5281

Uh, what’s the source of that chart b/c I’ll be honest, I think it’s bullshit.

5282

There you go: Waist-to-Height Ratio Is More Predictive of Years of Life Lost than Body Mass Index

Note that the further end correlates with a BMI of about 45. It is on the very extreme of morbid obesity.

Note that this also correlates with other data that shows that stuff like waist to hip ratio is very predictive of comorbidities (including cancer) once you move far away enough from the median.but again, the problem is where the point where it’s significant is (an equivalent BMI of 30, even in a not fit individual is not too bad) and the point where you want to try to take action (which is before you reach the significant point, because, again preventive medicine is a thing).

I do agree that weight loss is not easy, and that is a subject to be treated with care when talking to patients, but saying obesity is not statistically significant in reducing life quality and expectancy doesn’t bear the data.

5283

Hmm, that chart is very far from the actuarial “rated age” tables that I have seen in the insurance industry, although those tables use BMI. I note that study was based on the UK using NIH data apparently. Has it been replicated in the US?

5284

This is the BMI table for them same study, but is it less predictive:

And this is an US based study (using BMI, but at the extremes it doesn’t matter, a e5 BMI is unlikely to be because of muscle buildup):

Years of Life Lost Due to Obesity.

At BMI 45 and age 20-30, 12 YLL for white males, 20 YLL for black males. Not too dissimilar, although different studies are going to give different results due to different designs and target populations.

And this only looks at mortality (YLL). For health I pact you need to look also at QoL reduction.

And a relevant quote on this last study about obesity and healthy markers:

Also, please note that in all observational studies the overall life expectancy and overall health of the population can make the effects more or less extreme, sometimes in strange ways. Some environmental factors could multiply the YLL effect of extreme obesity, and others could mitigate it Igor example, if the baseline health or the median life expectancy was to be lower because of other independent factors).

5285

Skimming, that looks like a pretty bad study. All it cares about is whether WtH is more predictive than BMI, it can’t be used to try to establish any kind of causation between obesity and those lifespans outcomes. They don’t control for pretty much anything (wealth, gender, access to medical care, etc), explicitly stating that the data they were given was too sparse or too small of a sample size to be useful in those tays.

Also, the lead on that paper’s most recent published article was, uh, this:

A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms

I didn’t read it, but like…some potential red flags there about methodology and motivations.

5286

Trying to be objective, I do see some validity in Juan’s linked studies now that I look at them more closely but basically they show pronounced effects only at the extreme margins - the health impacts of “regular obesity” are in line with my expectations - its the number for morbid obesity that exceed my expectations.

It’s worth studying b/c these sorts of charts are at least trying to grapple with the numerical issue I raised, although I agree with CLWheeljack that there are limitations to the methodology.

What’s interesting is that if you look at the numbers for the “obese” at 30-35 BMI it’s right in line with my expectations, getting worse past 40 BMI. I wonder what the average numbers for all people classified as “obese” would look like - b/c the distribution of the morbidly obese is much less than the mildly obese, IIRC.

5287

There are literally dozens of studies that show a correlation. The data does pan out. The specific measure of the impact is in question (as @Sharpe points out) because of the limitations of observational studies, but:

-there’s a clear correlation seen in many different studies.
-the lower threshold for extreme obesity in 30 year olds seems to be a 7% or so reduction in life expectancy, with the highest very significantly higher than this (20 years, or 25%).
-there are many possible mechanisms why this correlation can happen, from cancer to cardiovascular stress, etc… it’s not a correlation without known direction of causation (in most cases).

5288

Yes, this is the gist of it. But also these are averages. While in the extremes it’s unlikely you will find people without a significant reduction, I’d like to see the spread in the moderate-to-severe category (I’d say around 35 BMI) since it might be a significant but not extreme reduction on most cases, or a split between a mild YLL and a severe one depending on other factors.

Also, BMI is confounding at lower BMI levels, so if you use a more precise measure of obesity (waist to height) you are going to see higher effects there (which is the point of the first article. WtH takes away fit but heavy people and looks at obesity in a more objective way, like waist-to-hip heavily correlates with several types of cancer incidence).

5289

To be clear, I’m not saying that there’s no correlation there, or that there’s no possible causative link. There probably is (almost unquestionably is on the higher ends of the distribution).

My main point is just that clear data from well-controlled studies isn’t as readily available as many people assume that it is, and that a lot of the pearl-clutching about the “obesity epidemic” overstates the risk to moderately fat people. And given that non-surgical weight loss fails 80+% of the time, our culture’s single minded focus on weight (and weight loss) isn’t necessarily the best approach. It’s possible that the lowest hanging fruit to save more years of life is by addressing some of the inequities in things like wealth / access to nutrition / access to medical care rather than focusing on the weight of individuals.

5290

In the US it seems 20% of the population falls into morbidly obese (again using the not-that-useful BMI).

It’s a significant economic impact. I’m not going to run the numbers, but it probably averages to around 2 YLL per American.

5291

Oh, it here are definitely other things to address that likely can have a big impact too, and obesity is caused by many factors that other interventions could address, and as you say not always under the control of the individual.

