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back to article Being a skinny is much more unhealthy than being fat – new study

Yet another study has shown that the so-called "obesity" epidemic sweeping the wealthy nations of the world has been massively over-hyped, as new results show that is is far more dangerous to be assessed as "underweight" than it is to be assessed even as "severely obese" - let alone merely "obese" or "overweight". "There is …

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I wouldn't have guessed

Healthy fat people have less chance of dying than unhealthy fat people and if we remove all the unhealthy fat people from the stats, it shows that fat people are no more likely to die than thin people.

Did someone pay for this research?

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Anonymous Coward

Re: I wouldn't have guessed

Did you not read the part where people who are underweight (by BMI) are TWICE as likely to die as 'normal' BMI people, and that severely obese people (again by BMI) are only 25% more likely to die than people with a normal BMI? That is, its actually healthier to be overweight than underweight?

The part you are referring to is that the 25% extra risk of death for severely obese people are down to 2 causes - diabetes and hypertension.

Maybe you should read the article before opening your mouth and making a tool of yourself...

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Anonymous Coward

Re: I wouldn't have guessed

Yes, but as Diabetes is a major cause of death for fatties, removing this factor is pointless..

Can we remove those that are anorexic or bulimic from the underweight figures, so that we can show that thin people are less likely to be malnourished. Hint: you can be massively overweight and still suffer malnutrition.

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Anonymous Coward

Re: I wouldn't have guessed

"the now widely discredited Body Mass Index (BMI) system..."

Yes, with your logic so far for once, Lewis

"Jerant and his colleagues, surveying nearly 51,000 Americans of all ages over a period of six years, found that "underweight" BMI was far and away the most dangerous category to be placed in."

Oooohhhkkkay.... BMI is shit, and here's a study that uses it to show something.

Seriously, Lewis? Really? And this is worth your time writing an article around?

I've always based my opinion on the 'which is healthier' debate on the number of fat old people I see wandering around. Not many, because they're all dead of heart disease or worse.

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Devil

Re: I wouldn't have guessed

I would assume the same people paid for this research as paid for the research that showed that teenage boys have an obsession with sex. I didn't read the report; perhaps they qualified it in some way....

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Re: I wouldn't have guessed

Removing diabetes and hypertension from the list is like saying "hey, if we ignore the risk of falling to your death, jumping along a rope bridge over a shark tank on a pogo stick is no more dangerous than sitting in your armchair".

Fat kills, and diabetes and heart disease are the ways it does it.

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Anonymous Coward

Re: I wouldn't have guessed

Self reporting. I understand its commonplace for GPs to test for diabetes in obese patients because of known higher risk. Mild diabetes is not at all uncommon and not necessarily strongly symptomatic so its quite possible that normal/overweight people are less likely to know they have the problem (my conjecture, I don't know if this is scientifically understood).

Add in acoholism and many other factors, this kind of 'research' methodology is open to many holes that would invalidate conclusions.

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Re: I wouldn't have guessed

I calculated my BMI recently, now I am a slim guy who barely has any fat on me, I do martial arts in my spare time and keep fit.

When I calculated my BMI it put me right at the upper end of "Normal" practically into "overwieght".

Given this study is talking about those who are considered underwieght by BMI, you would have to be extremely starved with a massive eating disorder to even reach that point.

Hardly surprising really.

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Anonymous Coward

Re: I wouldn't have guessed

To be fair, the report is removing diabetes and hypertension from the fatty risk factors to establish whether fatties have any other risks. Basically the conclusions from the report are:

1) It is really incredibly unhealthy to be underweight. Twice as unhealthy as average in fact. The report doesn't seem to identify the risk factors for why it is unhealthy to be underweight.

2) It is not unhealthy to be overweight or obese. Not at all.

3) It is definitely unhealthy to be morbidly obese. But not as unhealthy as being underweight. 1.25 times as unhealthy as normal. The entirety of the unhealthiness seems to be explained by diabetes and hypertension. Note that the study does not claim at any point that diabetes and heart disease don't kill fat people. In fact, all the study does at this end is state very clearly that it believes they are the primary killers of fat people.

Incidentally, I'm not in the least bit surprised by finding (2). The well known problem with BMI is that you expect weight to be proportional to volume, not area. BMI normalises with the height squared as a proxy for area, not height cubed as a proxy for volume. As average heights have increased BMI has become increasingly useless. My own personal example is intuitive. When I went through initial officer training in the RAF, my BMI was officially over 29. According to my BMI I was very overweight and borderline obese. I was also exceptionally fit. I could run a 4 hour marathon carrying a 15kg rucksack.

I would be very interested to look at the raw data behind this study. Specifically looking to see whether there is any height bias in the results. It wouldn't surprise me for example to find that if you use an adjusted BMI based on height cubed if you got a better predictor of unhealthiness at both extremes.

