Losing weight if obese not wise: study

[mr friendly guy]

linky

NEW YORK (Reuters) - It may run counter to advice from almost every quarter, but a Finnish study suggests that losing weight may not be wise for overweight people.

The results indicate that the likelihood of dying over a 24-year period associated with deliberate weight loss is on a par with that associated with weight gain among overweight or obese individuals.

The researchers propose studies to "assess if the optimal strategy among already overweight individuals could be to avoid further weight gain. If this is true," they add, "it puts a major emphasis on the need for prevention of development of overweight and obesity."

Previous studies have reported a link between weight loss and increased death risk. Dr. Jaakko Kaprio, from the University of Helsinki, and colleagues theorized that this may be due to other, ultimately fatal, diseases that also caused unintentional weight loss.

To look into the possibility, the team studied participants in the Finnish Twin Cohort, but excluded subjects with any recognized chronic disease that could induce weight loss.

The subjects, who were born in Finland before 1958, were surveyed in 1975 and in 1981. The 1975 questionnaire asked about current attempts to lose weight, while the 1981 questionnaire documented changes in weight. The subjects were followed until death or the end of 1999.

According to the investigators' report in PLoS Medicine, the final group included 2957 subjects who were overweight or obese in 1975. Two hundred sixty-eight of these subjects died during follow-up.

Individuals who lost or gained weight between 1975 and 1981 were roughly 40 percent more likely to die than those who kept a steady weight. Moreover, intentional weight loss raised the risk of death by 87 percent compared with maintaining a steady weight.

The researchers discuss numerous possibilities to explain their findings, and say more research is needed before the results "can be used as basis for advice about intentional weight loss in the large population of otherwise healthy overweight and obese individuals."

Bolded the parts which I thought were more relevant.

Essentially if obese and you try and lose weight there is an increase risk of death. So far this is only an association, and no "cause and effect" link has been found so far. This emphasises more need to not get fat in the first place as opposed to getting fat than losing weight.

[Darth Wong]

There have been some recent studies which have attempted to argue that thin people are actually at greater risk of early death than moderately overweight people, and I can't help but wonder if they are politically motivated by people such as the naafa.org crowd. Every one of these studies, without exception, has defied harsh criticism from the medical community and included people dying from cancer (for example) in the statistics for thin people.

The problem is that they draw conclusions about being thin based partially on people who got thin not by proper diet and exercise but by fucking chemotherapy and a wasting disease, among other problems, and they lump them all together.

In short, if someone is thin because of a medical condition, that should not be included in a statistical control group which is ostensibly being used to prove that thinness itself is unhealthy.

[The Dark]

DW - for the sake of being a devil's advocate, should people with metabolic disorders that make them heavy not be included under the deaths due to obesity? If it's due to a pre-existing medical condition, we can't be sure exactly what caused the death.

[Darth Wong]

DW - for the sake of being a devil's advocate, should people with metabolic disorders that make them heavy not be included under the deaths due to obesity? If it's due to a pre-existing medical condition, we can't be sure exactly what caused the death.

That depends on whether the "metabolic disorder" is a real, clinically diagnosed problem (and one which, I might add, is extremely rare and always crippling), or whether it's just a codename that someone has slapped on top of "I can't stop myself from eating too much and exercising too little".

Because quite frankly, cancer is far more common than legitimate diseases which make you blow up like a balloon.

[mr friendly guy]

In terms of metabolic conditions, hypothyroidism would cause weight gain (and despite being fat they are intolerant to cold). However that is usually easily treated by hormone replacements.

[Darth Wong]

In terms of metabolic conditions, hypothyroidism would cause weight gain (and despite being fat they are intolerant to cold). However that is usually easily treated by hormone replacements.

That's a different condition than the one I heard about, which was much more rare (and IIRC, not so easily treated). I don't recall the name of the one I'm talking about, though.

[Eleas]

In terms of metabolic conditions, hypothyroidism would cause weight gain (and despite being fat they are intolerant to cold). However that is usually easily treated by hormone replacements.

