November 13, 2007

Overweight and Living Longer: Why the Scowl?

So our last Random Friday Roundup discussed (really briefly) a recent study on weight and mortality. You remember--it's the one that looked at what people tend to die from, depending on how heavy they are. Want some more info on the study, like what might up and kill you one day? Check out the JAMA abstract, the AP summary, or one of a couple of interesting NY Times articles, here and here.

But the types of diseases and their prevalence are not what this post is about.

Here's the thing: it wasn't the particular causes of death that got most people talking on the web, though those are pretty interesting too. The thing that surprised everyone (including Crabby) was actually announced two years ago during the first part of the study: people who were overweight had an overall lower risk of dying during the study period than those of normal weight. (People who were underweight or obese, on the other hand, had a higher risk of death than normal).

So the study that's in the news right now is just a follow-up study, adding another year of mortality data and sorting out which things each group actually died of.

Which leads to the question: If this all came out a couple years ago, why are so many of us surprised? The fact that non-obese overweight people live longer than slimmer ones must have been in the news back then. Yet Crabby has no memory of it.

Why did that interesting bit of information seem to disappear entirely from the ongoing (and constant) media discussion of health and weight?

It seems like these study findings should be welcomed--as a society, more people are moving from the normal to the overweight category, so if being overweight actually keeps you from dying younger, isn't that a good thing? Crabby is not overweight herself, so has just now discovered that statistically she's actually more likely to croak early, but she still thinks this sounds like good news for the population in general.

Is the problem that the data came from a dubious source? Uh, nope. While we're always being bombarded with news reports about tiny obscure studies saying bizarre things, this wasn't one of those. It was a humongous CDC study published in JAMA, the Journal of the American Medical Association. (Which ain't Parade magazine, right)?

Yet it seems that most health experts don't especially want to acknowledge this result. In fact, there's been an immediate rush to explain it away and minimize it. As apparently happened the last time too! Which might be part of the reason the message got lost and we all went back to thinking that moderately overweight people (who are not obese) are at greater risk of death, not less. Which happens to be wrong.

So what's the deal with that?

Sure, one reason could be because "overweight" can be a stage people pass through on the way to obesity. Obesity is still a big health risk. So you don't want people to get confused and stop caring what they eat or how much they consume. And you still want to encourage everyone to exercise and eat healthy cancer-fighting heart-protecting whole foods--which, as it happens, will also likely lead to weight loss in folks who have been previously sitting in front of the tv every night eating mostly crap.

And it's true there are particular medical conditions made worse by even moderate excess weight--diabetes come to mind. People who are at high risk for one of those kinds of conditions should definitely take that into consideration.

But why do so many health experts seem so eager to cling to the "heavier body weight will kill you" idea? It's as though they'd almost be disappointed if it turned out not to be true. Do they see fat as a moral issue? Is there some inherent appeal to the notion that skinny must be healthier than chubby because it seems more "virtuous?"

As a practical matter, the study probably won't make that much difference anyway. Because many people, particularly women, aren't motivated to lose weight because of their health. They may say that's why, but it's really mostly because they want to look hot. And our culture, for the moment, insists that skinny is hot. Curvy or beefy is not.

On the other hand, some people who are somewhat "overweight" do care more about their health than their appearance. They're exercising, eating their vegetables and their lean protein, and they're not scarfing down junk food on a regular basis. Yet they can't get to "normal" weight no matter how hard they try because they're just not built that way. And their doctors continue to scowl at them like they're irresponsible children or greedy criminals.

This finding may be contradicted by another study, as often happens. Who knows. But what if it turns out to be true that going from a non-obese but chubby size to a tiny little skinny size doesn't buy you anything health-wise? What if being a bit overweight is all just about appearance?

Then Crabby may have to rethink her approach to things a bit. Eat all the healthy stuff, do all the exercise... but don't sweat a few extra calories? Or at least acknowledge that to forgo them is purely about vanity and not about health or longevity?

Hmmm. Further pondering may have to take place in the tiny Crab brain.

Anyway, Crabby might well be missing something obvious here. She's very curious what you all think.

