Tag Archive for: overweight

The Price of Obesity

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Continuing with comments made by Bill Maher, he suggests that the prevailing thought is that we can be healthy at any weight. Companies have embraced that thought with workout gear and other products featuring oversized models. Maher then goes on to talk about the ill health associated with being obese. Type 2 diabetes, cardiovascular disease, and cancer are associated with excess body fat. He says being overweight can compromise the immune system and cites statistics on the impact of COVID-19 on people who are obese. I checked them out, and he’s correct as it relates to hospitalizations, ICU placement, and mortality.

Fat and Fit Updated

I have repeatedly made the case that a person could be fat and fit if they exercise at a high level. That’s what the data from the Cooper Clinic demonstrated, and so did my doctoral research. I then add that it doesn’t matter—because very few people could or would do the work necessary. And that was correct, too.

But at 71, I think I was too optimistic in my recommendation even though that’s what the data suggested. The reason is that it’s difficult to maintain a high fitness level the older that you get. What’s possible at 30 years old is not at 50, 60, or 70 years old. The aging body changes.

The Price of Obesity

The cost of obesity is high. You may not have high blood pressure at 250 pounds while you’re younger and fitter, but you’re taxing your heart and cardiovascular system to sustain it. You may delay pre-diabetes and have perfect blood work—for now. And there’s a cost to your joints that may not be realized for decades, but when it hits you, you’ll find your world has shrunk because there are things you simply can’t do any longer.

I’ve been a runner for decades, but those days are over. I wonder if I had decided a decade or so earlier to lose weight and sustain 175 pounds instead of 225 whether my knee would have sustained less damage. Carrying 50 extra pounds generates forces up to ten times greater; that certainly has an impact on hips, knees, ankles, and feet.

Life Is a Struggle

Maher talks about how difficult it is to lose weight. There’s no question that it’s a struggle, but that’s no different than any worthwhile goal. It’s hard to get the weight off and difficult to keep it off. Even as the expert, I know that one well. Life is a struggle.

There is a commercial that we see repeatedly with an overweight woman in her 20s who is walking out her front door to go jogging. I think it’s powerful because she asks herself “What if a sprain my ankle?” and closes with her finishing her run. She’s at the perfect age to add the other components of eating better, eating less, and getting to a weight that is less taxing to her body. That’s aging with a vengeance in action.

The Bottom Line

I’m completely in favor of fat acceptance when it means loving and accepting those around you no matter their size. But if you see people you love trying to exercise and eat healthier, you can quietly let them know you’re rooting for them and will help in any way you can. Let’s not kid ourselves: it’s not the healthiest way to live, and sooner or later, we’ll pay the price.

Maher is a keen observer of the human condition and can be caustic in his commentary. But I think he’s got the tone and tenor just about right in his close:

“And that’s the saddest part. We can do this—I think. But by lying about it and making excuses, psychologically it’s telling ourselves that letting ourselves go is the best we can do. And I gotta believe that as Americans, we can still do better than that.”

What are you prepared to do today?

        Dr. Chet

Reference: https://www.youtube.com/watch?v=yfiWjnStE3w

Feast Mode!

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Comedian and political satirist Bill Maher has been one of my favorites since his first show Politically Incorrect aired over 20 years ago. He is also an outspoken critic of our nation’s health: it’s poor and getting worse. On a recent show, he used the term Feast Mode and explained why it’s a problem.

Feast Mode used to be going on vacation and eating whatever you wanted. It also used to be reserved for holidays such as Thanksgiving where you intended to overeat and then went back to a healthier way to eat, if not in the types of food, at least in the quantities. He suggests that Feast Mode now extends all year long for most Americans. I agree and have the numbers to prove it: close to 70% of us are overweight with 41.9% now classified as obese.

He goes on to talk about the politics of obesity, comparing the psychology of fat shaming to celebrating our fatness. No one should be shamed for being overweight, but that doesn’t mean that it’s healthy to be fat. He suggests that science gets re-written to support what you want it to be instead of reality. I would correct one thing: social science might get re-written, but hard science is based on hard numbers—and however we may feel about it, the number on the scale is the number on the scale. We’re not quibbling about five pounds here; we’re talking about 50 or 100 pounds or more beyond a normal weight.

The question is what does Feast Mode cost? I’ll cover that on Saturday.

