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NY Times Article: In ‘Obesity Paradox,’ Thinner May Mean Sicker

Answered on August 19, 2014
Created September 19, 2012 at 3:22 AM

http://www.nytimes.com/2012/09/18/health/research/more-data-suggests-fitness-matters-more-than-weight.html?partner=rss&emc=rss&_r=0moc.semityn.www [In ???Obesity Paradox,??? Thinner May Mean Sicker][1]

Here's a quote from the article: "In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments. The accumulation of evidence is inspiring some experts to re-examine long-held assumptions about the association between body fat and disease."

Thoughts?

26b7615ef542394102785a67a2786867

(7967)

on September 22, 2012
at 03:40 AM

Great comment, however I wonder where freaks like me, who have the marathoner body type (I'm 5'5" 105 lbs with 17% bodyfat) while eating high protein, lifting, and without doing much cardio to speak of.. fit in.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on September 19, 2012
at 07:22 PM

@thhq. I don't have an ability to test/measure. I was simply saying, after reading the article, that the causal relationship they suggest seems off. The body is made to store fat and use it as energy. A sick person who cannot store fat would be a signal that the body is not working properly.

Cc3ce03985eac5ebcbb95fc2329f13b0

(7370)

on September 19, 2012
at 05:26 PM

Sorry, failure to thrive includes healthy weight gain.

Cc3ce03985eac5ebcbb95fc2329f13b0

(7370)

on September 19, 2012
at 05:25 PM

Failure to thrive is a common marker of healthy child development. Failure to store may be just simple metabolism, but it could be poor apetite, poor absorption, or any other side effect of being ill.

Cc3ce03985eac5ebcbb95fc2329f13b0

(7370)

on September 19, 2012
at 05:21 PM

No, not everyone is, but some people are fatter and healthier. Generalisations rarely work. And, actually, the BMI was first devised by a Belgian Polymath, Adolphe Quetelet, who never intended it to be used as it is today. I think measurements and body fat percentage are a better tool.

Medium avatar

(10611)

on September 19, 2012
at 04:42 PM

-1. I'm tired of the paleo diet CW that discourages hunting-and-gathering. Putting up marathoners as diseased straw men does not negate the benefits of steady Hazda-like activity. It paints wolf et al into a corner where they're discouraging people from figuring out how to live a paleo lifestyle. Focus only on the grass fed liver grasshoppa....ommmmmm

Medium avatar

(10611)

on September 19, 2012
at 04:32 PM

I wasn't healthy when I was obese, using BMI as a marker, and I'm a lot healthier at lower BMI. It's not an absolute tool, just an index.

Medium avatar

(10611)

on September 19, 2012
at 04:30 PM

Feel-good feature articles sell copy. You have the sense that you're on top of the cutting edge research while you eat that big bowl of mini wheats.

Medium avatar

(10611)

on September 19, 2012
at 04:24 PM

How would you measure ability to store fat? Run a weight gain test on yourself? And I think that other factors come in to play, depending on what good health you're trying to achieve. For instance, for CV health blood pressure and HDL are well correlated with risk. I don't think "ability to gain fat" directly correlates, but it isn't a well defined test so far as I know.

Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on September 19, 2012
at 03:51 PM

+1 -- Love this!

Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on September 19, 2012
at 03:49 PM

Yep. Some of the MDs & researchers from the Lipid & Metabolism Society use the term "normal weight, metabolically obese." I love that, b/c it really hammers home the point that being "thin" or at an ostensibly "healthy weight" says nothing about someone's actual metabolic health. (Think people who look okay on the outside but have raging high trigs, out-of-control blood glucose, high A1C, etc.)

Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on September 19, 2012
at 03:49 PM

Yep. Some of the MDs & researchers from the Lipid & Metabolism Society use the term "normal weight, metabolically obese." I love that, b/c it really hammers home the point that being "thin" or at an ostensibly "healthy weight" says nothing about someone's actual metabolic health.

1edb06ded9ccf098a4517ca4a7a34ebc

(14952)

on September 19, 2012
at 02:56 PM

^ Exactly. low body weight does not mean low body fat and high body weight does not mean high body fat. They are using one term and (body weight) and inferring the other (body fat).

