Being a skinny is much more unhealthy than being fat – new study Yet another study has shown that the so-called "obesity" epidemic sweeping the wealthy nations of the world has been massively over-hyped, as new results show that is is far more dangerous to be assessed as "underweight" than it is to be assessed even as "severely obese" - let alone merely "obese" or "overweight". "There is …
Did you not read the part where people who are underweight (by BMI) are TWICE as likely to die as 'normal' BMI people, and that severely obese people (again by BMI) are only 25% more likely to die than people with a normal BMI? That is, its actually healthier to be overweight than underweight?
The part you are referring to is that the 25% extra risk of death for severely obese people are down to 2 causes - diabetes and hypertension.
Maybe you should read the article before opening your mouth and making a tool of yourself...
Yes, but as Diabetes is a major cause of death for fatties, removing this factor is pointless..
Can we remove those that are anorexic or bulimic from the underweight figures, so that we can show that thin people are less likely to be malnourished. Hint: you can be massively overweight and still suffer malnutrition.
"the now widely discredited Body Mass Index (BMI) system..."
Yes, with your logic so far for once, Lewis
"Jerant and his colleagues, surveying nearly 51,000 Americans of all ages over a period of six years, found that "underweight" BMI was far and away the most dangerous category to be placed in."
Oooohhhkkkay.... BMI is shit, and here's a study that uses it to show something.
Seriously, Lewis? Really? And this is worth your time writing an article around?
I've always based my opinion on the 'which is healthier' debate on the number of fat old people I see wandering around. Not many, because they're all dead of heart disease or worse.
Removing diabetes and hypertension from the list is like saying "hey, if we ignore the risk of falling to your death, jumping along a rope bridge over a shark tank on a pogo stick is no more dangerous than sitting in your armchair".
Fat kills, and diabetes and heart disease are the ways it does it.
To be fair, the report is removing diabetes and hypertension from the fatty risk factors to establish whether fatties have any other risks. Basically the conclusions from the report are:
1) It is really incredibly unhealthy to be underweight. Twice as unhealthy as average in fact. The report doesn't seem to identify the risk factors for why it is unhealthy to be underweight.
2) It is not unhealthy to be overweight or obese. Not at all.
3) It is definitely unhealthy to be morbidly obese. But not as unhealthy as being underweight. 1.25 times as unhealthy as normal. The entirety of the unhealthiness seems to be explained by diabetes and hypertension. Note that the study does not claim at any point that diabetes and heart disease don't kill fat people. In fact, all the study does at this end is state very clearly that it believes they are the primary killers of fat people.
Incidentally, I'm not in the least bit surprised by finding (2). The well known problem with BMI is that you expect weight to be proportional to volume, not area. BMI normalises with the height squared as a proxy for area, not height cubed as a proxy for volume. As average heights have increased BMI has become increasingly useless. My own personal example is intuitive. When I went through initial officer training in the RAF, my BMI was officially over 29. According to my BMI I was very overweight and borderline obese. I was also exceptionally fit. I could run a 4 hour marathon carrying a 15kg rucksack.
I would be very interested to look at the raw data behind this study. Specifically looking to see whether there is any height bias in the results. It wouldn't surprise me for example to find that if you use an adjusted BMI based on height cubed if you got a better predictor of unhealthiness at both extremes.
According to the study...
The mortality rate of 'Underweight' people as a whole is 200% that of 'Normal' people.
The mortality rate of 'Severely Obese' people as a whole is 125% that of 'Normal' people.
The mortality rate of 'Severely Obese' people (excluding those with diabetes etc) as a whole is 100% that of 'Normal' people.
Don't get hung up on the diabetes bit - the study clearly states that Severely Obese people face better odds than Underweight people. If true - that is, if we can find no other mitigating factor - this is a significant observation.
I calculated my BMI recently, now I am a slim guy who barely has any fat on me, I do martial arts in my spare time and keep fit.