(Also, Soap Box Girl had a great post on this study too, which you all should definitely check out.)


  1. Weight-loss is a huge industry. Anything that takes away from profit must be suppressed in a capitalist-based nation.

    Of course we humans think that if a little is good, then more must be better. If five lb. is healthy then 10 or 20 or 50 is even more protection. The healthy weight to slightly heavier message will be lost.

    The real problem isn't so much weight as the crap that passes for food in our culture. If we only had good-for -us food available then extra weight, or even slightly underweight wouldn't be so much of an issue.

  2. This is what I think. Most people will keep doing what they are doing and will find the rationalizations to convince themselves that they are right. Never underestimate the power of denial and mass hysteria. There are WMD in Iraq as I remember.
    We all have to make our own health and fitness decisions, often with insufficient or constantly changing data. I hope we all choose wisely.
    Dr. J

  3. Yep, I want to be skinny. I remember being skinny. I liked being skinny. I think I looked better when I was skinny. Wish I could be again. However, I am older now and I know that may not be realistic. I also find myself thinking more about my health now that I did when I was skinny - may also be an age thing.

    I have a friend who lost a whole bunch of weight on a diet that involved all kinds of herbal supplements, a strict eating plan and no exercise. Yes, she is thin, but I have a hard time accepting the fact that this automatically makes her healthier than a person who makes a regular habit of eating healthy foods and exercising. She certainly seems to get sick often enough.

    Health is not just a function of weight - there are many other factors. Maybe the "healthy weight ranges" don't quite work for everyone. Maybe we need to do our own individual assessment to figure out if we are at a healthy weight. Unfortunately, that is only going to work for those who are concerned with their health and are willing to make an effort.

    So, nothing new. It all comes back to living a healthy lifestyle. Either you are motivated to do it or not. I guess the only difference is that I don't have to automatically feel like my efforts are worthless if I can't lose those few extra pounds.

  4. Yup, Javachick, I agree with "I'd rather be skinnier" and getting older and being realistic and all. My sentiments exactly.

    My big problem with being 20 pounds heavier than on my wedding day (the one 8 years ago, not the first one) is that I feel the extra weight when I'm moving around. (And BTW I was 30 pounds heavier at the beginning of this year, so I should pat myself on the back.) I think my knees are giving out because of the extra weight. Then that keeps me from exercising, so it all just goes downhill. :-|

  5. Javagirl pretty much said what I think - you need to focus on your health. I used to be a size four when I was in my 20s, but I really don't think I am going to see that size again! Unless I go on a very unhealthy, restrictive diet. I think a person's "healthly" weight varies from person to person - I know women who are technically "overweight" who can and so run marathons. The zillion dollar diet industry does not want to acknowledge that such people exist.
    Finally feeling better today! yay!

  6. I think it's the whole deprivation thing.

    Maybe the slightly cushy people don't sweat everything per se and the stress free life makes them live longer whereas the skinny folks are too busy calorie counting and busting their humps to work off that tic tac that they end up in an early grave.

    I think it's that whole "nothing tastes as good as thin feels" that people buy into.

    Sorry sweetheart, but that cupcake is quite tasty and I'd eat it any day of the week and gladly walk around a few pounds heavier and happier for it.

  7. I agree it is all about business and making money. Will sales of all the "thin in 30" and other diets/weight loss programs/pills/shakes/low fat/low carb this and that drop if we accepted ourselves at a healthy (normal) weight?

    What would the magazines put on the front pages if they couldn't talk about who is packing on the pounds and is now a size 10 *gasp*

    I know I need to lose weight to be healthy. I also know I'm much healthier than some of the skinny girls who eat an apple a day (and only an apple). I know for sure that is NOT healthy.

  8. "Or at least acknowledge that to forgo them is purely about vanity and not about health or longevity"
    That's a hard one for me to swallow, so maybe I'll just ignore it. heh heh.

    Like missicat, I know people who aren't "thin" who could run circles around me at the gym.

  9. Crabby,

    Leah has a great point and I think if people read her last few postings on the Goat's Lunch Pail, we'd see the real problem. Everything today is fast including our food. So who knows what's really in most of what we eat.


