So here’s today’s news from epidemiology world: Time lived with obesity linked with mortality:
Monash University researchers have found the number of years individuals live with obesity is directly associated with the risk of mortality. …
The research showed that for those who had a medium number of years lived with obesity (between five years and 14.9 years), the risk of mortality more than doubled than for those who had never been obese. The risk of mortality almost tripled for those with the longest duration of obesity (more than 15 years).
Furthermore, the research showed for every additional two years lived with obesity, the risk of mortality increased by between six and seven per cent.
I’ve no doubt that their statistical analysis of the data showed these results. What ticks me off is that it doesn’t really tell us anything useful … and mostly serves as fodder for the “eat less, move more” crowd.
Remember: correlation does not mean causation.
But let’s consider a few reasons that the longer you’re obese, the higher the risk of mortality.
The Western Diet
Me, I tend to think that Gary Taubes was spot on when he said, “what makes us fat, makes us sick.” He thinks its excess carbs, but I’m more with Kurt Harris and other paleo and WAPF folks who point the finger more broadly at our Western diet and its excess sugar/fructose, refined grains, and modern processed vegetable oils.
Or as Michael Pollan said:
When you hear the phrase “health care crisis” or “health care cost crisis,” that is a euphemism for the catastrophe that is the American diet. 75% of our health care spending is on chronic diseases linked to diet. That’s really what’s bankrupting us, and that has to do with the way we’re eating — way too many calories, too much processed foods, tons of refined carbohydrates.
Does adipose tissue contribute to inflammation and disease? Absolutely. But how much inflammation is from that source and how much from dietary sources? Pretty important question IMO.
Pros and cons of weight loss
Here’s another: the longer you’re obese, the more likely you will have tried lots and lots of diets (with their, at best, 80-90% failure rate). Any chance that weight cycling could be harmful over the long term? Hmmm.
Doctors like even small amounts of weight loss, because health markers show improvement with even a 5% or 10% loss.
Well, duh. If someone’s health markers improve on such a small amount of lost weight, is it the weight that’s the problem or their pre-weight loss lifestyle? Hello, health at every size (HAES).
Note that dieting has its own perils. Linda Bacon and Lucy Aphramor tackle a number of issues in their recent HAES paper, including complications from dieting (see original for cites):
Research also suggests that dieting is associated with increased chronic psychological stress and cortisol production, two factors known to increase disease risk. Also, there is emerging evidence that persistent organic pollutants (POPs), which bioaccumulate in adipose tissue and are released during its breakdown, can increase risk of various chronic diseases including type 2 diabetes, cardiovascular disease and rheumatoid arthritis; two studies document that people who have lost weight have higher concentration of POPs in their blood.
Don’t get me wrong, I’m not against weight loss. But it’s not clear which is more damaging … spending years overweight or obese, or spending months or years futilely trying to lose weight.
Obesity stigma
But to me, the most important issue aside from the physiology of weight and diet is the psychology. Being obese is no picnic in modern America (despite the fact that so many are!). In yesterday’s HuffPo, Dr. David Katz spelled it out plainly: When Doctors Judge Their Obese Patients:
This woman came to see me seeking attention for some new medical concerns that had cropped up in her life. I quickly ascertained that seeing a doctor was quite a novelty for her. …
She avoided our kind like the plague because we had been that virulent in her life. Across an expanse of medical encounters for an array of reasons across a span of years, a whole battalion of us had abused her. We had treated her not as a patient, but as a fat patient. …
Whatever her reason for seeking our care, whatever her acute need — we apparently never missed an opportunity to remind her that she was fat. And we made it plain: she was to blame.
That was what was sown in my patient’s medical history. What did we reap?
I met a woman who should have received medical attention for a variety of remediable issues, but who had not. I met a woman who should have had cancer screening tests, but had not. I met a woman who should have had screening tests for cardiac risk, and received select immunizations — who had not.
You think that not getting treatment or delaying screenings might have an impact on mortality risk? I know I do.
Anyways, hope the next time you see a study that associates obesity with mortality, you consider what else might be at work.
I agree that it’s probably less the obesity and more the things that led to obesity that would increase mortality regardless of obesity. Problem is, it’s hard to find a study population who is obese but not consuming the typical western diet. Lack of medical screening is an interesting one. I may well be biased but It think pointing to dieting as a potential problem (even if it is in some forms) deters people from making changes at all. At the end of the day, it matters less that obesity is correlated with inc. mortality, what really matters is fixing some of these underlying problems
Sorry, I’m a little biased about this one. While I don’t agree with the health at every size folks on every point, I think it’s critical to get away from “diet” as in weight loss and move towards “diet” as in health. It’s unfortunate that the same word can be used so differently.
Right now, the problem is that when you say “diet” you know that lots of people — including Dr. Oz, who just promoted it to millions of people — think things like HCG. Me, I’d rather people not make changes than go that route.
My point with these “annoying studies” is maybe tilting at windmills, but it’s meant to change the framework of the discussion to one that’s more health-based!
Great post, Beth.
Re this statement: “Does adipose tissue contribute to inflammation and disease? Absolutely. But how much inflammation is from that source and how much from dietary sources? Pretty important question IMO.”
I presented last week at a professional meeting on this subject and asked the question: Is it the fat per se, or is it what’s affecting the fat that causes it to release inflammatory cytokines? I’m sure the question could be asked more elegantly but I do think that’s at the heart of the question when it comes to health and fat. Of course, that just leads us back to lifestyle, which is what HAES is all about.
Thanks Marsha! It was interesting listening to Art DeVany talking about adipose tissue in his podcast with Jimmy Moore on the subject. I don’t agree with Art 100% either, but liked his view of how the fat contributes to insulin resistance — so you can certainly imagine how that can snowball!
But like I said, if health markers can improve so dramatically with small weight losses, then why not make the focus healthy behaviors rather than weight?
Me, I just had my first workout session with a trainer, as my fasting insulin is still high (even with my much healthier diet). Gary Taubes would say I need to go lower carb. Me, I’m gonna give trying to make my muscle cells less insulin resistant. Can’t wait to see how that works out!
Great post Beth.
I’m guessing you’ll see tremendous benefit from the exercise.
Shocking to Gary I’m sure, I’ve seen literally hundreds of people markedly improve their hyperinsulinemia (we measure fasting insulin levels at our office) through exercise and/or through non-low carb calories restricted weight losses - and not necessarily in combination (meaning exercise alone has worked as has just modest non low-carb weight loss)
Healthiest life you can enjoy, not the healthiest you can tolerate.
Best,
Yoni
Thanks so much for visiting! Yeah, diet seems to do quite a bit (my BP and lipids are in a happy place), so am looking forward to seeing what adding the exercise will do.
Great post… and I agree 100%. Obesity is not the cause, it’s just another result/symptom of the real issue.
I’m considered obese and have rheumatoid arthritis. I recently cut sugar and artificial sweeteners out of my diet nearly 100%. My joint pain was drastically improved and was able to reduce my NSAID med’s to half. And this was all over a two-week period. Then, a couple nights ago, I ate a mini luna bar, extra raisins, and some other sugar… the next day and some today, my joint pain increased again. I am trying to decipher how much is related to sugar versus stress, because, at the same time I ate the sugars, I was under high-stress.
At any rate, I weighed the same throughout this whole thing, experiencing a reduction in joint pain with a change in my diet/stress…. NOT because I changed my obesity rating.
The obesity rating will likely eventually change as a result of my diet changes, but (as you say) that would just be result of change the root of the cause.