When I calculated my BMI it put me right at the upper end of "Normal" practically into "overwieght".
Given this study is talking about those who are considered underwieght by BMI, you would have to be extremely starved with a massive eating disorder to even reach that point.
Hardly surprising really.
That's where the BMI runs off the tracks. If you have amassed a lot of muscles for instance, you will have increased your mass, but your fatty tissues may have decreased. As such, BMI will put you on a higer plane. I happen to be on the lower side of normal, because I'm a skinny girly-man with t-rex arms...
BMI is only valid for sedentary people, ie: people with no muscle mass beyond that acquired in an office lifestyle with no external exercise. Unfortunately in the UK it's been given way too much prominence in welfare and medicine.
The underweight stuff is also bollocks for people of different ethnic backgrounds.
My brother used to cycle about 250miles/week. He told me of walking into a doctor's office and have the doctor, without looking at him, start the conversation with "well, we'll have to do something about your weight", looked up at my skinny, short brother, looked down at report, drew a line through it....
I didn't see any mention of age being factored in. I know plenty of obese people in the 18-60 range, but I don't know a single person over 80 that is obese, yet they are far more likely to die over the span of the study just due to their age. In my experience obese people are lucky to make it into their 70's let alone 80's or 90's.
"people who are underweight (by BMI) are TWICE as likely to die as 'normal' BMI people, and that severely obese people (again by BMI) are only 25% more likely to die than people with a normal BMI?"
Yes, but as correctly pointed out by the article the BMI index is crap because it basically says taller people are more overweight (and average heights have been consistently increasing since last century when the index was developed). With a 'true' index, people with 'underweight' BMI are probably severely underweight in reality, and people with 'overweight' BMI are probably at their healthy weight in reality. So what the study is REALLY showing is that it's more dangerous to be further out from your ideal weight at both ends of the scale, than it is to be only a bit out.
DUH!!!
Self reporting. I understand its commonplace for GPs to test for diabetes in obese patients because of known higher risk. Mild diabetes is not at all uncommon and not necessarily strongly symptomatic so its quite possible that normal/overweight people are less likely to know they have the problem (my conjecture, I don't know if this is scientifically understood).
Add in acoholism and many other factors, this kind of 'research' methodology is open to many holes that would invalidate conclusions.
I't absolutely no evidence to support my hunch that the study or it's authors are somehow involved with the fast food industry, one of the most powerful lobby groups in the western world. Much that we see and hear is engineered in this way.
"Jerant and his colleagues, surveying nearly 51,000 Americans of all ages over a period of six years, found that "underweight" BMI was far and away the most dangerous category to be placed in."
Could that be because ill and seriously ill people are often very underweight, for reasons unrelated to eating, and that in a set of 51,000 people a significant number will be in that unfortunate condition ?
I like the contrarian attitude when it is part of a reasoned challenge to conventional wisdom. However, I just smelled this one was going to be a troll and seeing the author, I didn't bother to read farther.
There are two assets of a journalist: credibility and Integrity. They have to be nurtured, but at this point I don't believe in the truth value of anything this guy says and wouldn't believe his personal testimony that the sun will rise tomorrow.
Why take Mr Page's word for it when you could follow the link to, what I assume is, a peer-reviewed journal?
The findings are in sympathy with a study I read an abstract of more than ten years ago: that when a women's attractiveness is plotted against their weight, the graph has the same shape as her health against weight- both peak in the same place, both drop off sharply if she is slimmer than the healthiest weight, but only decrease slowly if she is bigger than the ideal weight.
If you consider your Kelly Brooks and Sophia Lorens compared to your usual catwalk clothes-horses, it makes sense.
Dave: "Why take Mr Page's word for it when you could follow the link to, what I assume is, a peer-reviewed journal?"