That's a different condition than the one I heard about, which was much more rare (and IIRC, not so easily treated). I don't recall the name of the one I'm talking about, though.

It might be in discussions where I mentioned a friend of mine who has a severe problem in losing weight; i.e. he gains net weight despite exercise. We haven't spoken as to what really causes it, but he frequently mentions insulin levels and thyroid hormones, and seems to be going on a variation of Atkins diet (as he's not allowed to eat much in the way of carbohydrates). As I'm going to Stockholm later today, I could ask him about the specific condition.

[Xon]

Poor insulin and bloodsuger level control for diabetics can lead to weight gain. But it is purely a matter of self-control.

[darthdavid]

Did they factor in the healthieness of those people's diet plans? If you diet by anorexia then you'll cut your life short. But say you dieted by eating healthy food and exercising more? I can't see how that could fucking kill you.

[Broomstick]

There have been some recent studies which have attempted to argue that thin people are actually at greater risk of early death than moderately overweight people, and I can't help but wonder if they are politically motivated by people such as the naafa.org crowd.

There is political bullshit on both sides of the divide with this issue.

BMI is basically a height/weight chart, that's it. And for some people, such as dedicated athletes, it pegs them as overweight or even mildly obese when they are among the fittest of people. It also makes no allowances for natural body type. We don't expect a draft horse and a riding horse of the same height to maintain the same healthy body weight, why do we expect all people to be alike?

As an example, I have always tended to be at the upper end of the height/wieght range. If I lost enough weight to reach the bottom of my category I would be unhealthy - although technically a "healthy" weight, for me it would be underweight, leaving me weak, easily tired, and more prone to illness than if I carried a few "extra" pounds that for me aren't so extra. Not to mention I'd look like utter crap. I know this because I have had the misfortune to lose that much weight. I do better with the extra pounds.

And that's yet another way these statistics skew - There are people who, due to body build, should be on the low end of the range for their height, and those who should be on the "heavy" side.

The great flaw of the BMI is that is treats all tissue as equal - and it's not. Muscle is heavier than fat, and provided it's not artificially induced, it's almost always good weight. And extra 10 or 20 lbs isn't going to hurt if it's muscle.

So, if the study shows weight loss to be detrimental you not only have to look at possible acute or chronic illness, you have to look at whether folks were all shooting for one target weight regardless.

You also have to look at the speed of weight loss - sudden weight changes, either up or down, can be very stressful to the body. In someone with underlying conditions such as heart disease a sudden weight loss can have negative consequences, which is precisely why docs encourage slow, steady weight loss over crash dieting.

And with something like bariatric surgery, which shows positive results in regard to diabetes and heart disease, you may simply be exchanging one set of health risks for another set - post-surgical patients are at extremely high risk of malnutrition, vitamin/minerial deficiency, and osteoporosis and those can kill you or make your life miserable just like heart disease or diabetes.

In other words, like much to do with medical science, the question is much more complicated than it first appears.

[Broomstick]

In terms of metabolic conditions, hypothyroidism would cause weight gain (and despite being fat they are intolerant to cold). However that is usually easily treated by hormone replacements.

That's a different condition than the one I heard about, which was much more rare (and IIRC, not so easily treated). I don't recall the name of the one I'm talking about, though.

Are you thinking about Prader-Willi?

In PW the brain's appetite control system is mis-wired and hunger never shuts off. Then to make this an utterly cruel condition, PW folks also have a measurably lower metabolism than everyone else. So you have people capable of eating until their stomach ruptures (yet they still will not feel full or satisfied), but who need 500-1000 calories less per day than everyone else in order to maintain their body. It has nothing to do with willpower, it's a genetic flaw and a discrete medical condition.

[Darth Wong]

In other words, like much to do with medical science, the question is much more complicated than it first appears.

