Surprising New Findings on Obesity

One of the first Freakonomics Radio podcasts we made was an episode about the (surprisingly tenuous) link between obesity and health problems. A new study in The Journal of the American Medical Association finds that “Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality.”  Writing for The Daily Beast, Kent Sepkowitz explains:

Compared to people with a normal weight (a BMI less than 25), the overweight (BMI between 25 to 30) had a 6 percent lower mortality rate—and both groups had a rate about 15 percent lower than the obese, especially the very obese (BMI above 35).

The explanation for the finding is uncertain. Perhaps the pleasantly plump but not obese have an extra reserve—a literal spare tire—that confers a survival advantage should they become seriously ill, whereas the lean-iacs do not. Or maybe the thin ones were thin because of a serious illness that, in the course the various studies, killed them. Or maybe the thin ones were thin because they were chain smokers living off Scotch and potato chips. Or just maybe the occasional pig-out does soothe the soul and make for a happier, healthier individual.

(HT: Andrew Sullivan)


Scott Templeman (@tallbonez)

Real findings should be that BMI is a garbage metric

Scientistbymistake

I couldn't agree more about BMI being a grabge metric.

I am a triathlete, and in a recent medical at my company, the nurse exprerssed concern about my low BMI, after remarking on my powerful sounding heart and spectacular peak flow measurement. I am built like a whippet, am uber-fit and extremely healthy.

The next guy in after me was a 230 pound bodybuilder, really fit, ripped as anything but only 5'10", guess what?...

bob

We have the same problem at my office. Except every other person is morbidly overweight and many are struggling with diabetes.

If you bring up any simple measure of obesity (like BMI), they all point out how it's a junk metric and it doesn't address their muscle mass. I wonder if they could do a single push-up.

BMI is pointless. Fit people know that at best it's a weak guideline. Fat people dismiss it because they don't want to change to a healthier lifestyle. Rarely do you meet a person who actually wants to know what their healthiest weight would be and then change their life to achieve it.

As a person who is constantly trying to live healthier, I'd love to have an ideal weight for my height and build. I'm 5'11" and 167 lbs, and I meet the BMI guidelines, but I'd love to know whether another 10 lbs either way would extend my life (and it's quality) or reduce it.

NC

Or maybe the study included people with terminal cancer and other diseases which cause them to lose weight. This would be a very poor study indeed. And a source of incorrect information about the health risks of being overweight.

Enter your name...

The combined studies covered nearly 3 million people long enough that almost 10% of them died during the tracked time period. I think it was probably a pretty good study overall.

I understand that they excluded anyone in hospice care or in the hospital at the start of the study. It probably does include people with eating disorders like anorexia nervosa (known to have a high mortality rate among young adults), though; on the other hand, it probably includes a lot more people with binge-eating and other disorders that cause weight gain.

It is also true that most of the excess mortality in "healthy weight" people comes from the people whose BMI is in the skinnier half of that category. I think it is probably a good basis for us to consider whether the BMI categories need to be adjusted slightly, so that "barely heavy enough to be normal" is now considered "underweight".

Paul

Is it also possible that the use of BMI as the gauge for obesity is outdated? It doesn't measure muscle mass or fitness level. I understand it was used in this particular study for comparisons to other studies, but it seems to me that BMI is misleading at best.

Tomasz T.

It's true that BMI cannot distinguish between a plump couch potato and muscle-packed bodybuilder, but I would guess the number of these latter guys is so minuscule compared to the former, that they cannot disturb the results too much. BMI may be a very good proxy for overweight/obesity at a population level, even though it can be wildly wrong for a particular individual.

Paul

Using BMI to determine "weight" is like using horsepower to determine how fast a vehicle can go. I'm sure there are some relatively close relationships, but when it comes down to it, there are so many other aspects that should be taken into consideration before drawing a conclusion.

Djyrn

How long until insurance companies start dropping premiums for higher BMI's?

Enter your name...

"Lives longer" and "incurs fewer health costs" are not the same thing.

Doug

Perhaps BMI is a terrible way to measure healthy weight. This has been well insinuated by a number of beyer weight and health professionals.

Jen

Yup, there are a lot of very fit people who are in the 25-28 BMI range. BMI doesn't take muscle mass vs. fat mass into account.

When you have a selection of fit, muscular people being called overweight and have likely not weeded out the very sick, alcoholics, anorexics, etc. from your below 25 BMI, that may well explain the "advantage."

It may still indicate that some extra weight isn't actually harmful though.

Jessica

Not just the use of BMI, basically this whole "study" was full of garbage methodology. We are so desperate to continue living our crappy lifestyle that we'll allow anything to pass for science if it gives us hope.

Bridget

Even if we decide that the method for calculating BMI is reasonable (which I'm not sure it is), the ranges for what is considered "normal" vs "overweight" seem a little skewed to me. I have friends who I don't think for a minute need to be concerned about weight loss, who live healthy lifestyles and everything, they're just not model skinny, but they are technically in the "overweight" range. Maybe this study is just showing that those ranges are a little off, and the upper limit for "normal" should be raised a little bit, because those weights are actually still healthy.

Ned Cody

There's something dodgy about the mathematics, I think. How can mortality rates which differ by 6% both be equally below another mortality rate? And the cut-off values must be deceptive: how can a grouping of 29.8 bmi-ers be 15% less likely to die than a group of 30.0 bmi-ers.
I'm only saying...

Eric M. Jones.

Fat jiggles to attract attention--signaling breeding fitness.

TexCIS

Smokers usually weigh less. Reexamine the data excluding them and see what is revealed.

AaronS

I have a theory. It comes from a lifetime of being the "big guy." Very simply, I believe that some people are "designed" to carry additional weight. We've all seen those folks who, with just a few extra pounds, are huffing and puffing. Or even those folks who, morbidly obese, can barely get around.

And then we've seen folks who, even 50 lbs. overweight, are active, vibrant, etc.

For many years, I didn't understand why some people suffer heart attacks before 30, while I, much, much larger than them, enjoyed relatively good health.

I have concluded that some people have a body, metabolism, or something that simply permits them to successfully carry more weight. I'm not saying that's the best thing. I'm simply saying that IF they have more weight, it doesn't negatively affect them like it might another person. Perhaps later in life, but at least year-for-year, pound-for-pound, they do much better. No, they won't be going to the Olympics, but they will be able to enjoy a larger plate of food and desserts than others, all with relatively minimal impact to their health (at least until much later).

I see some morbidly obese who die in their 50s...then others who are big until true old age. Maybe they don't live as long, but for those special ones that seemed designed to handle lots of extra weight, it sure seems that they enjoyed life without worrying too much about calories.

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