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Is The Obesity Paradox An Illusion?

Over the in conclusion 2 decades, multiple independent inquiry groups have got come upward to the surprising determination that people amongst obesity (or, to a greater extent than commonly, overweight) mightiness truly hold out healthier than thin people inwards sure ways.  This finding is called the "obesity paradox".  Yet recent inquiry using to a greater extent than rigorous methods is suggesting that the paradox is an illusion-- in addition to excess torso fatty may hold out fifty-fifty to a greater extent than harmful to wellness than nosotros thought.

Introduction.  What is the obesity paradox, in addition to why does it matter?

We have got an enormous scientific literature suggesting that excess torso fatty increases the opportunity of many diseases, including the ones that kill us most-- cardiovascular disease, cancer, in addition to diabetes.  Yet approximately the plough of the 21st century, show began to emerge that the even mightiness non hold out thus simple.

Researchers reported that people amongst cardiovascular disease, kidney disease, in addition to lung illness tended to fare amend when they had obesity than when they didn't (1).  Then inwards 2005, a National Institutes of Health researcher named Katherine Flegal dropped a bombshell on the inquiry community: inwards her analysis of Centers for Disease Control data, people who were overweight had a lower overall mortality opportunity than people who were thin or obese (2).  In other words, people who behaviour some excess fatty are the to the lowest degree probable to die, implying that they're the healthiest overall.

Flegal followed this upward amongst to a greater extent than papers inwards a similar vein, including a 2013 meta-analysis representing 2.88 meg people that confirmed her group's previous finding: overweight people, non thin people, have got the lowest mortality opportunity (3).

The potential implications of these findings are enormous.  Two-thirds of American adults have got obesity or overweight, in addition to nosotros know that major weight loss is hard to accomplish in addition to sustain.  If the obesity paradox is true, in addition to thus it implies that nosotros should only halt pestering people to lose weight-- there's no occupation to get with!  This is a comforting sentiment for people who behaviour excess weight, especially if they've struggled amongst weight loss.

It's too a comforting sentiment for the saccharide H2O industry, including companies similar Coca-Cola.  If obesity isn't every bit bad every bit nosotros thought, in addition to thus maybe saccharide H2O isn't every bit bad every bit nosotros sentiment either.  Coca-Cola has funded several researchers whose operate supports the obesity paradox* (4).  I'm non questioning the integrity of these researchers, but Coca-Cola's involvement inwards this sentiment sure highlights its importance.

But is it real?

The sentiment of an obesity paradox was controversial from the beginning, in addition to many people have got critiqued it over the years.  This came to a caput inwards 2013, when Walter Willett, chair of the Harvard Department of Nutrition, aggressively criticized Flegal's study, stating on NPR that it "is truly a pile of rubbish, in addition to no ane should waste matter their fourth dimension reading it".  He too organized a symposium at Harvard explicitly to criticize the concept (5).  Willett was rebuked for his aggressive tactics, but despite this, many people agreed amongst his scientific position.

The cardinal occupation amongst the obesity paradox is that it's based almost only on observational evidence, important that it doesn't come upward from controlled experiments that are amend at identifying cause-effect relationships.  And inwards this exceptional case, it's non hard to imagine ways inwards which observational methods could obscure the truthful human relationship betwixt torso fatness in addition to health.  In other words, the obesity paradox could hold out zippo to a greater extent than than an illusion of the exceptional inquiry methods that were used to seat it**.

How mightiness this work?  As an example, nosotros know that illnesses such every bit diabetes in addition to Alzheimer's illness frequently Pb to weight loss (sometimes many years earlier diagnosis, important that y'all can't only eliminate the occupation past times excluding people amongst diagnosed disease).  So if you're currently thin in addition to sick, researchers may associate your illness amongst the thin category, fifty-fifty if y'all used to hold out overweight, in addition to fifty-fifty if that excess fatty caused your illness to get with.