  10. Hooray! There is now a scientific explanation for my existence! (She of the normal cholesterol, normal blood pressure, normal heart rate despite being ZOMG overweight!)

    I still would rather be about 20lbs lighter, though. :p

  11. I am aiming to improve the amount and type of exercise I get, and the amount and type of food I put into my body. If that results in weight loss great, wonderful in fact. I know I will never get back down to thin, but as long as I can walk a few blocks without panting, thats okay then.

  12. Great job explaining this complex issue, Crabby. I think the NY Times article was a little jumbled because the journalist tackled too many issues at once, without giving enough background information on the previous studies that lead to this claim. Obesity and downward mobility (though the Oprah/King Henry the VIII illustration was hilarious!) aesthetics, and a comparison of mortality rates among specific body types are too many topics to cover in one short article.

    I still have a lot of questions, though: How does exercise affect longevity? And what about folks like David Letterman? He was a runner and yet he had artery blockage--due to smoking and poor diet (?). So are the results point to people who are overweight but eat a healthy diet and exercise? That seems like something different than people who don't exercise or have low fat diets, but have forgiving metabolisms or are as you say "pass[ing] through on the way to obesity" ?

    I probably need to spend some time reading about this, but thanks for sorting a lot of it out for me!

  13. Wasn't there just a study that said it's big ups and downs in your weight and not what you weigh today that makes the difference?

    If the heavier people in the study about death rates had always been heavy, they would've probably been healthier than the ones in the group whose weight was subject to big fluctuations over time.

    What we eat and how we take care of ourselves determines our overall health, not what the scale and tape measure say.

    Grant money wasted, if the scientists didn't know that going in.

  14. Very interesting! I agree with other commenters who pointed out that it's likely less about a few extra pounds than it is about healthier food and adequate exercise.

    If you compare somebody who is at "ideal weight" but who doesn't eat a healthy diet and doesn't get much exercise to someone who is a few pounds over "ideal" but eats well and exercises, the latter person will be the healthier one. There's plenty more to health than just weight, though obesity certainly brings serious health risks of its own.

    In a society where we're surrounded by high-fat, sugary food, eating well is a challenge, no matter whether we're at "ideal" weight or a few pounds over. And as busy as most people are, making time to exercise can be a challenge, too -- but it's one of the very best things we can do for our health.

  15. I'm in agreement with a lot of what's being commented, but also I think blood pressure plays a big role in how healthy you are, as far as heart healthy. After all, if more weight causes more strain on your heart, than the blood pressure would indicate risk. If the blood pressure is normal or within normal ranges, yet one is considered "overweight," then I would think the risk would still be low. Is there any mention of overweight and being predisposed to cancers? I thought I read that as being the most recent info.

  16. Has anyone stopped to consider that using BMI alone may not be the best indicator of "health" or disease risk? BMI only takes into account height and weight. It doesn't take into account frame size, body composition (muscle mass), etc. Not to mention lifestyle, eating and exercise habits.

    I'm not saying that being overweight is healthy by any means, but I know plenty of people who fall into the overweight category (myself included) who wouldn't be considered by most "overweight" at all. Maybe they are very fit and muscular or have a larger frame size?

    Many people have been talking about this study since it came out. Claiming that it reveals we should no longer worry about what we eat because being overweight decreases our risk for certain diseases. In reality, it’s a whole lot more complicated then just looking at a measure of weight for height (BMI)! You need to cosider lifestly, genetics, diet, exercise habits (and the list goes on)...

  17. Wow, lots of great comments and what a sensible bunch you all are! Sorry it's one of those busy days when i can't back down here as often as I'd like, so just a couple of quick thoughts...

    Vickie, my recollection about the cancer info was: Obesity raised the risk of certain cancers, but just being overweight (but not obese) did NOT raise the risk of dying of cancer. However, I think there are plenty of studies that show higher cancer risk when you throw all overweight people into the same group, and don't separate out the obese from the overweight.

    So Lauren, I didn't realize people were talking about this study as though it meant it doesn't matter what or how much you eat--that seems really misguided! Like you said, it's complicated. And i agree BMI is a pretty poor indicator of actual body composition.