Oh, I agree completely about the BMI. It's a gross oversimplification. Nevertheless, there is such a thing as being overweight, even if the BMI is a wrong-headed way of determining it. And all of the medical evidence shows that being extremely fat is terrible for you, just like being emaciated. The difference is that anorexia is honestly recognized as a serious psychological disorder, while no one would dare publicly label chronic overeating as a serious psychological disorder because too many people do it. It's just not politically correct.

[HemlockGrey]

The difference is that anorexia is honestly recognized as a serious psychological disorder, while no one would dare publicly label chronic overeating as a serious psychological disorder because too many people do it. It's just not politically correct.

But how much of it is serious psychological disorder and how much of it is "I like food and I don't like exertion?" With anorexia you are denying a biological imperative, and indulgence is always easier than abstinence. I doubt your average fatass American in Wal-Mat is the victim of a serious psychological disorder rather than a simple lack of motivation.

[Alan Bolte]

For the "average fatass" I suspect you are correct, but once you cross the line from overweight to obese (wherever that line might be for a particular person, I'll leave that to the experts), I think that's a fairly good indicator that something's wrong upstairs. Allowing yourself to get chubby and not so fit is generally a choice, but becoming so fat that is begins to cause health problems or interferes in day to day life, yet either not feeling motivated to do anything about it or being unable to change despite wanting to, is essentially the definition of a disorder. Quite similar to depression really, and by my understanding depression often occurs along with obesity.

[Admiral Valdemar]

Are you thinking about Prader-Willi?

In PW the brain's appetite control system is mis-wired and hunger never shuts off. Then to make this an utterly cruel condition, PW folks also have a measurably lower metabolism than everyone else. So you have people capable of eating until their stomach ruptures (yet they still will not feel full or satisfied), but who need 500-1000 calories less per day than everyone else in order to maintain their body. It has nothing to do with willpower, it's a genetic flaw and a discrete medical condition.

Sounds like it may be it, I wrote something on it in a similar thread a while back here.

[mr friendly guy]

In PW the brain's appetite control system is mis-wired and hunger never shuts off. Then to make this an utterly cruel condition, PW folks also have a measurably lower metabolism than everyone else. So you have people capable of eating until their stomach ruptures (yet they still will not feel full or satisfied), but who need 500-1000 calories less per day than everyone else in order to maintain their body. It has nothing to do with willpower, it's a genetic flaw and a discrete medical condition.

How would one treat such a condition? Would certain weight loss drugs which work by suppressing hunger eg sibutramine still work on such a person?

[Broomstick]

There is no treatment, other than simply restricting food intake.

NO drugs work to suppress appetite in PW - the brain receptors are either absent or entirely ineffective. It's as if the shut-off switch just isn't there. Surgery doesn't work, either - bariatric surgery works, in part, by restricting the size of the stomach so the person feels full sooner - except these folks never feel full. They are just as hungry after a meal as before.

So... some behavioral conditioning, but mostly keeping food off-limits. Houses with PW sufferers have locks on the food cabinets and the refrigerator - locks they are given neither keys nor combinations for. Garbage sometimes also has to be controlled - PW sufferers have been know to eat discarded food, rotten food, and even non-food items although that's becoming less common with better treatments/coping routines.

It is possible for them to be brought down to normal weights, but they can never, ever, be left to control their own diets or have unrestricted access to food.

[Lord Revan]

It should be noted this study was made in Finland and Some finnish Universites can be quite BS factories sometimes and also alcoholism is/was very common here, so that might also have effect on the numbers

[Guy N. Cognito]

I hate to say it, a lot people who try to loose weight go about it the bad way. They starve themselves, and don't get much exercise. That is very hard on the body. Or they deny their body certain parts of our food group.
My mother-in-law eats this vegetable broth soup through-out the week to lose weight and then eats like a horse on the weekend. Very rich things. Then critises my wife for eating healthy and getting exercise and slowly losing weight. Some how I think my wife's method is a touch healthier, and will last longer.