Tomorrow night is the monthly Insider Conference call. I’ve got a couple of topics related to dietary supplements to cover and then I’ll answer Insider questions. Become an Insider before 8 p.m. tomorrow and join the discussion.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

Triathlon Observations: Prepare to Compete

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Let me be clear: I think that the single most important thing that you can do to be healthy is to exercise regularly. Whether walking, swimming, or one of the hundreds of other types of exercise, talking with your physician about it may be all that’s required for you to get started.

Moving from exercise that helps your health to competing in fitness events requires more—that’s independent of your body weight lest you think I’m talking only about the very heavy people that competed in the triathlon. Here’s what I recommend.

First, you should have a stress test that assesses how your heart and blood vessels perform under maximal conditions. That applies to men over 40 and women over 50, for sure. But I also think if you have been overweight for over five years, you should have the test regardless of age. The maximal exercise test is not foolproof, but it’s the best available predictor of heart problems. This isn’t just me being a worrier; I’m sad to report that one participant died of a heart attack last Sunday. Getting checked out before you start is the best way to protect yourself.

Second, you should have a complete lipid profile, HbA1c, and a blood insulin test as a minimum. As I suggested in Thursday’s memo, you need to know whether you’re a prediabetic or even an undiagnosed type 2 diabetic. The best option for you would be to exercise, but when you push yourself hard for long periods of time, it’s going to affect your blood sugar levels as it would affect a diabetic’s, not someone who has a normal carbohydrate metabolism; for instance, you could pass out if your blood sugar gets too low, and if you’re out alone on a run, that’s a problem. You can deal with it, but you have to know if it’s an issue.

Third, you should get an orthopedic analysis. By that I mean that your joints should be evaluated for range of motion, tendon and ligament stability, and gait. Swimming affects the shoulders, bicycling the lower back, and running the hips, knees, and feet. Any abnormality will be exacerbated; for example, the forces you create when you run is five times your body weight. Do the math—that’s a lot of stress on your knees and feet.

Once you get the all clear, get after it. Start conservatively but if you have the urge to compete to see what you’re capable of, do it. I think if you want a challenge, whether to walk or run a 5K, swim a mile, or bike 50 miles, or combine them into a single event such as the triathlon, you should do it. Just make sure you get your body checked out before you do.

Final Observation

While I believe exercise is important no matter the level at which you do it, exercise won’t help you lose a lot of weight. Surprised? Remember the size of the people I mentioned that competed in the triathlon—not just overweight but obese? If they had put in the training, and I know some of the competitors and know that they did, you’d have thought they would have lost a significant amount of weight. They didn’t.

Burning calories helps with weight loss, but as a well-known expert once said “Americans can’t out run their appetites.” If you could exercise six or eight hours a day, you could probably lose weight without changing your diet, but I doubt you have that kind of time. You can use exercise as a tool to help you lose weight, and exercise pays major benefits in fitness, strength, and stamina. But you will not lose weight unless you also eat less and eat better.

What are you prepared to do today?

Dr. Chet

 

Triathlon Observations: Heavy and Healthy?

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The major observation I had as I volunteered at the Grand Rapids Triathlon was that the body weight distribution of the people participating in the triathlon mimicked the population of the U.S. We’re a fat nation; 70% of the population is overweight and half of those are obese. Those percentages also seemed to apply to the participants in the race.

In addition to being a regular Grand Rapids event, the Grand Rapids Triathlon was also the National Championship for the Clydesdale and Athena athletes. In order to qualify for the Clydesdale division, men must weigh over 220 pounds; for women to qualify for the Athena division, they must weigh over 165 pounds. Based on my observations, a majority of the participants would have qualified for that category, whether that was their intention or not.

There were men well over 300 pounds and women over 250 pounds that participated in the triathlon. Talking with several other volunteers, I said that unless they had a signed release from their physician, I would hesitate to let them participate. They countered that as long as people put in their time training, they were fit enough to compete. Good point, but that logic doesn’t really hold up. The primary concern everyone thinks of is cardiovascular disease and that makes sense. But if someone is overweight, the real concern is undiagnosed type 2 diabetes and orthopedic stress.

While I applaud their effort and would never want to prevent anyone from exercising, I would hope that they would have had a thorough medical exam before they took their first step. We can’t assume because they had trained for the race they were actually healthy enough to compete in the race. I’ll cover what those tests should be and a surprise conclusion that you don’t want to miss on Saturday.