F040035b2008ec80b205481afbd39ad4

(1837)

on September 19, 2012
at 11:00 AM

Only one mention in that article of physical composition! Shocking. We've all seen 'skinny fat' people and it is NOT a template for health. Muscular people with low body fat can look thin (particularly when clothed), but metabolically can be far from 'skinny fat' types.

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6 Answers

7
96440612cf0fcf366bf5ad8f776fca84

(19413)

on September 19, 2012
at 10:38 AM

Leanness is absolutely not a marker for good health.

Although the article doesn't mention it, if you look at pro-joggers/marathoners you'll find a lot of them have heart issues, and a lot of them keel over and die.

Lean muscle tissue and lots of it is a better indicator. I forget which podcast Robb Wolf discussed this in, but basically, if you run a lot, your body adapts to using only those muscle fibers used for running and starts to get rid of anything else. If you don't eat enough protein, (i.e. as those do who carb load and shun meat) you start catabolizing muscle tissue, including heart tissues. The heart adapts by enlarging one side of it, and it leads to big issues later on. I think Robb used the very memorable "It's a fire sale, everything must go" in that discussion, meaning you're adapting your body to do just one thing and one thing only at the expense of your health: running. It makes sense that if you're in an environment where survival means outrunning predators that you'd need to be as lean as possible, however that destroys longevity, and you're left with just enough life span to procreate and not much else.

Art De Vany, and others, mentioned that this kind of steady state cardio also gets rid of heart rate variability (which is a marker of health), and also burns off stem cells. Art had tons of pointers to articles about how this, or that marathoner died, chock full of quips "But, oh why did he have to die, he was so young and fit!"

There's a recent post here: http://www.cavemandoctor.com/2012/07/19/sprinting-from-lions-to-health/ that mentions some of this. I just had someone sing me the praises of the book "Born to Run" about how wonderful it is to run and what a great and wonderful book. Well, after listening to one of the Caveman Doctor episodes, it was mentioned that one of the main characters in that book, Micah True, died of heart failure, and I showed them articles about the autopsy plus pointers to studies about marathoner deaths. Granted, it's probably a lovely, well written book, but that doesn't mean it's a healthy lifestyle...

In terms of Type 2 diabetes, lean muscle tissue and fat cells both act as a sponge for excess glucose. If you consume lots of carbs and have a very low percentage of body fat and very little muscle, and you're not burning it off fast enough, that glucose will cause the usual nerve/artery damage seen in T2D. And since you don't have enough tissues to store it in quickly enough, you'll wind up generating more and more insulin, to which muscle, liver cells, and what little fat you have, will get more and more resistant to.

Certainly fat tissues will expand as more and more is fed to them, but there are limits to how fast they can grow, and they grow much slower in some people (we all know those people who can eat tons of carbs and not gain fat, while others - myself included gain fat very quickly at medium carbs). If those lean folks keep getting sugar/insulin spikes every 2-4 hours every day, it can lead to big problems.

So you're better off either with lots of muscle tissue, or lots of fat vs being super lean and eating a ton of carbs that you can't burn off fast enough.

(Or better yet, never get into that situation in the first place by not jogging, running marathons, and do resistance training, and eating lower carb. - by lower carb, even the Perfect Health Diet is included, as I'm talking about folks who eat something like 80%-90% carbs - you know, bagel/cereal with lowfat milk, pasta and bread lunch and dinner, followed by a sweet desert and juices as drinks... Wouldn't surprise me if some of these folks also take calcium supplements without magnesium, which they don't need, that wind up helping line their arteries with plaque.)

Medium avatar

(10611)

on September 19, 2012
at 04:42 PM

-1. I'm tired of the paleo diet CW that discourages hunting-and-gathering. Putting up marathoners as diseased straw men does not negate the benefits of steady Hazda-like activity. It paints wolf et al into a corner where they're discouraging people from figuring out how to live a paleo lifestyle. Focus only on the grass fed liver grasshoppa....ommmmmm

Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on September 19, 2012
at 03:51 PM

+1 -- Love this!