Because the problem isn't with the study, which appears to be reasonably well-designed and draw sensible conclusions, but with Lewis' utterly batty derivation from it. He seems to be assuming that the incompetents he believes are generally running everything had no idea, until this BRILLIANT and SHOCKING piece of research, that being underweight was a really bad thing. The problem is, they did. Ask any health professional and they'll tell you. It's not as if the risks of bulimia / anorexia and so on are exactly unknown or under-publicised.
The reasons that, overall, obesity gets more focus / attention are pretty bloody simple and not affected at all by this study. One, there are a lot more obese people than underweight people. Two, obesity is much more 'normal'; people who are obese occasionally have really serious physical/mental problems, but usually they're just the usual 'eat too much, don't exercise enough' suspects. Obesity is much more susceptible to being addressed by general hectoring in the press, tweaking of policies on food tax and labelling and exercise, and mild intervention in the course of GP visits and that sort of thing.
People who are underweight are much much more likely to be suffering from a serious medical condition. You can't really put out a press release saying 'there's an anorexia epidemic! People should eat more and puke less!' and expect to get anywhere. They're utterly different issues subject to utterly different approaches. Lewis and zillions of others love to believe that The Government, health professionals, and really everyone but them is either incompetent, hoodwinked, evil, or otherwise Resistant To The Truth, but sadly for them, the fact is that health professionals do actually know what the hell they're doing most of the time. I know that doesn't make such a sexy story. Sorry, Lewis.
Same here. Overweight and have to work to keep it down to that, but my doctor assures me I am fitter than a lot of much thinner people.
As opposed to my brother who developed Chron's Disease a few years ago and is very thin and unwell, though getting better since the diagnosis allowed the condition to start to be managed. I offered to donate my body-fat to him for a transfusion, but they don't do that, apparently :-(.
And therein lies a potential source of huge bias in the study: there are plenty of serious diseases (Chron's is just one, there are many others e.g. emphysema, some cancers, some thyroid diseases, some heart diseases) which make people thin. Those serious diseases can significantly reduce the life expectancy of the sufferer. So what the study *may* be showing is that thinness is an indicator of existing serious life-threatening disease, not that thinness is in itself in any way causal.
I'm not 100% convinced of the utility of BMI for the reasons Lewis points out above - when I tell people HOW heavy I am most don't believe it - I must carry it well!
Am I overweight? Well, according to my BMI measurement I have to lose 9 stone to get to a 'normal' level - and let me tell you if I did I'd look like I'd just escaped from a concentration camp, yet this is the measurement doctors use to classify you (and other medical tests like life insurances).
Surely there's a better way to measure this? Build types (I'm quite wide across the shoulders, not something that is measured by BMI) should be taken into account.
Overall? I'm a fatty.
Skull and crossbones, cos I'd be a skeleton at my perfect BMI.
I can't agree more.
Other studies say that a good percentage of us will also get Cancer. I was diagonsed with Leukaemia a few years ago. My doctor said that thanks to me being overweight I'd have a better chance of surviving than if I'd been underweight. I lost 5st in fighting the disease. If I'd been a skinny person where would those fat reserved used by the body to help fight the disease come from then?
And tomorrow another study will tell us that we are all living in a dream.
There are certain recognised body types, you sound like an endomorph or mesomorph (http://www.muscleandstrength.com/articles/body-types-ectomorph-mesomorph-endomorph.html)
The whole BMI thing is crap. at 6' 6" and about 16.5 stone, I'm overweight. Not badly, but still overweight. I work as a web developer so I'm generally not that active during the day, but I also train in powerlifting, go climbing regularly and have a 30" waist, so not a lot of it is excess fat. Still, doctors recommend that I lose weight.
It should be based on a combination of height, body weight, body fat percentage and body type, as well as various blood markers.
Yes, but statistically at 6'6" and a powerlifter, you're an outlier anyway. If you're just saying "BMI is a crock because look, the numbers don't work for Peter Dinklage or Yao Ming", then you're missing the point. The point of BMI is that it's easy to calculate and for most people it'll give a reasonable answer.
If a doctor's recommending you losing weight, they *should* be looking at body fat percentage. If they just base it on BMI, you've got a bad doctor.
