still obese). He asked, skeptically if I was sure. I assumed he meant that it was still too high, so I said that I thought I'd try to maintain the 200 for a while before deciding whether to go lower, and he explained that he meant I should consider a more modest goal. We settled on 250 (still morbidly obese).

At first, it seemed like the whackiest thing a doctor had ever suggested, and then it felt like a humongous weight had been taken off my shoulders. My goal weight was flexible, huh. What a radical concept. Having a goal weight higher than "ideal" was ok. It didn't mean it had to be my goal forever. I could reevaluate it when I got there. I can even try it on for a while and see how it fits.

And it's why every one of us, even if we've lost only one measly pound does belong in the maintainers forum, because maintenance isn't just about losing every ounce of weight that somebody says you're "supposed to," it's about maintaining the achievements (and not just the weight, but perhaps even more importantly, the fitness improvements as well).
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Old 10-22-2008, 03:11 PM   #26
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And it's why every one of us, even if we've lost only one measly pound does belong in the maintainers forum, because maintenance isn't just about losing every ounce of weight that somebody says you're "supposed to," it's about maintaining the achievements (and not just the weight, but perhaps even more importantly, the fitness improvements as well).
Amen to that! Thanks for some great posts here.
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Old 02-09-2013, 06:04 AM   #27
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I know this is a SUPER old thread, but I just finished this book last night. Really fantastic read. Some chapters feel quite dated, but most of it feels right on track. Including yet ANOTHER longitudinal study which showed lower mortality among the 'overweight' BMI category http://www.nytimes.com/2013/01/02/he...verweight.html

The big take-aways for me were:
*the BMI lines drawn for 'overweight' and 'obese' are meaningless.
*most of the people who work in the field of obesity and public health are 'fat phobic' (this ties in with my own experience having worked in public policy arenas)
*there is a lower mortality risk associated with being in the current overweight category than in the 'normal' - there is significantly less risk to being overweight and 'low-obese' than in being even 5lbs underweight for a person of average height.
* there ARE significant health risks for living an unhealthy lifestyle that we normally associate with weight gain - i.e. sedentary lifestyle and poor diet - but these health risks apply to the thin and the fat
* an overweight and unhealthy person who wishes to improve their health would benefit far more from adopting a healthy lifestyle (good diet, moderate exercise) - so would a thin person with the same unhealthy lifestyle.

And on a personal level
*this book re-affirms the commitment I made to myself. NO MORE DIETS. I am aiming to improve fitness and change the way I eat.
*I overate. I ate bad foods. I did this to soothe emotional pain. It made me fat. I felt bad about myself and didn't exercise. I don't want to do this anymore. I am losing weight. I want to commit to eating the way I do for the rest of my life. The way I am learning to eat now is completely sustainable. I eat whatever I want. Nothing is off limits. But I only eat when I am hungry and I stop when I am satisfied. Fortunately, I love veggies and legumes! And the more I eat of them the less I want junk.
*I will never exercise to lose weight again. EVER. I will exercise because it is fun being fit and it is fun to move your body and it is fun to play sport. Sometimes I do exercises that aren't so fun (hello, burpees - yes, I'm talking to you - I hate you) but give me better functional fitness. When I go to ground in a ruck, I need to be able to get up again fast and move onto the next one, so I will do burpees but I will not like it.
*yes, I have a goal weight - but I'm seriously re-considering that now... I know I am too fat. I know I'm not fit enough. Is 155 (still in the overweight category) my ideal weight? I don't know. Maybe it's 170 or 160 or 182.5. I don't know. But I'm committed to living my ideal lifestyle - good food, not overeating, not under-eating and plenty of exercise.
* I am going to enjoy my body as it is today and enjoy it as it is tomorrow. I am going to absolutely revel in the fact that my heavy but sturdily built body is an advantage in rugby - and I'm going to hurl myself into skinny girls without remorse (and fat ones, too)
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