The idea that people can be healthy at any weight has gained credence in recent years, despite widespread evidence that obesity creates health risks. While the idea is attractive, it’s also dangerous because it can lull people who need to lose weight now into a false sense of security.
In a new book The Obesity Paradox: When Thinner Means Sicker and Heavier Means Healthier, for example, US cardiologist Carl Lavie argues that people with certain chronic diseases who are overweight, or even moderately obese, often live longer and fare better than normal weight people with the same ailments.
This may indeed be the case for a small proportion of people, but messages such as this are cause for concern because they can lead to complacency and delays in action against overweight by governments, health professionals and individuals alike.
Being fat and fit?
Lavie’s idea is not new. An increasing number of reports show it’s possible to have a body mass index (BMI) in the overweight (25 or more kilograms per height in metres squared) or obese (30 or more kilograms per height in metres squared) range and still be metabolically healthy. The latter is defined as the absence of certain risk factors for metabolic diseases typically associated with being overweight or obese, such as diabetes and cardiovascular disease.
While the proportion of obese people who are metabolically healthy varies depending on how obesity and health are defined, it’s much smaller proportion than those who are not metabolically healthy. And it’s not possible to predict who will remain metabolically healthy despite excess weight gain.
What’s worse, recent research suggests it’s only a matter of time before obese people who are metabolically healthy start facing health issues. And whether or not a person with excess weight develops illness, sooner or later the mechanical effects of excess weight and the resultant gait abnormalities, combined with systemic inflammation, are likely to take their toll.
Overweight adults are more than twice as likely to develop knee osteoarthritis, and the risk increases with weight. Carrying excess weight also contributes to escalating difficulties in performing everyday activities, such as walking, getting out of a chair and climbing stairs.
Any delay in action is even more worrying because of emerging research in animals such as mice, rats and monkeys that suggests there may be a limited window of opportunity to do something about excess weight.
After a while on an excessive diet (several months in rodents; unknown in people), carrying excess weight may become “hard wired” into the parts of the brain that regulate appetite. It may then become almost impossible to lose weight.
Effects of processed food
Exposure to a processed, energy-dense diet that’s high in fat, or high in fat and sugar (the default diet of modern societies), initially leads to physiological changes in animals and humans that tend to counteract weight gain.
These include a loss of appetite, but whether you actually lose weight in this phase depends on whether you pay attention to how you feel or eat when you’re not hungry. Problems arise when signals for reducing food intake are ignored and people continue eating more than they need.
Chronic exposure to excess food in rodents leads to the breakdown of these compensatory responses. Changes in the brain similar to those seen in drug addiction also occur. Both changes are thought to contribute to a compulsive drive to overeat.
So, instead of the body fighting ongoing fat build-up, as is the case during the initial stages of kilojoule excess and weight gain, long-term excess and fat accretion lead to physiological changes that enable the body to put on weight more easily.
While we know this happens, we don’t know why or how eating too much over time breaks down the body’s natural defences against weight gain. And we don’t know whether the effects of long-term overconsumption to promote a seemingly permanent state of obesity in rodents also occur in humans.
More importantly – and more worryingly – we don’t yet know whether the detrimental effects of long-term excess can be reversed by switching to a healthier, lower-kilojoule diet.
Advantages of acting early
While there are gaps in the evidence for this idea, in light of emerging evidence from animals showing similarities with human brain pathways controlling body weight, it’s probably safer to act now rather than wait.
That’s why the increasingly widespread promotion of the idea of being healthy at any weight, which is potentially a recipe for complacency, is bad.
Governments should take urgent action to ensure that healthy diets are readily accessible to everyone, and that highly processed high-fat, high-sugar diets are difficult to access. We also need more research to find better ways to help people to lose excess weight.
Anyone carrying excess weight should do whatever it takes to rid themselves of it gradually. They should start as soon as possible – while their body is still likely to be amenable to weight loss.
If you put off losing those excess kilos until later, it may be impossible to do it without bariatric surgery or other extreme measures that leave you feeling permanently hungry.
As a society we need to work together to nip excess weight in the bud – the earlier the better, while it is still possible.
John Doyle
John Doyle is a Friend of The Conversation.
architect
Good article, but the penchant for equating weight gain due to" fat" consumption is just a distraction from the main points, and it is repeated here.
Read moreIt might seem logical that eating fat causes fat to accumulate in the body. The body however doesn't work that way. Fat is the most desirable and taste satisfying food as far as the body is concerned, [the sixth taste]. It also satisfies hunger most effectively. Fat is stored in response to signals in the diet that starvation is imminent. What we eat…
Jenna Cowie
Dietitian
Maybe fat is the most satisfying in theory and I'm sure there are particular studies that demonstrate this, however I would suggest this depends on so many other factors that it is not usually relevant. It's the kilojoule density that is the issue, which I assume is why Amanda brings it up. No matter which way you look at it, if you are eating high amounts of fat all day, purely the amount of energy that you are putting into your body means weight gain is likely. I am not talking about percentage…
Read morerory robertson
rory robertson is a Friend of The Conversation.
former fattie
Jenna,
I think it is a stretch to worry that the masses are getting fat and diabetic from eating salty peanuts.