One of the best ways to figure out whether someone is fat or not is girth measurements. A friend of mine told me recently that an insurance company measured his girth around his gut and another girth around his arse. They considered gut > arse to be overweight and gut < arse to be normal. Obviously the same measurement doesn't work for women, but I believe similar tests exist.
To make BMI more useful you should switch to a measure called RI (Rohrer's Index - http://en.wikipedia.org/wiki/Rohrer%27s_index) which is weight divided by height cubed. It has been shown (in peer reviewed journals) to have a more linear relationship to health and health care factors. I suspect the ideal measure is actually somewhere between the two. It should be relatively easy to figure out an ideal measure though. If diabetes and hypertension are the predominant factors that affect fatties, just perform a regression analysis against weight/height^alpha and see what the best fit coefficient is. My suspicion is you will find somewhere around 2.5 < alpha < 3.
Well when I was 20 or so I was still nearly overweight despite having very little fat.
Now I have ballooned out through inaction and two operations with recovery time in one year I am heavier than ever. Yet I can walk fine. I do not eat much, healthy diet, just that programming is not a muscle using job.
Well, lets put the health aspect aside, as mentioned, if you remove all unhealthy people from the obese sample they are doing fine. I am sure the skinny ones also do fine if you account for aggravating circumstances, such as eating disorders or chemotherapy.
But who is happier? The fat ones surely have lots of hunger hormones and get a different kick from eating, but the stairs are surely more fun for us small guys.
And stop worrying your your weight! Yes, Lewis, I am looking at you!
I have been hitting the gym hard this year and lost 2" round the waist. My BMI has changed from overweight to obese. (Not as obese as Schwarzenegger or Stallone of course.)
The best simple guide I have found is waist measurement should be less than twice height. (I still need to be two inches taller :( )
There are many factors that make up weight, BMI just serves to scare people into acting and doesn't do a very good job at that.
We all got to die sometime, some with be in agony because they chose to live an unhealthy existence, some will slip quietly away and the rest because they kept nagging about housework...
This study is all very well, but it doesn't take into account quality of life.
I'm sure it's a great consolation to the "blobs" that they will live as long as ordinary-sized people. But what will their lives be like? Will the enjoyment factor be the same for someone who is able to lead an active life: kicking a football with their kids/grandchildren, as it is for those who can only sit on the sofa and watch TV?
Similarly, if it takes you 10 minutes to recover from walking upstairs, will you have the same optimistic, happy, positive attitude as a slimline version of you who bounds up them; two at a time?
So while life expectancy may well be the obvious factor in the fat vs. thin debate, the ability to enjoy your allotted time is just as important.
If, as the author asserts, BMI is a largely useless measurement (which I am inclined to agree with) then you can't also say "being skinny is much more unhealthy than being fat".
Firstly, body weight is NOT necessarily linked that closely to "fatness" (which is partly why BMI is a crap metric). You can be skinny and also have a fairly high percentage of body fat; you can also be heavy and have a low or normal percentage of body fat (e.g. many athletes). Further, two skinny people with the same % body fat could still have different health levels - one may exercise regularly, the other not; one may smoke, the other not, etc. The same applies to people at the other end of the BMI scale.
So yes, BMI is a fairly useless measure. And therefore the conclusion in the headline isn't really accurate.
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I think you may be confusing correlation with causation. Underweight people are probably underweight due to an underlying pathology; that is, they're already ill. Overweight people are likely to be overweight because they eat too much but are otherwise healthy... for the time being.
Thank you so much for saving me a few mins and putting my exact thoughts to "paper", I wonder how many "thin" people happened to be drug users too... Surely if you are going to start removing sample data (diabetics as an example) then why not remove drug users, alchoholics etc. Also how do these thin people die? Does every fat person die of a heart attack but the thinnies are all dieying of old ages becasue it just so happens that 90% of the thin cohort are all over 90?
