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The Obesity Paradox

According to the Center for Disease Control (CDC), approximately 65% of Americans are overweight or obese. The CDC has declared this an “epidemic”. Research shows there is cause for concern. If you are overweight you have a 150% - 200% greater chance of premature death.

But wait! What about the obesity paradox?

Obesity Paradox is the media friendly term for something called, reverse epidemiology. In short it is the result of epidemiological research indicating that people classified as overweight or obese actually have a lower mortality rate than their healthy weight cohorts. This finding is supported by multiple studies across a range of chronic ailments including, heart disease, high cholesterol, kidney failure and, most recently, dementia.

Popular media has paid a lot of attention to the phenomenon and experts have been hotly debating the validity of the findings. I personally think too much has been made of this seeming paradox. In my opinion it’s a case of apples and oranges.

Obesity Is Correlated With A Higher Mortality Rate
If you follow for a long period of time groups of people with a broad range of health status from healthy to already suffering from severe illnesses, as is normal in the general population, you will find that being overweight is strongly correlated with many serious health problems and with a higher mortality rate. This kind of study is behind the statistics I quoted in the first paragraph.

But, A Few Extra Pounds Can Save Your Life
On the other hand, if you study only people already diagnosed with a serious illness, you will find that people who are overweight (or even obese) have higher survival rate than people with healthy weight.

The curve is actually a U-shape. Up to a point, higher Body Mass Index is associated with higher survival rates and then beyond that point survival rates drop again. The “point” differs from study to study, but seems to be around a BMI of 30.

This all makes perfect sense to me. If you are, in most respects, healthy but overweight, being overweight puts you at higher risk of becoming ill. But, once you are already ill, being a little overweight gives your energy reserves that increase your chances of survival especially if the treatment of the illness is one that is likely to put a strain on your energy reserves, for example heart surgery or dialysis.

Being badly obese comes with complications that make treatment more difficult and forces you to probably fight health battles on multiple fronts at the same time, hence the U-shape curve.

So, where does this leave us?

Should we target a particular BMI in hopes of avoiding chronic illness? Maybe we should deliberately carry a few extra pounds as insurance?

My approach is practical. I don’t think BMI is a particularly helpful measure of one’s appropriate weight. Please read my previous blog post for more details. Our bodies have built in feedback mechanisms that, when heeded, serve to guide us to the correct weight. This correct weight almost certainly does not conform to any statistically derived optimum BMI nor does it likely match the BMI of your favorite celebrity.

If you keep your neuroendocrine system healthy, listen to what your body is telling you, exercise regularly and practice moderation in all things, your body will naturally maintain the appropriate weight for you at this particularly time in your life. Forcing your body, deliberately or through bad habits and neglect, to be anything unnatural is detrimental to your health.

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