Here's a particularly well-documented sample of what some of our less-well-off are eating on the way to getting fat and sick: see Box/Table 2 in https://www.mja.com.au/journal/2013/198/7/characteristics-community-level-diet-aboriginal-people-remote-northern-australia
That sugar and other refined carbs are at the centre of the growing health disaster for our information poor seems to have slipped unnoticed past some of the most influential food scientists in our Group of Eight universities: Section 4 http://www.australianparadox.com/pdf/RRsubmission2inquiry.pdf
Regards,
Rory
Gary Cassidy
Hi Jenna,
You seem to make an unjustified leap from demonising a nutrient (fat) to demonising a food (peanuts) because it has some of that 'bad' nutrient, and then go on to blame an additive to that food (salt) and the context (mindless eating in front of the tv) anyway?
Peanuts (as well as other true nuts) are a perfectly fine food, and are consistently shown to be so in various studies.
Surely it would be better to satisfy hunger with a handful of nuts, than a handful of skittles; and to set up strategies to not eat mindlessly when you're not hungry?
John Doyle
John Doyle is a Friend of The Conversation.
architect
That might be because we live in a food obsessed culture. We just plain eat too much and food is cheap today, even good food, not just junk food. I don't think kilojoule density is relevant to your thesis.
Fat is the sixth taste identified not too long ago. We are primed to eat and enjoy fat but traditionally, like sugar, it was a treat but an important one. People starve without fat as the rabbit starvation episode- I think in Canada - showed. Fat is an important carrier of nutrients , vitamins etc around the body. Sugar in glucose form is also essential to cell energy.
Excess is what we have to beat. It requires that our ability to know when enough is enough is not sidetracked by bad diets. Our levels of leptin, ghrelin etc have to be functioning well and mostly today they are not. The right diet is the answer and it must be based on what and how we ate thousands of years ago - sort of a neolithic regime. The diet humans ate to become human.
Jenna Cowie
Dietitian
Thanks Rory, that's what you call an example. I wasn't insinuating that everyone eats full bags of peanuts in the evenings.
Jenna Cowie
Dietitian
Hi Gary, I was waiting for someone to take any opportunity to accuse someone of 'demonising' fat. Can you please advise where I did this? I like fat, I eat fat, in fact if you care to know my diet is about 35-40% and have never had problems in managing my weight. Largely from nuts in fact. Saying that fat is more kilojoule dense than other macronutrients is not a judgement, it is a fact. I don't claim that kilojoule intake is the only thing that affects weight, but would you be willing to argue that…
Read moreJenna Cowie
Dietitian
I agree excess is the key, which is why I referred to total amount of fat rather than percentage of the total diet. Combined with the distraction of television, inactivity, the nice taste and mouth feel, and numerous other factors, fat is easy to over-eat in the way it is presented in today's food supply - I don't think this is an unknown phenomenon.
rory robertson
rory robertson is a Friend of The Conversation.
former fattie
Jenna,
Yes, a poor example. If we are talking about combating obesity and type 2 diabetes, highly processed high-carb products like sugary breakfast cereals, softdrinks and bakery items, even bread, would have been better examples than peanuts.
Jenna Cowie
Dietitian
Yes, if that's what I was talking about it would have been a bad example.
Sue Ieraci
Public hospital clinician
Thanks, Jenna Cowie - your comment seemed clear to me. You were saying that behavioural (TV watching distraction) and flavour (salty nuts) factors can overcome our body's natural satiety signals, no?
Having observed many discussion threads about diet and nutrition on TC, I can see how frustrating it must be for dietitians to have to defend themselves against the self-informed zealots. As Rosemary Stanton says, people seem to want simple solutions, but human physiology isn't simple.
Gary Cassidy
Hi Jenna,
Read moreThanks for the clarification, although to me you comment reads -
1. High fat diet = High energy diet - this is not proven, there are many experts that claim that macro-nutrient content doesn't correlate to energy intake.
2. High energy diet = likelihood of overweight - not disputable, although probably not relevant to macro-nutrient contents.
3. Peanuts are a high fat food.
4. Eating salted peanuts in front of the TV is likely to lead to overeating because of distraction and the added…
rory robertson
rory robertson is a Friend of The Conversation.
former fattie
Dr Sue,
When "simple solutions" are available, it is sheer negligence for them to be ignored, in my opinion.
