Monday, June 09, 2014
Why being FAT can be good for you: A controversial book by a top doctor claims being overweight can help you fight disease - and even live longer
The "war on obesity" is a major political theme. What if its very basis -- the unhealthiness of obesity -- is wrong?
Consider the various bits of advice doled out by so-called medical experts in the past 100 years or so and you’ll realise how often there has been a complete about-turn when it comes to the validity of a certain fact, claim, or practice.
At one time or another, scientists deemed it acceptable to use X-rays to measure shoe size, recommended baby formula over breast milk, and even endorsed cigarette smoking.
Looking back, it seems incredible that we were ever misled in this way and yet I believe that we are currently subject to one of the greatest misconceptions of all — the belief that obesity is necessarily bad for us.
Our modern culture has duped us into thinking excess body fat should be burned away at all costs.
But, as a cardiologist who has been in practice for nearly three decades and written more than 800 medical publications, including two text books, I am here to tell you that fatness has been sorely misunderstood.
Indeed, there is much evidence to suggest that, just as a glass of wine a day has been proven to impart health benefits, so body fat in the right amount can be exactly what we need to live long and healthy lives.
Don’t get me wrong: I’m not suggesting that people of ‘normal’ weight start embracing cream buns and piling on the pounds.
But if you are already carrying extra fat, it’s not the end of the world, especially if you maintain a certain level of fitness (and I don’t mean being able to run a six-minute mile or committing to an exercise regimen on a par with an Olympic athlete’s).
For the millions of people categorised as overweight or mildly obese by the most commonly used standard today — the body mass index, or BMI — the good news is that achieving optimal health may mean staying exactly where you are in terms of weight.
That’s right: you don’t have to set your sights on getting your BMI down to ‘normal’, defined by the World Health Organisation as between 18.5 and 25.
You may, in fact, be much better off sustaining a BMI of between 25 and 30 — ‘overweight’ in WHO terms — or even slightly above, venturing into the realm of the mildly ‘obese’ (BMI above 30).
This advice holds true for people who want to prevent chronic illness and those already living with it, but it was those in the latter category who first inspired my research into this subject more than a decade ago.
Day in, day out I care for heart patients in Louisiana, the most obese state in the U.S.. And, like other colleagues in the cardiology profession, I began noticing that patients who are on the chubby side often live longer after diagnosis with heart disease than do their thinner counterparts.
We call this idea that fat can protect you from an early death the ‘obesity paradox’ and to say that it has ruffled a few feathers in my field is an understatement.
As I began to publish research papers on this phenomenon, I faced a tidal wave of ingrained ideology. Even veteran scientists and respected journal reviewers were reluctant to entertain new thinking about fat, but the science has since spoken for itself.
Over the past few years, a multitude of studies around the globe have not only confirmed the existence of the obesity paradox but demonstrated that it also applies to a host of chronic ailments in addition to those related to the heart, including diabetes, cancer and kidney disease.
We often attribute excess weight to an increased likelihood that these conditions will be worsened or aggravated as a result, but the evidence proves otherwise: people who have been diagnosed with any of these ailments fare better in the long run if they are overweight or even mildly obese than if they are normal weight.
One explanation is that when the body is bearing the weight of a chronic disease, it requires more energy than usual so it makes sense that extra fuel in the form of body fat is helpful.
But it’s also well documented that fat tissue and fatty molecules circulating in the blood help reduce some of the harmful effects in serious illnesses — so the more body fat you have, the more ammunition you have in your arsenal.
As if this wasn’t enough of a challenge to conventional medical wisdom, other research has suggested that being fatter can be of benefit not just to those who are chronically ill, but to the population as a whole.
In 2005, the scientific community poured particular scorn on a paper published in the prestigious Journal of the American Medical Association (JAMA) by epidemiologist Katherine Flegal.
This involved an analysis of data from the National Health and Nutrition Examination Survey (NHANES), a long-term study into the health and diet of 33,000 Americans. Ranging from two-month-old babies to people aged 75, the subjects are chosen to give a representative snapshot of health and diet across the USA.
For years, we thought that an optimal BMI for the general population was around 23, but Flegal’s research turned all that on its head. As you would expect, she found that the biggest risks of death lay at the extreme edges of the BMI spectrum — being either underweight (below 18.5) or severely obese (above 35).
But remarkably, those classified as mildly obese were at no greater risk of dying prematurely than their normal-weight counterparts.
And, more extraordinary still, those who were overweight were actually at a slightly reduced risk of dying compared to those in the normal weight range.
Flash forward a few years and Dr Flegal decided to confirm the NHANES results further by reviewing 97 similar studies from across the world, encompassing a staggering 2.9 million people.
Time and again they arrived at the same conclusion, the combined statistics revealing that those who are overweight have a six per cent lower risk of dying than people of normal weight.
Of course, none of this is to deny the well-documented relationship between obesity and myriad illnesses. To be clear about this, being obese or overweight poses a major risk for chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer.
In fact, it’s estimated that every third person born in 2000 will have type 2 diabetes as an adult. And according to the American Heart Association, 70 per cent of diagnosed heart disease cases are linked directly to obesity.
Many argue that, should we fail to stop the obesity epidemic, we will soon lose serious ground on extending our life expectancy.
But there is a difference between being a little fat and being morbidly obese. And faced with evidence that the ideal BMI is somewhere between 25 and 30, the scientific community has been forced to rethink its definitions and try to explain why being ‘plus size’ can be to our benefit in certain circumstances.
One answer is that fat cells are not all created equal and their different characteristics mean that, while some types of fat feed illness and dysfunction, others are harmless and can even prevent disease.