The 'obesity epidemic' isn't a problem of mortality rates.
It's a crisis because of the massive public healthcare costs associated with managing / treating morbidity from chronic (long term) illnesses, most of which are preventable through sensible lifestyle choices. Most of which also happen to limit obesity.
Nobody in the public healthcare sector worries if you die quickly & cheaply.
Possibly because 'underweight' is a bucket from 0 to 18.5, whereas overweight, extremely overweight and obese is nicely graduated. Crunch the numbers again with underweight being 15-18.5, very underweight being 12-15, and skeletal being <12, and see if being merely 'underweight' increases mortality...
All of these measures are only pointers. You could be at your ideal weight, but be a heavy smoker and not do any exercise, and you will die early. You could be 9 stone overweight because you are a shot-putter, and not die early. You could be fat and still be able to run a mile, or you could be thin and fall over at 200 yards due to your congenital heart condition making you weak as a kitten. Eat a sensible diet, try and do some vigorous activity and don't smoke or drink a lot and you will probably have a good long life.
Live healthily and your body will find it's own equilibrium, which may not be the same as somebody else's.
Having a look at the abstract, they've just lumped everyone below "normal" into the "underweight" category. There are several underweight categories (very severely underweight is <49kg, severely underweight is <52kg, underweight is <60kg, normal being 60-80kg), just like there are several overweight categories. Of course you'll find that being "underweight" is bad for you if you decide to treat "a couple of kg below normal" in the same way as "malnourished & anorexic" for statistical purposes.
Also, if you're going to decide that the only concerns about obesity are medical conditions that result in death, you're going to miss out (at all points on the spectrum) being able to compare relative actual health, especially when (and here's the important bit) the entire study is based on self-reported information. This wasn't monitored, they weren't checked for other conditions that might relate to their body mass, they just got "A self-administered questionnaire includ(ing) items about respondent smoking and health conditions."
There are problems with BMI, and bigger problems with how parts of the medical establishment use it, but this study is far from the Smoking GNU Lewis misrepresents it as being.
Goddamn it: And there was I trusting Lewis to highlight any minor issues with the paper regardless of if they backed up his pet theories or not, in the name of good journalism. He has failed me, and my confidence is shattered. :o(
The moral panic was never really about obesity in the first place. That was all just a convenient excuse.
It's about making people feel guilty by convincing them that they have made bad choices, so that they will be less reluctant to give up the freedom to make those choices.
The Government want to be able to tell you what to eat (actually, they want to be able to tell you what to think, but telling you what to eat is just one small part of that). People -- quite understandably -- don't want to be told what to eat. Therefore, the Government have to engage in various levels of subterfuge, until people are ready to crawl through broken glass begging to be told by the Government what to eat.
'The moral panic was never really about obesity in the first place. That was all just a convenient excuse.
It's about making people feel guilty by convincing them that they have made bad choices, so that they will be less reluctant to give up the freedom to make those choices.
The Government want to be able to tell you what to eat (actually, they want to be able to tell you what to think, but telling you what to eat is just one small part of that).'
Yes, it is a convenient excuse, but not because the government wants to tell you what to think. It's a convenient excuse for putting more taxes on things such as 'fatty' foods and sugary soft drinks. The government is using the moral panic to make it look as if it is helping people by whacking these taxes on various foods and drinks.
Whenever a government anywhere declares something to be bad, but doesn't ban that something, then you can bet it's a tax-raising exercise.
I don't dispute that it's about raising taxes, but what will happen is this:
1. The Government groom the public to believe that they are a bunch of unhealthy slobs who need to be protected from themselves. (This is happening now.)
2. Claiming popular support, the Government impose taxes on "unhealthy" foods.
3. The scope of the "unhealthy foods" tax is gradually widened, budget by budget, as new reasons are invented to tax new foods. ("Let's tax potatoes -- after all, they can be made into chips!")
4. Eventually, you won't be able to buy an oil-free, egg-free, vinegar-free, salt-free, taste-free organic rocket salad without paying tax on it.