[mr friendly guy]

Starving yourself isn't a good idea as opposed to just eating healthy. For one thing, when you starve, your body uses carbohydrates before starting to use up the fat. So in effect it takes of your usual energy sources leaving you tired before starting to get to the excess energy stores (fat).

[Darth Wong]

The worst thing about this is that groups like naafa.org ("National Association for the Advancement of Fat Acceptance"; I wish I was making this up) use it as an excuse to declare that obese people are actually healthy, and that a 230 lb 5'2" tall woman has no reason to want to lose weight. They cite half-truths and they distort facts, such as the fact that crash diets are known to be unhealthy, as "proof" that being morbidly obese is A-OK.

[wilfulton]

The worst thing about this is that groups like naafa.org ("National Association for the Advancement of Fat Acceptance"; I wish I was making this up) use it as an excuse to declare that obese people are actually healthy, and that a 230 lb 5'2" tall woman has no reason to want to lose weight. They cite half-truths and they distort facts, such as the fact that crash diets are known to be unhealthy, as "proof" that being morbidly obese is A-OK.

You can't make this shit up .

How about a 5'2", 500 lb woman that can't even get out of bed because she weighs too much? I suppose that is perfectly healthy?

[Darth Wong]

The worst thing about this is that groups like naafa.org ("National Association for the Advancement of Fat Acceptance"; I wish I was making this up) use it as an excuse to declare that obese people are actually healthy, and that a 230 lb 5'2" tall woman has no reason to want to lose weight. They cite half-truths and they distort facts, such as the fact that crash diets are known to be unhealthy, as "proof" that being morbidly obese is A-OK.

You can't make this shit up .

How about a 5'2", 500 lb woman that can't even get out of bed because she weighs too much? I suppose that is perfectly healthy?

They would tell you that it is possible to be "fit at any size" (that's one of their slogans).

[wilfulton]

Okay, I peeked around a little at the naafa.org website. Some things they say do bear a little resemblance to reality, but no more than "a little".

THey do advocate that fat people can improve their physical condition by performing exercises that are fun (and thus they don't mind sticking with) and not too strenuous at first (avoid injury, those can set you back on your exercise plan. I spent over a month not being able to run due to tendonitis, for example).

Naturally what they didn't say is that people who adjust their intake (i.e. more fruits, vegetables, grains, lean meats, etc, and fewer cakes, cookies, ice creams, processed meats [50% fat, 50% sodium ], etc) will actually lose excess body fat with a regular exercise program.

Also, excess body fat puts excess strain on the body, especially on joints. A person's frame is designed to hold up a certain amount of weight. Too much weight on that frame, while it can hold it, puts extra strain on the joints. Overweight people tend to also be prone to joint injuries for this very reason.

As a fat person, I started exercising. Although I lack the self discipline to avoid the junk foods (and I'm an officer in the united states army, go figure), I find it easy to stick to a regular exercise program, but largely because there are things I love to do. For starters, I love hiking, and I love mountain climbing.

Naafa wants fat people to be role models for fitness, so here goes. I go hiking on weekends, and I stick to a pull up program during the week (okay, easy for me, I've got a bar right behind the office, but it's two wooden posts with a piece of steel tubing about 7 feet off the ground. Simple enough to make.

In the last few months I went from being able to do 3 pullups to now I do 12. I haven't lost any weight, but I'm sure I've gained some lean muscle mass. If I haven't dropped anything, then that means I must have less excess body fat as a result. Good all the way around, the way I look at it. Exercise is your friend.


And I also read where Naafa wants fat people whose rear end fills two airline seats to only have to pay for one. My apologies, but if you fill two, you gotta buy two. Don't like it... Exercise is your friend.

[Eleas]

They would tell you that it is possible to be "fit at any size" (that's one of their slogans).

It's dogma, I suppose. Of course, it's also bullshit. Even Sumo wrestlers, who despite what an observer might suppose can be shockingly muscular, soon discover that their sheer body weight work against them, shortening their lifespan and granting them all kinds of exciting disorders.