
Obesity Paradox: Overweight patients with some chronic conditions fare better - Amorymeltzer
http://qz.com/550527/obesity-paradox-scientists-now-think-that-being-overweight-is-sometimes-good-for-your-health/
======
ucaetano
The article seems to mix "thin" and "normal weight" all the time, being just
poorly written. Including underweight people and normal people in the "thin"
category is a major mistake.

Also, this quote is troubling: "That people at higher weights are going to be
OK."

Not only NOTHING in the article supports that, almost every single piece or
research shows the opposite: that in general, people at higher weights have
much higher mortality rates. The article just shows that, when some chronic
diseases are present, overweight people seem to fare better than non-
overweight (which I take includes underweight people).

Even if they fare better under certain very specific conditions, in general
they fare quite worse. Source:
[http://www.hsph.harvard.edu/nutritionsource/questions/ask-
th...](http://www.hsph.harvard.edu/nutritionsource/questions/ask-the-expert-
does-being-overweight-really-decrease-mortality-no/)

~~~
nkozyra
Those higher mortality rates start _above_ what qualifies as "mildly obese,"
though. Even discounting factors such as existing illness and smoking, people
with higher weights (weights below the "obese" definition) in general have
longer lives.

Once you go beyond the "overweight" (or perhaps mildly obese, which has a
negligible uptick in mortality) then the curve starts changing very rapidly.

[http://www.independent.co.uk/life-style/health-and-
families/...](http://www.independent.co.uk/life-style/health-and-
families/features/why-being-overweight-means-you-live-longer-the-way-
scientists-twist-the-facts-10158229.html)

[http://healthland.time.com/2013/01/02/being-overweight-is-
li...](http://healthland.time.com/2013/01/02/being-overweight-is-linked-to-
lower-risk-of-mortality/)

~~~
ucaetano
Sorry, but that's not what the results show:
[http://www.ncbi.nlm.nih.gov/pubmed/21121834](http://www.ncbi.nlm.nih.gov/pubmed/21121834)

Body-mass index and mortality among 1.46 million white adults.

 _With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among
women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI
of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00
(95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17)
for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to
34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI,
2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the
men were similar._

And the conclusion:

 _In white adults, overweight and obesity (and possibly underweight) are
associated with increased all-cause mortality. All-cause mortality is
generally lowest with a BMI of 20.0 to 24.9._

~~~
nkozyra
This is going to shock you, but there are a great many studies on this, not
all of which come to the same conclusion. From a meta-analysis:

 _Relative to normal weight, both obesity (all grades) and grades 2 and 3
obesity were associated with significantly higher all-cause mortality. Grade 1
obesity overall was not associated with higher mortality, and overweight was
associated with significantly lower all-cause mortality. The use of predefined
standard BMI groupings can facilitate between-study comparisons._

[http://www.ncbi.nlm.nih.gov/pubmed/23280227](http://www.ncbi.nlm.nih.gov/pubmed/23280227)

~~~
ucaetano
This is going to shock you, but I guess you didn't read the Harvard link
addressing that specific study that I posted on my first post. But here it
goes:

[http://www.hsph.harvard.edu/nutritionsource/questions/ask-
th...](http://www.hsph.harvard.edu/nutritionsource/questions/ask-the-expert-
does-being-overweight-really-decrease-mortality-no/)

Shocking, right?

~~~
dang
Please don't use "I guess you didn't read" as a rhetorical device. That sort
of point-scoring only makes comments more abrasive and doesn't add
information.

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

~~~
ucaetano
My apologies, I got carried away by the "this is going to shock you" :)

------
mrerrormessage
I wonder if anyone has run the data using body fat percentage instead of BMI.
BMI is a very coarse metric that will sometimes label short and/or muscular
people as overweight/obese when they are quite healthy (think football players
or weight lifters).

~~~
sageabilly
I came to post more or less this exact same comment. BMI does not take muscle
mass into account at all. The Rock has a BMI of 31 (260lbs at 6'5") which is
classified as obese. Hafþór Björnsson has a BMI of 41 (419lb at 6'9").

I agree with some of the other commenters too in that a full
nutritional/lifestyle analysis over a long period of time is next to
impossible because it relies on self-reporting which is known to be flawed
[1][2]. People under-report their intake and overreport their exercise
frequency and duration.

[1][http://www.ncbi.nlm.nih.gov/pubmed/2082216](http://www.ncbi.nlm.nih.gov/pubmed/2082216)
[2][http://ajcn.nutrition.org/content/76/4/766.full](http://ajcn.nutrition.org/content/76/4/766.full)