Taxing food is the holy grail. Everybody's got to eat, and most people aren't in a position to avoid the tax by growing their own food (which probably will be quietly outlawed in some apparently-unrelated bill in the meantime anyway). But there's still a little bit of mind-control somewhere behind all this.
From what I can see the study was entirely based on self-reported evidence, and calculated BMI based on reported height and body mass. No measurements for body fat or muscle mass were taken.
It is, at best, an example of how poor application of a simplistic and blunt tool like BMI can result in confusing or incorrect information. At worst, it's bad science and FUD mixed together.
Which tells us one thing:
Eat a balanced diet, get some exercise.
Not massively difficult, eh?
Well, actually, it is. That's half the problem. We're constantly bombarded by mixed messages in advertising - your too fat / eat this hamburger!
It makes common sense harder to listen to - this constant babble about food, health, exercise, obesity, anorexia - so what's up exactly?
Growing up in the 70's and 80's I don't recall any of this ever being an issue - being really fat or really skinny was rare. Most people were just average.
But I remember back then, being skinny was a sign of being ill - just as it is today.
Being obese was generally just someone who ate too much. No big deal, "cut down on your pork life mate"
The BMI is pointless argument is common amongst serious gym goers, but I'm not entirely convinced.
There have been a few studies that show that a trainer who doesn't use steroids can expect to gain lean mass to the point where their Fat Free Mass Index (FFMI), which is their BMI ignoring body fat, is around 25. (The boffins who did the work added a small adjustment, but it's not far off.)
If someone is above this limit then either they're underestimating their body fat (which seems very common), or pumping themselves full of drugs (which can have unfortunate and damaging side effects). The hypothetical bodybuilder with a BMI of 40 is probably rather unhealthy.
So someone of my height (6'3" / 1.9 meters) could expect to build a maximum lean weight of 215 lbs / 88 kg. Working back through the numbers, at a BMI of 30 (108 kg), such an individual would be around 19% body fat, which is getting towards the overweight category. At 117 kg, which gives a BMI of 32.5, body fat would be around 25%, which is considered obese in men.
I reckon that BMI has some merit, and a lot of those who say it doesn't count because they pump iron have a habit of being on the slightly chunky side, despite their impressive biceps.
Oh dear. get it in the Lancet or the BMJ or something half credible and I may start to believe you. Lewis - go report to Ben Goldacre for a lesson in good science, 'cos this isn't it, for the many reasons described above. Actually, it's not good journalism either, as the source evaluation is shoddy too.
I'm not familiar with the exact journal in question, but most publications with the terms "Family" and "American" in them tend to be of a christian, capitalist, right-wing flavour and have an agenda. That agenda is unlikely to have much in common with impartial health advice.
Interestingly, anything with European or Social names tend to have a left leaning agenda which is ALSO unlikely to have much in common with impartial health advice.
How about common sense and a rational middle ground? The BMI is not terribly useful in all reality, and it is still clearly unhealthy to be a tub of goo who never gets any exercise or good food.
The point I took away from the article is that BMI is shifted too far in one direction, perhaps going by body fat would make more sense? I'd like to see the same study, but reworking the results with bodyfat as well as BMI. I bet the ranges would be much more sensible with real life health.
people who are underweight (by BMI) are TWICE as likely to die as 'normal' BMI people, and that severely obese people (again by BMI) are only 25% more likely to die
If we eliminate all vampires from our figures, all human beings of whatever BMI are 100% likely to die. Get over it. (Anyone know what Lewis Page weighs?)
>Anyone know what Lewis Page weighs?
Nothing, he is a semi-intelligent virus lurking in the Reg's computer system.
He is believed to have been created when a Mr Clarkson committed an indecent act with the sat-nav in a new BMW
Still - it's better than another story about $$$$ing iPads or the Olympics
Come on people, you don't need to do any higher math to figure out if you need to drop a few.