What are you prepared to do today?

Dr. Chet

 

The Truth Behind the Obesity Paradox

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In my opinion, the short answer to the obesity paradox is that it doesn’t really exist. But what fun would that be? That doesn’t teach you anything. Let’s take a look at the problems with the research that contributed to this paradox.
 

Study One: Dialysis, BMI, and Mortality

A study of dialysis patients led to the first observation that people with higher BMIs lived longer (1). After tracking over 1,300 subjects on dialysis for a year, researchers found that those who were overweight had a decreased risk of dying and had fewer hospital stays when compared to those who were underweight. This may have been the study that yielded the name The Obesity Paradox. The problem? The study lasted only one year. Trying to generalize what will happen to all overweight and obese people on dialysis from a study that lasted only one year and at only a single location isn’t realistic. It raises an intriguing question, but we’ll need a much more extensive study to really make a solid prediction.
 

Study Two: The Rotterdam Study

I described this study on Thursday (2). While the study appeared to show a protective benefit from being overweight or obese, the subjects were elderly with an average age of 77 at the study’s beginning. One risk factor that you cannot change is age: the older you are, the more likely you are to die. But that’s not the whole story. We can probably say that older people may live longer with a little extra weight, but to extend that prediction to all age groups isn’t valid.
 

Study Three: BMI and Mortality

While this study claimed to analyze the data on over two million people, it was still a meta-analysis (3), which doesn’t yield cause and effect, just a statistical association. Further, they used studies of varying lengths without necessarily knowing exact causes of deaths. They also did not have precise BMIs on everyone; some studies included metrics such as BMI under 27.5 and over 27.5. They tried to include the highest number of subjects, but the quality of data varied and that made it a mess. Researchers chose too many different types of studies in the meta-analysis, and it just doesn’t work. I wouldn’t bet my life on it.
 

Study Four: A Broader Look

The real problem with every approach is the lack of acknowledgement that people with advanced disease may have lost weight before they were included in the study; diseases such as heart failure, diabetes, or renal disease will often lead to weight loss. Those who were heavier when disease hit had the benefit of extra energy stored as fat to deal with the disease, and that could explain the outcomes of those studies. It had nothing to do with being obese; it was a matter of timing.

A study published last month appears to confirm that (4). Researchers in the Cardiovascular Disease Lifetime Risk Pooling Project obtained data from 10 different longitudinal studies, including individual-level data and accurate mortality data. They found that as BMI increased, the death rate from all forms of CVD increased. For those who carried extra weight while younger, CVD occurred earlier, making it more likely they would die before their time.
 

The Bottom Line

As I said, there really is no obesity paradox. Being overweight or obese carries with it risks of degenerative disease. Some people may have better genes and may gain protection for a few years. But in the end, being overweight or obese carries a higher risk of various diseases than the limited protection from an advanced disease you may gain by carrying extra weight. So my advice is the same as it always was: if you’re overweight, your best bet for a long, healthy life is to lose it.

What are you prepared to do today?

Dr. Chet

 

References:
1. Kidney International, Vol. 55 (1999), pp. 1560–1567.
2. European Heart Journal (2001) 22, 1318–1327.
3. JAMA. 2013; 309(1): 71–82.
4. JAMA Cardiol. doi:10.1001/jamacardio.2018.0022.

 

Does a Little Extra Weight Keep You Alive?

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The Rotterdam Study was begun in 1991 to investigate the risk factors of cardiovascular, neurological, ophthalmological, and endocrine diseases in people 55 and older (1). The study is still ongoing, but periodically subsets of subjects are examined to find out which characteristics are associated with these diseases. In a study published in 2001, researchers reported on a group of subjects who were diagnosed with heart failure at the beginning of the study and followed for an average of six years—181 out of over 5,000 subjects. By the end of five years, 85 subjects had died. One of the observations that researchers noted was that a higher BMI was associated with reduced mortality; in plain terms, the heavier people were more likely to stay alive.

It didn’t stop there. In 2013, a study was published that directly examined the relationship between BMI and mortality (2). This meta-analysis included 97 studies and examined more than 2.88 million participants and more than 270,000 deaths. They reported that while grades 2 and 3 obesity (grade 2: BMI of 35-39.9; grade 3: BMI more than 40) were associated with increased mortality, grade 1 (BMI of 30-34.9) was not, and the overweight category (BMI of 25-29.9) actually showed a reduced risk of dying. (How do you rate? Check your BMI here.)