In discussions of obesity, if "trained" doctors and dietitians showed appropriate awareness of the most-relevant facts - carbohydrate consumption drives insulin secretion drives fat accumulation - then the rest of us would become less annoyed by "health professionals" bumbling along explaining that fixing obesity is fiendishly complicated.
Readers, here's a version of the time-tested…
Read moreSue Ieraci
Public hospital clinician
I'm not sure what Mr Robertson means by '' "trained" doctors and dietitians.''
''I simply do not understand why severely restricting dietary carbs is not the standard approach to treating obesity and diabetes''
Maybe because an understanding of physiology requires one to be ''trained''.
rory robertson
rory robertson is a Friend of The Conversation.
former fattie
Dr Sue,
More snarl than substance, as usual. Maybe you could show a bit more respect to other readers here, if not to me, by explaining in detail via your profound "understanding of physiology" why what happened to this morbidly obese man via a basic LCHF diet was so damaging to his health: from minute 12.42 https://www.youtube.com/watch?v=D0GSSSE4l8U
Fiona Willer
HAES researcher, APD, university lecturer
Unlike the author of this piece, my area of research is the investigation of health outcomes associated with taking a Health at Every Size (R) (also referred to as HAES) approach, when applied by health professionals, particularly for people who are overweight and obese.
There is no doubt that many people who are overweight and obese suffer a greater burden of illness, disease and disability. They also bear the brunt of deeply ingrained social stigma and discrimination which pieces like this…
Read moreJohn Doyle
John Doyle is a Friend of The Conversation.
architect
How to sift that mountain of evidence is a big issue, however. Then there is the "one size fits all" shortcuts to banish.
Governments have been complicit in all the misinformation out there. So government regulation is a big no-no!.
Hark back to their use of "war", It may be intended metaphorically but the results are tragic.
The 'war' on terror produced more terror; the 'war' on drugs, the same; the 'war' on poverty also the same. A 'war' on obesity will be exactly the same. It will be utterly counterproductive!
Governments are the problem, not the solution, which is very unfortunate.
Joe Gartner
Tilter
Fiona,
you wrote '...deeply ingrained social stigma and discrimination which pieces like this validate'
How does the recitation of the research around obesity 'validate stigma'? Should we not discuss the reality about it?
Sue Ieraci
Public hospital clinician
It seems to me that the HAES approach and the attempt to prevent the complications of morbid obesity should not be mutually exclusive.
Of course everyone should pursue healthy habits, good self-esteem and well-being. That approach alone, however, does not prevent the degenerative arthritis, metabolic syndrome or hypertension that frequently complicate long-term morbid obesity. (I am using the term ''morbid'' in the medical sense, not to mean ''gloomy'').
I did not see anywhere in the article where the author advocated ''feverishly chasing weight loss at any cost''. On the contrary, she advised ''Anyone carrying excess weight should do whatever it takes to rid themselves of it gradually.''
It is possible to be respectful of a person's dignity but also advise them of long-term complications of their body habitus.
Fiona Willer
HAES researcher, APD, university lecturer
Hi Sue,
That's precisely the statement I was referring to, particularly the 'whatever it takes' section. Advocating doing whatever it takes is promoting weight loss at any cost. No evidence is presented about how to achieve it, whether quickly or gradually as suggested. Even the 2013 NHMRC best practice guidelines for the treatment of overweight and obesity concede that most weight losers will have regained the weight lost by the five year mark.
HAES approaches typically result in weight…
Read moreFiona Willer
HAES researcher, APD, university lecturer
Hi Joe,
We should absolutely discuss the reality about obesity. Reality that includes that long-term weight loss is largely impossible in today's environment. Suggesting that people should just try harder and do 'whatever it takes' to lose weight is an insult to everyone who is living a healthy lifestyle despite having a heavier body. It's also quite insulting to the researchers who have spent their careers trying to help people lose weight.
Suggesting that everyone who isn't losing weight is just putting off trying to perpetuates the stereotype that people in larger bodies are lazy. Lazy people come in all shapes and sizes, just like intelligent people.
Joe Gartner
Tilter
Fiona,
You've overstated one point in the article to demonise the entire article.
There's very little in this article that stigmatises anyoine, in fact it nicely states the difficulties of losing weight in an obesogenic environment and the 'resetting' of metabolism that accompanies fat gain.
If you are claiming that pointing out the statistics linking obesity and illness is 'stigmatising', than what you really want is censorship.
rory robertson
rory robertson is a Friend of The Conversation.
former fattie
Fiona,
You wrote: We need to...accept that long term weight loss for the majority of people is not achievable...". I have excellent news for you: you are wrong on that but you are far from alone.