For example, belly fat releases fatty acids and inflammatory compounds into the body, leading to higher bad cholesterol, blood glucose and blood pressure.
But it’s a very different story for fat that’s stored in the lower-body areas. Researchers at Oxford University found that this traps the potentially harmful fatty acids that can travel through the bloodstream (and to the heart).
So, while we might despise our ‘thunder thighs’ and ‘saddlebags’, they could actually be good for us in helping reduce the risk of diabetes and coronary disease.
Such thinking challenges the ideas that prevailed when I started at medical school in the late 1970s.
We believed then that fat cells were primarily biological storage bins for excess calories.
But today we know they are much more than that. Almost every week the scientific literature unveils another function for the humble fat cell. Did you know, for example, that two-thirds of the brain is composed of fat (and, incidentally, one-fifth of it by weight is composed of cholesterol)?
As well as helping us think, fat cells bolster immunity. In the early stages of their development, they devour invading germs and bacteria, which is why people who diet to extremes tend to become sick more often.
Fat cells also generate many important hormones, including those which, if under-produced, can leave us vulnerable to an array of diseases including Alzheimer’s, cancer, major depression and inflammatory bowel disease.
Another important molecule produced by fat cells is nitric oxide, which governs both the growth of our hair and, believe it or not, blood flow to the male organs during arousal.
I could go on about the various molecules pumped out of fat cells but you get the picture: fat tissue is very active in our body and part of our essential tool kit for health and longevity.
This helps to explain why BMI is a terribly unsophisticated and unreliable measure for evaluating the health of individuals.
Based on a simple formula which involves dividing the square of your weight by the square of your height, it does not distinguish between muscle and bone, let alone between different kinds of fat. Nor can it take account of individuals with what’s known as ‘metabolically healthy obesity’. That expression may seem a contradiction in terms.
It may be common knowledge that a high BMI is associated with a greater risk of conditions such as type 2 diabetes and heart disease, but more than half of ‘overweight’ and more than a third of ‘obese’ people are perfectly healthy from a metabolic standpoint.
In other words, they don’t have raised blood pressure, high cholesterol, or show any of the typical red flags we attribute to the carrying of extra weight. Yet those same metabolic abnormalities are found in almost a quarter of ‘normal’ weight people.
The obvious explanation is that weight isn’t the issue when it comes to determining whether we have such abnormalities. Far more important are factors like nutrition and fitness.
The importance of what we eat was most recently highlighted by one clinical trial which revealed how adopting a Mediterranean diet reduced cardiovascular risk — regardless of how much weight subjects had lost.
As for fitness, there is substantial evidence that this is so protective that it essentially cancels out the adverse impact of traditional risk factors, including being overweight, obesity, type 2 diabetes, and high blood pressure.
This is borne out by studies which have tracked many physically fit ‘obese’ individuals (those, for example, who’d have no difficulty climbing up several flights of stairs or walking a mile or two at a decent pace) and discovered that they have lower incidence of heart disease and death from any cause than do sedentary people of ‘normal’ weight.
Clearly, the fitter you are, the less your weight matters and I believe the term ‘obesity’ needs to be redefined.
A fit person with a BMI of 28 (‘overweight’) could easily outlive a thinner person who has a BMI of 22 (‘normal weight’) but is unfit. And yet it’s these ‘full figured’ people — who are not necessarily in danger of dying early — who are relentlessly censured by society and penalised by insurers, not to mention being targeted by the multi-billion-pound diet industry.
In a perfect world, BMI would reflect other variables, including fitness levels, genetics and biomarkers of metabolic health such as blood glucose. Until then, I worry about doctors who push weight loss on their patients, based purely on the BMI scale.
They have good intentions but the message people may hear is they should lose weight at whatever cost, via extreme diets and controlling weight through eating habits alone.
This can be downright damaging, leading to people becoming what some experts call TOFI — thin outside, fat inside. While they might look good, their abdominal organs can be coated in visceral fat which puts them at risk for type 2 diabetes.
Rather than tirelessly encourage weight loss and focus on the numbers on the weighing scales or BMI index, we should promote cardio metabolic fitness and urge people of all sizes to think about their health in terms of how well they eat and exercise.
Gamers are more educated, more social: study
Admittedly, citing data may not help fight the perception that gamers are nerds. But the results of a new study commissioned by the video game streaming network Twitch and conducted by noted social researcher Neil Howe (aka the man credited with coining the term "millennial") offer an entirely new picture of the gaming community. The study suggests that gamers actually tend to be more social, more successful and more educated than the non-gaming population.
The study, released on Thursday by Mr Howe's LifeCourse Associates consulting firm, surveyed more than 1000 people via the internet about their gaming habits and then pulled some basic demographic information. For purposes of this study, a "gamer" was defined as anyone who has played a game on a digital device in the past 60 days. Approximately 63 per cent of those surveyed fit that definition.
According to the study, gamers are more likely to be living with other people such as family, friends or significant others, and are more likely to agree with the statement, "My friends are the most important thing in my life." About 57 per cent of gamers said they agree with that statement, as compared to 35 per cent.
The study also found that gamers are split more evenly by gender than they have been in the past, with 52 per cent of video game players surveyed identifying as male and 48 per cent as female. A 2004 survey from the Entertainment Software Association estimated that 40 per cent of gamers were female.
Gamers are also slightly more likely to be employed full-time – 42 per cent for gamers, versus 39 per cent for non-gamers – which undoubtedly comes in handy when trying to figure out how to financially support a gaming hobby.
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Posted by JR at 12:36 AM