    Thanks, everyone, for your thoughtful comments!

  18. Remember that weight is a very poor critia for health. The BMI does not take many items into account such as muscle mass & bone density. A very skinny person can also be very unhealthy. We need to stop focusing on weight and focus on healthy lifestyles. BTW one is vastly easier to measure than the other.

  19. The Bag Lady is really late for this party, and is very impressed with all the thoughtful and intelligent opinions expressed here.
    She also thinks we would all do well to remember that health is far more important than some arbitrary weight standard, and eating healthy food and getting at least a modicum of exercise will do a lot more for length of life than constantly starving ourselves to be a size 1. (Sheesh, what is happening to this world? When the Bag Lady was a wee thing, there was no such thing as a size 1!) And isn't living long, healthy, happy lives what we are all striving for?
    The Bag Lady also wonders why she always gets such hysterically funny word verifications? This time it's tjomespy....

  20. First beer is good for us and now we can be a bit chubby. November has been a very good month for good news. :}

  21. Completely off topic, I'm afraid. Have just seen your change of url notice. Consider it as moving up in the world, Crabby. You'll soon regain any lost ground - or scattered sand, or whatever.

  22. Crystal, I totally agree with you: the focus should be on health, not weight!

    And bag lady, didn't you just have a tjomespy recently?

    Amy, I think maybe it's time for another chocolate one, too! Those are my favorite kinds of studies.

    Hi Dawn, Great to see you again! Hope you and the pups are doing well! I'll have to pop over this morning to see what's doing in your neck of the woods.

  23. The study flies in the face of other studies that show thin people live longer than normal weight or overweight people...

  24. In response to some of the comments along the lines of "if you're overweight but eat well/exercise, of course you're healthier than someone normal weight who doesn't": What makes this study (not so much the most recent paper breaking down causes of death but the earlier one looking at all-cause mortality) especially compelling and surprising is that they *didn't* compare overweight people with good habits to "healthy" weight people with bad habits. They compared thousands of somewhat randomly selected people and grouped them *just* according to BMI, and presumably within each group some had good habits and some had bad ones. So if the only reason an "overweight" person would live longer than a "healthy" weight person is better health habits, that implies that "overweight" people *on average* have better health habits than "normal weight" people. Which could be true, but would be pretty surprising to a lot of people. (most possible explanations of these results are surprising to a lot of people, really)

    I suspect what might actually have happened is that the "healthy" BMI cutoffs were first set according to risks other than death. Somebody figured out what BMI range was least likely to get heart disease and then everyone decided that must be The Best BMI Range For Everything, ignoring the fact that what keeps you from getting heart disease might not keep you from getting Alzheimer's or dying. There's basically nothing medical that prevents or treats one illness without at least possibly causing another one (drugs, etc. all have side effects), maybe it's the same deal with weight. In which case, just like with deciding to take drugs, you have to think about what's important to you and how your personal body responds to things and add all that into figuring out a sensible thing to do.

  25. I do remember when this hit the news last year....the ADA, AHA, et all raised hell!!

    The sentiment that was voiced most often was that it was "irresponsible" of the CDC to publish these findings, because people would take the news and overdo it....and assume that overweight is good, obese is better! OK....yea, right. But the general sentiment seems to be that people need to be treated like children and protected, even if it's from themselves.

    Personally I think the current weight guidelines are a joke. Back in the late 60s my brother was rejected from the draft because he was "dangerously thin" (we all agreed), but today at the same weight, but with 2 additional inches in height, my son is considered "ideal" weight? Nope....he's too thin to me!

    My goal is right on the edge of "normal" and "overweight". I'm 53 years old and looking for health, not good looks! With all the loose wrinkly skin I have, looks isn't a motivator! lol

  26. Talia--it is confusing, isn't it? But this was a fairly big study. Be interesting to see what further studies say!

    janedoe, excellent points! I think, as you point out, the bottom line is to figure out your own health issues & risks and priorites and act accordingly.

    Cindy, I'm totally with you--it's health, not numbers on the scale that should be important! And the older I get, the less vanity seems like an important motivator.


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