~~~
Alex3917
> The Rock has a BMI of 31 (260lbs at 6'5") which is classified as obese

Why shouldn't he be classified as obese? If he was that heavy because he was
working out then that would be one thing, but the reason he's that heavy is
due to using steroids to put on low quality muscle mass. I don't see why that
would be any less unhealthy than just sitting around eating doughnuts or
whatever.

~~~
adrianN
If it were as unhealthy as eating donuts (which you would need to prove), it
would most likely be unhealthy by a different mechanism. So it would make
sense to distinguish this if you want to find out what causes illnesses.

I also don't understand what you mean by "low quality muscle mass".

~~~
Alex3917
> I also don't understand what you mean by "low quality muscle mass".

Muscle with a low weight to power ratio, and/or with an unfavorable type I to
type IIa/b ratio. E.g. you can quickly bulk up by lifting 3 x 3 at a high
weight (or whatever Starting Strength recommends), but you're going to develop
much lower quality muscle than if you just do 6 x 10 or whatever in terms of
power. And similarly if you're not doing cardio in at least 90 minute
increments then on a regular basis then your type II muscles aren't going to
be able to properly utilize fat, because they'll never get past the point of
just relying on stored glycogen or whatever.

------
Zarkonnen
AFAIK a plausible thesis for why overweight is correlated with better health
is that the extra fat means greater energy stores in times of crisis.
Basically, if you're thin and you get sick or injured, your body doesn't have
the resources to heal itself effectively.

~~~
buzzdenver
Not sure about that. Just one pound of fat has the caloric value to sustain
you for over a day. 10% BF for males (and 15% for females) is low enough that
your mother will probably say that you're too thin. So you could go for a week
without ingesting any calories for a week if you were to lose 5% BF while
you're sick.

------
ericdykstra
It seems like these kinds of "studies" are only made to write headlines and to
write books (notice how half of the people quoted in the article have some
surprising new "facts" that they reveal in a book they wrote?).

The only paradox is why researchers still latch onto a calculation of health
based on just height and weight that was concocted in over 150 years ago. What
other field would rely on such a primitive, outdated formula and use it as the
base of research?

~~~
jdkuepper
Another paradox is why the media always seems to portray meta studies
(correlation) as fact (causation).

This just in: Margarine Causes Divorce in Maine [1]

1\. [http://tylervigen.com/spurious-
correlations](http://tylervigen.com/spurious-correlations) (99.3% correlation
between Maine's divorce rate and margarine consumption)

~~~
dragonwriter
> Another paradox is why the media always seems to portray meta studies
> (correlation) as fact (causation).

correlation vs. causation is a completely different axis of differentiation
from meta-study vs. (direct) study, which is a completely different axis of
variation from (something that isn't fact) to fact.

So, you've conflated at least three _different_ distinctions there.

------
siginfo
It should be called the "slightly overweight paradox".

Article makes lots of qualitative statements. Much easier to look at the data
(900,000 person study):
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662372/figure/f...](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662372/figure/fig2/)

Optimal BMI appears to be 23-25 (at least for minimising the risk of death).

Another large study (1.46 million people) shows a similar result:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066051/figure/F...](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066051/figure/F1/)

Looking at either side of optimal BMI: People with a BMI of 26 (BMI 25-30
'overweight') have mildly better survival than those with 21 (18.5-25
'normal'). Push BMI up a little bit to above 28 and death rates are worse than
with a BMI of 21. Not a huge paradox. Maybe we should just shift 'normal' BMI
range to 20-27.

------
Grue3
And low birth-weight children born to smoking mothers have a lower infant
mortality rate than the low birth weight children of non-smokers [1]. Clearly
that must mean that smoking while pregnant can "protect" your baby, and
totally not a misuse of statistics.

[1] [https://en.wikipedia.org/wiki/Low_birth-
weight_paradox](https://en.wikipedia.org/wiki/Low_birth-weight_paradox)

------
MrPatan
You can't write reality into compliance.

But you can make a lot of money failing.

