Weight and Health: Consider the Source, Dismiss the Facts?

The subject of weight and health and obesity can be a great way to shut down a conversation. Or really stir it up. It all depends on whether people are ready to listen to each other.

Does Overweight – Not Obesity – Cause a Shorter Life?

A lengthy article in The Atlantic illustrates how quickly people can stop listening. Olga Khazan interviewed a wide range of respected researchers on this subject. She quickly understood how polarizing and controversial the question is. She describes researchers as “entrenched, having reached opposite conclusions and not budging an inch.” They seemingly cannot agree whether a bit of excess weight will shorten a person’s life.

On one side of the question, Katherine Flegal has published papers in 2005 and 2013 suggesting that people with overweight, but not obesity, can live longer.

On the other side of the question, Walter Willett calls her work “a pile of rubbish.” He goes on to say that “no one should waste their time reading it.” We’ll take a pass on his model for scholarly dialogue. Perhaps the wisest conclusion is to call this question unresolved.

Metabolically Healthy Obesity

But the conversation about weight and health and obesity is much broader. A definition of overweight that falls short of obesity is a bit arbitrary. That’s because weight is merely a proxy for adiposity – the way a body stores energy as fat. Even BMI is just a crude screen for excess adiposity.

Unfortunately, though, BMI is the tool that epidemiologists use to measure rates of obesity. And that sets up another nasty argument about “metabolically healthy obesity.” Another chapter in that argument came last month with a study of cardiovascular risk in people who might be described as having metabolically healthy obesity.

Researchers from the Imperial College of London studied people who were otherwise healthy with a BMI in the range of overweight or obesity. They found a higher risk of heart disease in these people, even though they were healthy in other respects.

A Broader View of Health at Different Sizes

The academic argument will grind on. BMI and risk are abstractions. However in real life, health and weight are intensely personal subjects. Being mortal, everyone has health issues. And everyone has to figure out how to cope.

People make choices every day that influence their health. But those choices only provide an illusion of control. In reality, biology has the final word. We might influence the size of our body, but we don’t choose it. We don’t choose how our bodies will store fat.

But faced with a body that stores fat in an unhealthy way – obesity – we have to make peace with it. That might mean losing a bit of weight or a lot. Or it might means maximizing health at one’s present weight. Cookie-cutter solutions just don’t exist.

Click here for more from The Atlantic and here for the study from the Imperial College of London.

Listen, photograph © niko si / flickr

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September 4, 2017