Discussion: More weight - live forever?

Clark, could you please comment?

http://www.cnn.com/2013/01/02/health/overweight-mo...

Gee j-man...why me? Am I the only person on a/p who is willing to discuss this notoriously "hot" a/p topic?

Yes I read a similar NYTimes article with my coffee Tuesday morning, and kind of dismissed it. The study has the smell of a lot of other studies which start out to prove a point...and by God they slice the data just so, and claim revolutionary findings! Bunch of fat researchers looking to justify having another jelly doughnut each morning!

It seems similar to the study last year that reversed the AMA's recommendation on getting your PSA tested. Now they're saying the risks outweigh the benefits, and men SHOULD NOT be tested for PSA!

So are you no longer going to either monitor your PSA or watch your weight? I think most orienteers reject these studies, and plan to continue to do both.

The flaw in both studies IMO, and in US medicine in general, is that doctors and researchers are too intent on MORTALITY...IOW measuring the QUANTITY of life as tho living to 100+ is the most important thing...even tho you might be senile, immobile, and in constant pain. Notice both studies deal with how long a person can be expected to live. Neither consider the QUALITY of life.

As I've aged, I've been more and more aware of that trade-off. And I have consciously chosen more QUALITY, even if it may mean less QUANTITY. For instance, even tho I'm now over 70, I continue to totter around Chicago daily on my bike, through busy city traffic, rather than drive because I LIKE biking, dislike driving.

The same is true in this obesity issue...even the researchers agree. Notice that toward the end of the NYTimes article the lead researcher concedes:

Still, death is not everything. Even if “being overweight doesn’t increase your risk of dying,” Dr. Klein said, it “does increase your risk of having diabetes” or other conditions....

Frankly, I don't want diabetes...or bad knees, hypertension, urinary problems, heart palpitations, etc that come with a higher BMI, even tho modern medicine can control those problems with various drugs and procedures for years. I'd rather minimize my time in doctors' offices now.

IMO all these single-minded studies and research, intent only on extending peoples' lives...what is it for? The US economy and health-care industry are confronting a huge coming problem with our aging population. By the time folks reach 80 years of age, something like 80% have some form of dementia. My overweight grandmother lived to 100, but the last 15 years were on MedicAid, completely gone, drugged out of her mind, wailing in a nursing home bed. Can't even imagine the cost! Was she one of the subjects that contributed to that study's favorable mortality findings for high BMI folks? Are you looking forward to your parents' later years with joy...or dread?

Two years ago, when I became involved with PG's Lost and Found program, lost 30 pounds which I've pretty much kept off, and brought my BMI down from 25 to 21, I noticed a tangible improvement in my health. I sleep better, pee better, run better. My wife says I look better. And my various blood tests have improved too.

No j-man, on the contrary. I do not want to live forever. I want a low BMI so I can enjoy life NOW; and when it is time to go...I plan to accept it. In the past 50 years we've come to accept BIRTH planning as a sensible way to live. Rather than foolishly hoping to live forever, I think that in the next 50 years we'll also come to accept DEATH planning as a sensible and compassionate facet of life. For our sake, for our family's sake, and for our country's sake.

And until then I think we all know: folks with lower BMI's have fewer chronic conditions as they age, spend less time in doctors' offices, generally feel better about themselves...and enjoy a higher QUALITY of life.

Thanks!

I think another "flaw" might be the use of BMI. Isn't a stronger person heavier than a weaker person that is the same height. Does that mean they are less healthy.
Ever since I graduated High School my BMI has been right around 25. But I don't think I would consider myself bordering on being unhealthy (or a muscle man). I actually consider myself quite healthy and active. I am not overly concerned with what I eat but I try to make sure I get everything I need. I know I could lose some weight and still remain healthy but don't find that necessary. I personally have never considered BMI a good test of health. Sure it can sometimes be a useful metric but not an all encompassing metric.

After reading the CNN article I wouldn't go out and raise my BMI so that I live longer. I would ask is BMI the true cause for the effect of a longer life or is it just a side effect of another cause. It didn't seem like they could really put a finger on why they saw the results they did. There may be a good explanation the the effect and if identified I would certainly consider that when making life choices.

I agree that you can slice and dice data and get different results. When I create models I always perform a validation to make sure my output "makes sense." If it doesn't I go back and look for a mistake or something I should have considered and may have overlooked.