First test, you get out of the shower, are your feet wet? If no, then a trip to the local fat camp may be in your future, if yes, first test passed.
Second, look in the mirror; you will know if you should get a little more exercise by pushing yourself away from the dinner table.
Also there is the general waist to height rule, if you measure your circumference at your belly, it should be less than or equal to half your height, if it is not, a regular brisk walk around the block now and again would be in order. (If some studies are to be believed, the belly fat is the worst of the lot.)
A note to Mr. Page: In a previous article of yours I encouraged you to branch out by debunking other things that make people feel guilty besides climate change and I am so happy to see you have taken that suggestion to heart. While I could drop a few myself, and am thus encouraged by this report, I am still waiting for you to hit the mother lode, namely the whole smoking kills you thing, so that I might stop feeling guilty about that.
As a now 41 year old man, I've struggled with my weight since I was a teenager. I was diagnosed with diabetes about 10 years ago, and go through cycles of managing it well and not so well. I have to confess that when I consider "quality of life", there are conflcting factors at work.
When I eat healthfully, I do feel better overall. But I am constantly thinking about food and how much I'll be able to eat of it. It becomes an obsession and a source of personal torment that never goes away even as the pounds disappear. When I indulge myself, I suffer from poor body image and feel like a failure. Either option sucks.
Overall, I'm happiest when my stomach is full. Will my life be cut short from diabetes if my belly wins out? Almost certainly. Will I be happier for having lived longer but feeling constantly deprived? It's really debatable. Condemn me as a ignorant fatty if you must, but the choice isn't as simple as it might seem to those of normal weight.
"Overall, I'm happiest when my stomach is full. "
Aren't we all? The question is full of what? You can get a full stomach from a large pizza - or a vegetarian curry with a quarter of the calories and no carbohydrates or fat. If you are going for a dessert, you can have a banana split or strawberry with yoghurt. (600 v. 150 kcal)
Eat lots of fresh veg which are bulky but low on calories, and you can have a full stomach and minimal weight gain. These days you can check the calories on every packet and on the net. You may not want to live like a bunny rabbit, but if a full stomach is your aim, remember that ten large carrots are less fattening than one chocolate bar. (And since ten carrots would probably get your bowels moving like an express train, you might even lose weight.) No wonder Bugs Bunny is slimmer than Elmer Fudd
This was already known and glossed over in a 90's study by the U.S. center for disease control. That study showed exactly the same results as this one. Those "overweight", but not obese, tended to have the longest lives. Though the difference between them and those at ideal weight is not statistically significant, so let's say they are on a par. Certainly being very overweight, really obese, isn't ideal, but it is also not the death sentence it is made out to be. It also seems that staying fat is generally better, for life expectancy, than losing weight. This may be down to the destructive effects of yo-yo dieting.
So people that have enough money to over eat probably have money to cover health services also. People that starve and are underweight typically are poor and can't pay for health services that may extend their lives. I'd say that someone that is skinny that is eating properly is a hell of a lot healthier than someone starving and some overweight person. Aside from the fact that they relied on self reporting, I'd think that they'd also qualify their data with people across the same economic strata.
Good thought, but no.
It is often harped on that poor people don't have access to healthy food, and that makes them overweight. My own ancedotal evidence backs this up (dieting and being successful in life are both hard, requiring willpower and effort). Therefore, poor people would be in the overweight category and have no insurance (supposedly).
It is interesting that government interference in public health is probably, in at least part, responsible for the current obesity epidemic. There is increasing peer reviewed research about how low fat diets have actually significantly contributed to obesity. Around the time big Western governments started promoting low fat diets there is a knee in the curve of obesity in the west where a lot more people started being reported as obese. In fact, since the beginning of promotion of low-fat diets, calories from fat in the average western diet have reduced by 1000 basis points. Those calories are now being consumed in carbohydrates. There is again increasing evidence that the increased consumption of carbs is at least partly responsible for increased levels of obesity. The reasons of this (as explained to me by my diet doctor) are relatively simple:
1) When you eat a lot of carbs you get an insulin spike. When this dissipates a few hours later you feel hungry again. Unlike eating fat and/or protein when you don't get the post-eating crash.