Influenza A virus subtype H5N1 similar phenomenon happens amongst cigarette smoking.  Smoking causes weight loss, in addition to it's too a fast rails to illness in addition to premature death.  It's non hard to imagine how smokers mightiness brand leanness expect a lot to a greater extent than unsafe than it truly is.  It's too non hard to imagine that some smokers don't accurately written report their smoking habits, making it hard to fully concern human relationship for inwards studies.

Researchers have got recognized these pitfalls for many years, in addition to those who did the best project of correcting for them ordinarily constitute that thin people tend to hold out healthiest (6, 7).  Yet a novel inquiry method developed past times Andrew Stokes, assistant professor of global wellness at Boston University, promises to furnish the clearest motion painting notwithstanding of the truthful human relationship betwixt torso weight in addition to health.

To minimize the pitfalls of traditional methods, Stokes looks non only at electrical flow torso weight, but at weight history.  He asks a elementary question: how does a person's maximum attained weight associate amongst wellness outcomes?  Weight is compared using the torso volume index (BMI) scale, which corrects for the effects of superlative on weight.

Maximum weight should produce a amend project of capturing the outcome of excess torso fatty on health, because traditional methods don't consider the possibility that a mortal mightiness have got previously carried to a greater extent than fat, in addition to may have got been exposed to its damaging (or protective) effects for many years.  If this is true-- which seems fairly obvious to me-- in addition to thus Stokes's method is a amend examine of the obesity paradox hypothesis than previous methods.

In 2014, I wrote nearly Stokes's firstly study using this method, which suggests that thin people have got lower mortality opportunity than people who are overweight or obese (8).  Recently, Stokes in addition to his mentor Samuel Preston published 2 to a greater extent than papers on the subject, in addition to they are much to a greater extent than detailed (9).

Using the maximum weight method, Stokes confirmed his previous finding that people who stay thin throughout life have got the lowest opportunity of dying.  Consistent amongst this, they too have got the lowest opportunity of developing diabetes in addition to cardiovascular disease.  Both associations were substantial.  Furthermore, people who already have got diagnosed cardiovascular illness have got a higher opportunity of dying if they're too obese, non lower.  There is no paradox inwards these data, which is a proficient sign that nosotros finally sympathise what's going on.  It's too reassuring that his results align good amongst what nosotros know from experimental studies inwards animals in addition to humans.

His newspaper goes on to furnish valuable insight into why previous studies frequently went astray.  With the weight history method, he was able to exhibit that people who lost weight in addition to went downwardly a BMI category were inflating the opportunity score of that category, confirming that this was warping the results of previous studies.  The most probable explanation is that these people were losing weight due to illness (perhaps subclinical) or smoking (perhaps unreported), making leanness appear less salubrious than it is.

As a reminder, in that location is no show that voluntary fatty loss is unhealthy, in addition to quite a fleck of show that it's beneficial (10).


The obesity paradox is in all probability an illusion of the inquiry methods that are used to investigate the human relationship betwixt torso weight in addition to health.  We tin never hold out sure that the results of observational studies are gratis of confounding, but in that location are proficient reasons to believe that Stokes's maximum attained weight method is to a greater extent than accurate than methods that only consider a weight snapshot.  I hope these findings volition get other researchers to adopt his methods.

* To my knowledge, Flegal has never received funding from Coca-Cola.  But inwards whatsoever case, I don't scream upward it's ethical to assume a researcher is biased past times a funding source without show to back upward that accusation.  It's logical to scream upward inwards a full general feel that manufacture funding has the potential to bias research, but specific accusations need specific evidence.  I don't abide by it especially rational to dismiss inquiry findings out of manus only because of a funding source.  In fact, ironically, this is ane of the most mutual ground tactics used past times people who are ideologically biased themselves.

** We tin add together this to a long listing of wrong conclusions that have got resulted from confounding inwards observational studies.  A few examples off the overstep of my head: the human relationship betwixt calorie intake in addition to torso weight, the outcome of vitamin E on cardiovascular health, in addition to the outcome of hormone replacement therapy on cardiovascular health.


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