Is this true? Is body weight not associated with an increased risk of death? Have we been trying to lose weight for no reason? I’ll finish this on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. European Heart Journal (2001) 22, 1318–1327.
2. JAMA. 2013 January 2; 309(1): 71–82.

 

What Is the Obesity Paradox?

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Did you ever hear something that didn’t seem to make sense? That seemed to go against everything you thought to be true? One example of this is something called “The Obesity Paradox.” I’ve seen a few headlines this week that have talked about it, so it’s time to address it in the Memo.

One of the variables that we would think is related to the development of cardiovascular disease would be body weight. It seems logical: as weight increases, so does the strain on pumping the blood through the additional blood vessels required to feed the extra fat and muscle. People who are overweight may eat the wrong foods, consume too much food, and move too little.

But since the early 2000s, several studies have been published seeming to show that body weight wasn’t necessarily a risk factor for CVD or an early death. They showed that those who were overweight, a BMI between 25.0 and 29.9, had lower mortality rates than those who were normal weight. Some showed that stage-one obesity, a BMI between 30.0 and 34.9, was also not related to mortality. Thus the term “The Obesity Paradox” was coined. But is it true? We’ll take a look at the research the rest of the week.

What are you prepared to do today?

Dr. Chet

 

Santa, Rudolph, and Merry Christmas!

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The final question about Santa Claus has to do with his girth. How can he deliver gifts all over the world in one night while being so heavy? Here’s something that we all need to understand: just because people are overweight, that doesn’t mean they can’t be fit.

Fat and fit? You better believe it. The problem is that we have so few heavy people who move into a high fitness category. But if they do, they can be fit according to a classic definition of fitness: the amount of oxygen used per kilogram of body weight per minute. Santa most likely qualifies; he must work out hard in the off season.

Would it be better to be leaner? Probably but remember, he’s a fictional character. I think we need to worry more about ourselves. But that’s a Memo for another time.

Rudolph’s Red Nose

I got a great question related to this week’s Christmas theme: why is Rudolph’s nose red? I couldn’t pretend to figure out that one, but wouldn’t you know it, someone else did. You can read about it in this news release from Johns Hopkins faculty and staff (1). They also diagnose the Grinch’s heart and explain how Scrooge could travel through time. The writing isn’t excessively scientific, so it might be something you could share with the older kids in your life who’ve grown skeptical about the magic of Christmas.

The Bottom Line

We hope you had fun with this week’s Memos. Health news can be overwhelming. As you prepare for this holiday, safe travels, and enjoy the time with family and friends. I’ll resume the Memos next Thursday with some ideas for your 2018 health goals.

From Paula and I, Merry Christmas, happy Kwanza, happy Dhanu Sankranti, we hope your Hanukkah was happy, a belated Happy Mawlid al-Nabi, and Happy Holidays to everyone! If we missed your holiday, let us know and we’ll be sure to include it next year. What’s important is that we all enjoy our holiday festivities and our family and friends, and we get to eat our special holiday foods.

What are you prepared to do today?

Dr. Chet

 

Reference: http://releases.jhu.edu/2017/12/04/johns-hopkins-scientists-explain-rudolph-grinch-scrooge/

 

A New Commitment

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The numbers are in and the U.S. is fatter than ever: 39.6% of all adults over 20 years old are obese based on the Body Mass Index. That’s a rise of close to 2% since 2015, the last time the statistics were released. This isn’t affecting only adults; children 2–19 are also fatter than ever with 18.5% now considered obese. If we throw in those who are overweight, more than 70% of the population is fatter than ever.

I could review the causes, from refined carbohydrates to chemicals with estrogenic properties. I could talk about all the diets that could help. I could talk about supplements that may help to give people an edge. I’ve done that all before. There’s no single diet nor exercise program nor supplement that works for everyone. We all just have to find our own way. Instead, I’m going to tell you a story and issue you a challenge.

One of my best friends for the past 30 years, Dick Heller, died last week; he’d fought off cancer several times, but it finally got him just before his 80th birthday.

Dick and I were professors together in Buffalo. He was an excellent swimming coach and a competitive swimmer throughout his life. He was also a great teacher, especially when it came to helping people change their habits; he would help people identify what they wanted to achieve in the health and fitness classes he taught, have them write it down, develop a plan, and track the progress. Their grade was not based on how they compared to others; it was based on the goals they set.