2) The metabolic pathway for eating fructose (and carbs containing fructose like sucrose, and most starches) produce no chemical to tell you to stop eating. This is unlike eating protein or fat when the metabolic pathway includes the production of chemicals that tell your brain to stop eating.
3) When you have produced lots of insulin from eating carbs, this insulin binds to receptors in your cells that make it difficult for those cells to break down fat into glycogen for a number of hours. After carb loading your body won't burn fat.
Personally, I've applied this knowledge to lose about 50kg. I cut out most of the carbs in my diet, and then used the reduced appetite that results from (1) and (2) above to reduce calorie intake (largely by restricting fat). The funny thing is, throughout the diet I've not been feeling hungry between meals (again see (1) and (2) above). Most of the weight loss (according to my diet doc) is actually fat.
Anecdotally, a lot of people talk about the eating of fast food helping to make people fat, and then associate it with fat. Burger and Chips contains quite a lot of fat, but is also a tonne of carbs from the potato and bread. Fish and Chips is tonnes of carbs. Even going out for a curry involves eating a load of bread and rice. I've been eating loads of curry on my diet, just without the bread and rice. Correctly, people associate beer drinkers with being fat. That has little to do with fat, but loads to do with all the carbs in beer. If you drink 4-5 pints of beer a night you are probably getting 100g of carb from it.
Reliance on BMI is another of the public health disasters. Fortunately, the insurance companies are moving away from it now.
He got cancer. Lots of people get cancer.
If you ask old people how they got old, they tend to give you completely batty answers like 'gin and tonic' or 'mars bars'. That doesn't mean it's _true_. You can't conclude anything at all about causes of health problems from a sample size of, well, one.
That in order to be underweight according to the BMI you have to be really, really skinny. Most people you'd consider thin/skinny are still well within normal BMI range, whilst you only have to be a bit chubby to be overweight according to the BMI. So this revelation isn't really that surprising.
I read the referenced paper, and didn't see any correction for serious illnesses, such as cancer. Since having cancer (for example) tends to cause both increased mortality and decreased weight, I'm not sure that there's any content in this paper at all.
As a matter of fact, the authors say that they purposely excluded people with BMI between 18.5 and 20.0 from normal, since people in that category are more likely to have "concurrent illnesses" that increase mortality, and they didn't want those ill people making normal weight people appear more ill and thus hide potential relative negative health effects of obesity.
The study was careful to exclude sick people from the normal weight group, but it did so by moving them into the underweight group. So, I don't think the study says anything meaningful about being underweight, only about being overweight.
"Yet another study has shown that the so-called "obesity" epidemic sweeping the wealthy nations of the world has been massively over-hyped, as new results show that is is far more dangerous to be assessed as "underweight" than it is to be assessed even as "severely obese" - let alone merely "obese" or "overweight"."
Ah, some classic Lewis Logic there. What exactly does the danger or otherwise of being underweight have to do with the danger or otherwise of being overweight? I mean, the two are essentially entirely different; they have different causes and different consequences. Your argument is essentially 'obesity isn't as much of a problem as we thought it was, because being underweight is a really big problem'. Eh? What? How do you get from A to B there, exactly?
As other commenters have pointed out, precisely because of the problem you noted with BMI - that it tends to skew to 'overweight' with a population that's generally taller than the population for which it was devised - you have to be _seriously_ undereating to fall into the underweight category. And it's been well known by doctors for eons that serious undereating is a big problem. There's nothing terribly wrong with any of your facts, but your analysis is completely cuckoo.
(Another possible factor: I suspect the risk of suicide/self-harm among the underweight is generally higher than among the overweight. I suspect if you look at the details, you'll find some of the underweight deaths were suicides.)
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