In case you missed it in my post to Dr Sue earlier, here's a version of the time-tested diet that has been reversing obesity and type 2 diabetes for two centuries: (scroll down) http://www.australianparadox.com/pdf/why-we-get-fat.pdf
The process seems to be as simple as science historian Gary Taubes…
Read morerory robertson
rory robertson is a Friend of The Conversation.
former fattie
Hi Dr Salis,
Thanks for your piece and congratulations on your (long ago) weight-loss. Another former fattie!
I reckon your headline "Fat and fit? There’s no such thing for most people" would be better if it read "Fat and Healthy...etc". (I guess you didn't get to write the headline).
My point is that too many people confuse fit with "healthy". Anyway, I agree. And I agree when you write we "need more research to find better ways to help people to lose excess weight". I wonder if you have…
Read moreAndrew Dickson
Lecturer at Massey University
So often we social scientists hear scientists like author use phrases like this (quoted from above):
"Governments should take urgent action to ensure that healthy diets are readily accessible to everyone, and that highly processed high-fat, high-sugar diets are difficult to access"
This totalising belief in the role of 'government' and its apparent god-like ability to radically transform the economic, social and political landscape is astonishingly naive. The institutional structures that…
Read morerory robertson
rory robertson is a Friend of The Conversation.
former fattie
Andrew,
You wrote in your article (linked to above): "...I conclude that public health practitioners who find themselves promoting weight loss towards the ‘healthy’ range of the BMI are in an unethical position, one that should be entirely rejected."
Both "unethical" and "should be entirely rejected" are unreasonable stretches, reckless actually, given that obesity is strongly correlated with type 2 diabetes and related maladies.
As you should know, the problem for many becomes as simple as lose weight or get ready to lose a limb: http://www.crikey.com.au/2012/07/12/how-diabetes-council-advice-bucks-scientific-proof/?wpmp_switcher=mobile
Regards,
Rory
Andrew Dickson
Lecturer at Massey University
Hi Rory,
I suspect that we will permanently disagree here.
It is reckless for a health practitioner to treat weight rather than diabetes, this is the difference between correlation and causation.
Andrew.
rory robertson
rory robertson is a Friend of The Conversation.
former fattie
Andrew,
On the former, I agree. On the latter, I think it is reckless for a health practitioner to ignore the weight and, in the process, ignore the prospect of pre-diabetes.
Chris Ford
logged in via Facebook
As another "former fattie" I tend to agree with Andrew re BMI - it seems to me to have become a distraction as much as an aid. By all means doctors should promote weight loss if a patient's weight is causing health issues, but not simply because their BMI is over 25. As a simplistic tool in assessing weight it's quite handy, but it should be the starting point not the endpoint.
Sue Ieraci
Public hospital clinician
As a community, don't we value prevention as well as cure?
The idea of weight management is like other preventative health measures - to avoid or delay the onset of the disease. This is not a perfect system, because you can still get diabetes or various cancers without any apparent preventable cause.
The real problem with BMI, like GI, is that tools developed for a specific purpose, or a guide, tend to be mis-used or over-used.
As I said before, people like simple solutions, but human physiology isn't simple.
Gary Cassidy
An interesting article. Thanks.
Of coarse if you take a population of obese people and weed out the fit ones, then some of them will be metabolically healthy - until they become metabolically unhealthy, subsequently unfit and then excluded from the minority population of fit obese people.
Obesity (for most people) is primarily driven by environment. Part of that environment is non-modifiable external environment, and part is modifiable personal environment - there is very little good advice…
Read morePaul Richards
integral operating system
Appreciate the worldview and the article demonstrating the narrow focus of current nutritionalists.
Read moreGary Cassidy wrote; " ... the primary tool sold to people has been the ineffective fad "Eat less, move more" ... " Could not agree more. Particularly as the epidemiologist worldwide are currently engaged in a range of studies of the human gut micro-biome. Having started long term studies on effect on the uptake of nutrition, response to disease and the role out colonies of unique gut flora play…
Rachel Dawson
ecologist
I am really saddened by some of the comments here - That advice to "eat less move more" is a fad that doesn't work and will become a relic. (Works for all the people who aren't overweight, nothing else will) The outrage at the suggestion that the fat individual is responsible for their condition. (Blame the Government) That we should just aim to be healthy and not worry about being fat. (So let's just give up) Outrage at the obesogenic environment. (Are you being forced to the lolly counter…
Read moreStuart Germon
IT Administrator
Fat is not the culprit.
People simply eat to much and don't exercise enough. It is really that simple. Look at the trolley of an overweight person in the store, you will not be surprised by what is in it.
It is not education. I don't care how dumb people are, a vast majority know Junk food is bad and fruit and vegies are good. They know eating a whole packet of tim tams in one sitting is bad, but they simply don't care. Apathy is to blame.
Fat pride and excuses aren't helping either.
Don't panic the world will have a food crisis in the next century or so. Our exponential growth has a sharp growth in it's future. That'll thin the herd.
Stuart Germon
IT Administrator
Heh "Drop".