To honor Dick, Paula and I are going to use that approach as we continue to improve our diet. Getting enough vegetables is a particular problem so we’re going to add at least one serving per day, every day, until it becomes a new habit.

Here’s my challenge to you. Pick one small health habit you want to improve, write it down, and start doing it every day until it becomes a new habit. Whatever small habit, if done repeatedly, that will help you achieve your goal. It may be related to your weight because, like I said, 70% of us are overweight or obese. It may be a different health goal. If people you know have died because of a health challenge, do it to honor them.

Identify. Write it down. Plan. Execute. Evaluate. I can’t think of a better tribute to Dick than that.

What are you prepared to do today?

Dr. Chet

 

Reference: https://www.cdc.gov/nchs/products/databriefs/db288.htm.

 

Normal BMI but Still Too Fat

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Last week the health headlines shouted “Study Shows Over 90% of All Americans Are Overfat!” The rate of overweight as assessed by Body Mass Index (BMI) is already 70%; now scientists want to say even more people are too fat? What’s going on? I’ll explain what overfat means first and then tell you about the study behind it.

For the most part, the greater the BMI, the greater the risk for cardiovascular disease, prediabetes, and hypertension. For those of you who aren’t sure of your BMI, check out your BMI in the Health Info section of our website. And if you think you’re just big boned, we show you how to prove it.

But there are people who have a normal BMI under 25.0 but still may be overfat. Considering Waist Circumference in addition to BMI may help but that could still miss some people. How? They may have lost muscle mass; the subtle loss of lean muscle with a gain of fat could lead to overfatness. That increases their risk for the diseases I mentioned earlier.

Here’s the most common example of someone who has a normal BMI but is overfat: a very sedentary elderly person who looks slim, but has very little muscle. As the saying goes “use it or lose it” and they’ve lost it.

A clinician from Arizona has taken it upon himself to redefine the terminology associated with excess body fat. He claims that overfatness gets missed in too many people. The problem he sees is that people who could begin treatment with diet, exercise, and medication if necessary are being missed. He outlined his arguments in a paper published in January 2017 (1), but it was his paper published in July that lead to headlines (2).

He and his co-authors examined the BMIs of people in countries all over the world. Using prior studies that estimated the number of normal-weight people who are overfat, ranging from 9.7% to 20%, he then applied that to the normal-weight populations (as assessed by BMI) in the top 30 developed countries in the world. That’s how they derived the headlines of over 90% overfat—not just in the U.S. but also New Zealand, Iceland, and Greece as well. To be fair, this applied only to males. Don’t rest on your laurels, ladies. All the same countries were greater than 80% for females.

 

The Problems

There are three with his approach in my opinion. First, adding another definition to replace BMI doesn’t really help people or their physicians as he implies. Confirming a person with normal BMI is overfat would require a more advanced exam or assessment of body fat. I’m not sure that’s practical.

Second, I looked at his work from every direction and couldn’t get the numbers to work. If 70% of Americans are overweight or obese and you add 20% of the remaining 30%, it adds up to 76% not 90%. Even if the numbers worked, the statistic would apply to a physician’s total number of patients. There would be no way to identify who is overfat without additional testing.

Third, there’s another group that needs to be addressed, and that would be those who are overweight according to their BMI but are metabolically healthy. In fact, that’s a significant problem today. Even after losing over 30 pounds, my BMI is still in the overweight category. By every test of metabolic fitness—blood pressure, cholesterol, HbA1c, or insulin—I’m at no additional risk of heart disease, yet I’m still classified as “at risk” due to my BMI. I think that’s a greater issue and will be more so as healthcare gets debated. Is your BMI over 25? You’ll pay more, even if your test results are stellar.

 

The Bottom Line

I agree with the concept that the author put forth: there are people with normal BMIs that are overfat, and they’re at greater risk for CVD and metabolic diseases. But new definitions aren’t necessary. What is necessary is identifying who is at risk. That will only occur when doctor and patient meet face to face. When was your last doctor’s appointment?

What are you prepared to do today?

Dr. Chet

 

References:
1. Front. Public Health 4:279. doi: 10.3389/fpubh.2016.00279.
2. Front. Public Health 5:190. doi: 10.3389/fpubh.2017.00190.