I also agree that QoL is important. Maybe I'll get the best of both worlds by being right on the border.

Just read the NYT article. The "experts not involved in the research" referenced in that article seemed to be on the mark. They also referenced the imperfection of BMI. Liked the presentation in the NYT much better.

I don't think they set out to "prove" this point, on the contrary from CNN:

"I think there's a lot of under reporting of this finding ... and so people are sort of repeatedly surprised by it," Flegal says. Because many researchers don't expect to find a benefit associated with being overweight, she suggests, they may not believe their results are valid if they find such a connection, which may make them more hesitant to publish them and invite review and discussion about what may be driving the trend."

This explanation or variations on it make sense to me:

"There is also some evidence that heavier people may have better survival during a medical emergencies such as infections or surgery; if you get pneumonia and lose 15 pounds, it helps to have 15 pounds to spare, for example."

I think that some have argued fat having been an evolutionary advantage in some cases in our history. For example, take a bunch of skinny people and some fat people with a 3 month food supply, put them out on a boat in the ocean to find a new island to colonize, which do you think are still alive 6 months later when they finally make land fall?

"Reporting" these days seems to involve finding a tiny sliver of information that may or may not be correct then blowing it up into a major news story. After all, doesn't just about every food these days have some link to cancer? Doesn't exercising give you heart attacks? Too much sleep and not enough sleep are both unhealthy.

Coming next to your metro daily's Health section...

Large Doses of Heroin Improve Concentration, Increase Productivity, Study Finds

Pack-a-Day Shrinks Tumors, Extends Lifespan

Arsenic, Strychnine, and Cyanide: Superfoods of 21st Century

We, we know what we've got in the year 2173.

Thank you, Clark, for your sharing your interesting thoughts around health and getting older. I really liked that.
By the way: Sports (even competitive) for the elderly is a rising market.

According to Wiki, the guy that first devised BMI in the 19th century said it should be used for populations rather than for individuals.

I remember around 15 years ago where studies suggested that those that drank moderate amounts of alcohol had the best life expectancy and many people reported that alcohol in moderation was good for you. Then a few years ago someone decided to breakdown the figures further and came up with a very different conclusion that when you removed people who drank no alcohol it appeared increasing consumption of alcohol increased mortality. A finding that seems much more logical, but didn't get much publicity.

Who knows, if someone sliced up the data further they may find there are a significant number of unhealthy underweight people included in the 18.5 to 25 group that is effecting this grouping, just as seemed to occur when people who did not drink for medical reasons and those that chose to abstain were excluded from the alcohol studies.

That's the point of every empiric data. If you put the data together you may miss a certain answer.

I have also heard that the BMI formula is inaccurate for people who are tall or short. From Wikipedia:

"The exponent of 2 in the denominator of the formula for BMI is arbitrary. It is meant to reduce variability in the BMI associated only with a difference in size, rather than with differences in weight relative to one's ideal weight. If taller people were simply scaled-up versions of shorter people, the appropriate exponent would be 3, as weight would increase with the cube of height. However, on average, taller people have a slimmer build relative to their height than do shorter people, and the exponent which matches the variation best is between 2 and 3. An analysis based on data gathered in the USA suggested an exponent of 2.6 would yield the best fit for children aged 2 to 19 years old.[31] The exponent 2 is used instead by convention and for simplicity."

"I think there's a lot of under reporting of this finding ... and so people are sort of repeatedly surprised by it," Flegal says. Because many researchers don't expect to find a benefit associated with being overweight, she suggests, they may not believe their results are valid if they find such a connection, which may make them more hesitant to publish them and invite review and discussion about what may be driving the trend."

Here is a perfect example of this, from a 2005 paper:

http://www.ncbi.nlm.nih.gov/pubmed/15840860

Mortality was significantly lower in the "overweight" group than in the "normal" group, but the abstract dodges this completely by saying only that "overweight was not associated with excess mortality".

I haven't been able to find this for BMI, but many statistics define the "normal" condition as the condition at the time the statistic was invented, or when data collection became standardized. For example, for a half-century, the pediatric charts in doctor's offices were entirely based on births in Yellow Springs, Ohio in 1953. Similarly, federal flood maps were long based entirely on rainfall events between 1940 and 1960. I assume something similar for BMI. The health data seem to suggest that the reference population used to define "normal" was probably a bit underweight.