But it is a tool that is useful. While I think it would be better to focus on exercising (which has more benefits than mere weight loss) other than dieting, there’s a lot of benefit for doctors to recommend patients with associated risk factors and comorbidities to lose weight. And if there are no known comorbities, at least to check for the most common ones if severe obesity is present.

5292

There’s also an argument in medicine about whether eating disorder patients should know their own weight. I thought these cards might be related to that.

But seeing all the following argumentation in thread about BMI (where I fall very much on the “mostly bullshit” end of the spectrum) I seem to have guessed wrong.

5293

It’s not not related to that.

The focus on putting a specific number on weight is definitely contributing to a culture where it’s a thing to be gamed and constantly front of mind, which contributes to eating disorders. So, it’s definitely more immediately salient for people recovering from eating disorders, but there’s also a broader general position about whether it is generally useful for any patients. I.e. you don’t have to have a diagnosed eating disorder to benefit from not obsessing about minor fluctuations in weight.

5294

The big picture on weight is that it’s a whole mind/body issue which requires a holistic health care AND lifestyle approach, and for overweight people, is NOT easy to manage. So in that context, I can actually see the pushback against the simplistic “weigh people all the time approach”.

I get the frustration of many patients - the most common approach of the health care system to weight issues is the simplistic “weigh the person and then lecture the fuck out of them if they are over X pounds” which is not a helpful approach.

Although I continue to feel the numerical magnitude of the health impacts of weight is exaggerated in popular imagination, it’s also true that there are meaningful negative impacts from being overweight. Problem is, we as a society and as a health care system do a truly shitty job of addressing this.

For example, there is very good evidence that overweight people feel the urge to eat more frequently than the non-overweight. Why is that? There are many theories but for many people the causes are complex and may involve many different factors. Truly helping a patient lose weight is going to require looking at behavioral issues AND psychological/psychiatric issues AND environmental issues AND personal/family/work/lifestyle issues AND and and.

And our health care system does a truly shitty job of addressing system issues like that. That’s why I can see patient pushback on constant weighing not being stupid shit.

Here’s one of the key things to think about: there is good evidence that non-overweight people think that maintaining a healthy weight is not that hard b/c for them it is not in fact that hard. It’s one of those self fulfilling situations: non-overweight people tend to have lower rates of hunger urges, etc. such that it’s easier to manage. That’s why (for many folks) they are non-overweight to begin with. Now some people do manage weight successfully by virtue of great effort, but it’s also true that many overweight people expend great effort only to be unsuccessful. The failure rate of diets is shameful.

So there’s two big issues here: on the one hand, as an overweight person I think that our society deeply underestimates the difficulty of maintaining a healthy weight for those with weight problems, but it is also true that I and people like me would be healthier if we could manage a healthy weight. But our society sucks at providing the kind of deep, multilayered, holistic help that would actually improve outcomes.

And then lastly, there is also some current research on brain development and hunger urges showing fairly interesting findings that the nutrition levels of prior generations, particular mothers and maternal grandmothers, affect current generation weight. It is possible that it will turn out that deep, even generational, brain development issues are involved, and that truly managing weight is going to be a multi-generational deal, for at least some people. (This last part is speculative and relatively new - but my prior paragraphs are backed up by pretty good science from my understanding.)

5295

There’s some interesting sounding studies, but I don’t know enough to really peer review their data and methodologies. It seems like the kind of thing that could show up with data mining, so we’d probably need lots more studies in different locations to validate.

5296

While I agree with everything you say, including the low likelihood of success for weight interventions, there’s something of a catch 22.

Because surgical procedures do work and are very non-invasive nowadays. However, to be able to address morbid obesity (over 0.7 waist-height ratio) medically (without taking away the need to address the issue in a more holistic way, these are not exclusive) we need to really medicalize the condition as an illness. Because otherwise it’s hard to get a good uptake of patients willing to undergo more aggressive treatment (I’m not going to get surgery “just” to lose weight…).

So yes, it’s important to acknowledge that the problem is systemic and complex in many ways, but that should never take away the seriousness of the condition in the morbidly obese (or those tending towards that). Not to push them necessarily into lifestyle changes (although weight interventions seem to work better for slowing weight gain than to lower weight) but in those cases to push for aggressive beneficial treatment.

5297
5298

It’s already a law here in WA.

It sucks. I have to ask every time.

5299

California has this law as well, though it won’t be in effect until June this year. But most takeout places already do it. Honestly it’s pretty transparent. They say “do you want any chopsticks or hot sauce with that?” and I say “Yes, please.” Agree that this probably has very little impact on overall waste, but it’s also pretty painless.

5300

Same in Oregon. From a number of places the takeout order form has a checkbox for utensils and the like.

Its a pretty non issue.

Plastic straws are another case, one that can vary depending on location. You have to ask for straws at many locations, but there are a number of beach towns that ban them completely, as in you can’t get plastic straws period in those towns. Which, given that beach tourism is the main industry for them, makes a lot of sense. If the only thing keeping your town afloat is people visiting your beaches, then obviously you would want to keep them clean, and plastic straws were a nuisance, and harmful to wildlife.