26b7615ef542394102785a67a2786867

(7967)

on September 22, 2012
at 03:40 AM

Great comment, however I wonder where freaks like me, who have the marathoner body type (I'm 5'5" 105 lbs with 17% bodyfat) while eating high protein, lifting, and without doing much cardio to speak of.. fit in.

2
3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on September 19, 2012
at 02:11 PM

Am I missing something. The article says that, for people already diagnosed with a chronic disease, that lean patients fare worse.

That makes sense. The inability to hold weight is obviously correlated to heighten disease risk.

Wouldn't it make more sense to conclude that, the body's ability to store fat is an indicator of health. Not whether the person is overweight.

Cc3ce03985eac5ebcbb95fc2329f13b0

(7370)

on September 19, 2012
at 05:26 PM

Sorry, failure to thrive includes healthy weight gain.

Cc3ce03985eac5ebcbb95fc2329f13b0

(7370)

on September 19, 2012
at 05:25 PM

Failure to thrive is a common marker of healthy child development. Failure to store may be just simple metabolism, but it could be poor apetite, poor absorption, or any other side effect of being ill.

Medium avatar

(10611)

on September 19, 2012
at 04:24 PM

How would you measure ability to store fat? Run a weight gain test on yourself? And I think that other factors come in to play, depending on what good health you're trying to achieve. For instance, for CV health blood pressure and HDL are well correlated with risk. I don't think "ability to gain fat" directly correlates, but it isn't a well defined test so far as I know.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on September 19, 2012
at 07:22 PM

@thhq. I don't have an ability to test/measure. I was simply saying, after reading the article, that the causal relationship they suggest seems off. The body is made to store fat and use it as energy. A sick person who cannot store fat would be a signal that the body is not working properly.

2
Cc3ce03985eac5ebcbb95fc2329f13b0

on September 19, 2012
at 05:29 AM

I don't think weight is the best health marker. I am not surprised by this article, as I have read that people with a bit of extra weight do better after surgery.

The BMI is generally the accepted way of determining whether people are overweight, and it is a very flawed and inaccurate way to measure such things. Some people are very healthy when they're overweight.

Cc3ce03985eac5ebcbb95fc2329f13b0

(7370)

on September 19, 2012
at 05:21 PM

No, not everyone is, but some people are fatter and healthier. Generalisations rarely work. And, actually, the BMI was first devised by a Belgian Polymath, Adolphe Quetelet, who never intended it to be used as it is today. I think measurements and body fat percentage are a better tool.

Medium avatar

(10611)

on September 19, 2012
at 04:32 PM

I wasn't healthy when I was obese, using BMI as a marker, and I'm a lot healthier at lower BMI. It's not an absolute tool, just an index.

2
0a9ad4e577fe24a6b8aafa1dd7a50c79

on September 19, 2012
at 03:54 AM

Sounds like some pro-fat/fat-acceptance propaganda, but either way it doesn't really matter because we should all be striving for a lean, but toned physique. Underweight & flabby is bad, but fat & flabby is just as bad.

Medium avatar

(10611)

on September 19, 2012
at 04:30 PM

Feel-good feature articles sell copy. You have the sense that you're on top of the cutting edge research while you eat that big bowl of mini wheats.

0
1edb06ded9ccf098a4517ca4a7a34ebc

on September 19, 2012
at 02:48 PM

They are using terms interchangeably as if they are the same thing. Low body weight does not mean low body fat, and high body weight does not mean high body weight. I would imagine that the thin and sick people also do not carry a lot muscle mass and are not fit/in shape...they're likely skinny-fat. I would also guess that the individuals with best body composition are also the healthiest and live the highest quality lives.

0
0e1e1fb7cb5ba898eed1976f988cdc37

on September 19, 2012
at 03:47 AM

Thanks for posting this, definitely an interesting article. I like that at the end they talk about why this may be the case. Even with their ideas about genes, the skinny fat issue, and fitness it still doesn't quite make sense. I'm interested to see what others say and what future research points to.

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