Women Having Tea (The Sick Woman)

Presuming What Is Healthy Based on Appearance

Media images of good health are a tricky business. On one hand, fashion and lifestyle businesses are feeling pressure to include more diversity in the imagery they blast at us. But when they do, guardians of public health protest. So we have debates about what is healthy to show people in Cosmopolitan. Or the health status of a Nike mannequin. We find extremely vocal people making confident presumptions about what is healthy, based solely on appearance.

But once again, new research gives us good reasons to say, hold on just a minute. In Diabetes Care, Young-Rock Hong et al tell us a person can enjoy good cardiometabolic health after bariatric surgery – even if they have some residual adiposity.

Observational Data from NHANES

This analysis uses data from NHANES gathered from 2015 to 2018. It focused on six measures of health risk in 6,274 persons who answered questions about bariatric surgery. In that sample, they found 132 with a history of bariatric surgery. In addition, 2,698 were eligible, but had not had it.

So they analyzed three groups. The reference group had no surgery and a BMI in the normal range – between 18.5 and 25. Next was the group of 132 bariatric surgery subjects. The final group was the folks who were eligible but had not elected to have surgery.

In the surgery group, the average BMI was still in the range of obesity – 34.9. That is significantly higher than BMI in the reference group, which averaged 22.3. Nonetheless, all but one of the risk factors were similar for the reference group and the surgery group. The exception was HDL cholesterol. Often referred to as “good” cholesterol, the levels were higher (better) in the reference group.

However, in the eligible group that didn’t elect surgery, all six risk factors were worse.

Appearances Can Be Deceiving

So the bottom line is quite simple. If you judge the health of people who have had bariatric surgery based on their size, you might reach the wrong conclusion. Overall, these people had very similar health risk profiles to people in a healthy BMI range – even though their BMI was still high.

BMI does provide a good clue about adiposity and health risks. But it doesn’t tell the whole story. Thus, appearances and media images can be quite deceptive. Arghavan Salles summed it up quite well on Medscape recently:

“Assessment of health is most accurately judged by each person with their medical team, not by observers who use media images as part of their own propaganda machine, pushing one extreme view or another. As physicians, we have the opportunity and the responsibility to support our patients in the pursuit of health, without shame or judgement. Maybe that’s a New Year’s resolution worth committing to.”

Well said, Dr. Salles.

Click here for the study by Hong et al and here for the perspective by Salles.

Women Having Tea (The Sick Woman), painting by Ernst Ludwig Kirchner / Bayerische Staatsgemäldesammlungen

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January 28, 2021