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Silver badge

Re: I wouldn't have guessed

I't absolutely no evidence to support my hunch that the study or it's authors are somehow involved with the fast food industry, one of the most powerful lobby groups in the western world. Much that we see and hear is engineered in this way.

"Jerant and his colleagues, surveying nearly 51,000 Americans of all ages over a period of six years, found that "underweight" BMI was far and away the most dangerous category to be placed in."

Could that be because ill and seriously ill people are often very underweight, for reasons unrelated to eating, and that in a set of 51,000 people a significant number will be in that unfortunate condition ?

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Alien

Re: I wouldn't have guessed

That's where the BMI runs off the tracks. If you have amassed a lot of muscles for instance, you will have increased your mass, but your fatty tissues may have decreased. As such, BMI will put you on a higer plane. I happen to be on the lower side of normal, because I'm a skinny girly-man with t-rex arms...

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Joke

Re: I wouldn't have guessed

You need a lighter rucksack - then you could carry useful stuff

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Anonymous Coward

Re: I wouldn't have guessed

I didn't see any mention of age being factored in. I know plenty of obese people in the 18-60 range, but I don't know a single person over 80 that is obese, yet they are far more likely to die over the span of the study just due to their age. In my experience obese people are lucky to make it into their 70's let alone 80's or 90's.

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Facepalm

Re: I wouldn't have guessed

"people who are underweight (by BMI) are TWICE as likely to die as 'normal' BMI people, and that severely obese people (again by BMI) are only 25% more likely to die than people with a normal BMI?"

Yes, but as correctly pointed out by the article the BMI index is crap because it basically says taller people are more overweight (and average heights have been consistently increasing since last century when the index was developed). With a 'true' index, people with 'underweight' BMI are probably severely underweight in reality, and people with 'overweight' BMI are probably at their healthy weight in reality. So what the study is REALLY showing is that it's more dangerous to be further out from your ideal weight at both ends of the scale, than it is to be only a bit out.

DUH!!!

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CJM
IT Angle

Re: I wouldn't have guessed

According to the study...

The mortality rate of 'Underweight' people as a whole is 200% that of 'Normal' people.

The mortality rate of 'Severely Obese' people as a whole is 125% that of 'Normal' people.

The mortality rate of 'Severely Obese' people (excluding those with diabetes etc) as a whole is 100% that of 'Normal' people.

Don't get hung up on the diabetes bit - the study clearly states that Severely Obese people face better odds than Underweight people. If true - that is, if we can find no other mitigating factor - this is a significant observation.

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Boffin

Re: I wouldn't have guessed

RISK = chance * consequence

Your chance of dying is 0.999999 The consequence of dying is that you don't collect as much pension and interest on your savings account.

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Mushroom

Re: I wouldn't have guessed

BMI is only valid for sedentary people, ie: people with no muscle mass beyond that acquired in an office lifestyle with no external exercise. Unfortunately in the UK it's been given way too much prominence in welfare and medicine.

The underweight stuff is also bollocks for people of different ethnic backgrounds.

My brother used to cycle about 250miles/week. He told me of walking into a doctor's office and have the doctor, without looking at him, start the conversation with "well, we'll have to do something about your weight", looked up at my skinny, short brother, looked down at report, drew a line through it....

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Whatever

Yet another study is right. Yawn.

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Childcatcher

Crossing the line, anyone

I like the contrarian attitude when it is part of a reasoned challenge to conventional wisdom. However, I just smelled this one was going to be a troll and seeing the author, I didn't bother to read farther.

There are two assets of a journalist: credibility and Integrity. They have to be nurtured, but at this point I don't believe in the truth value of anything this guy says and wouldn't believe his personal testimony that the sun will rise tomorrow.

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Silver badge

Re: Crossing the line, anyone

Why take Mr Page's word for it when you could follow the link to, what I assume is, a peer-reviewed journal?

The findings are in sympathy with a study I read an abstract of more than ten years ago: that when a women's attractiveness is plotted against their weight, the graph has the same shape as her health against weight- both peak in the same place, both drop off sharply if she is slimmer than the healthiest weight, but only decrease slowly if she is bigger than the ideal weight.

If you consider your Kelly Brooks and Sophia Lorens compared to your usual catwalk clothes-horses, it makes sense.

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Pint

Peer Reviewed Journals

"...19 times out of 20..." is still a common yardstick for the stats. Such studies are expected to be perfectly incorrect about 5% of the time; that aligns with what we see.

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Stop

Re: Crossing the line, anyone

Dave: "Why take Mr Page's word for it when you could follow the link to, what I assume is, a peer-reviewed journal?"

Because the problem isn't with the study, which appears to be reasonably well-designed and draw sensible conclusions, but with Lewis' utterly batty derivation from it. He seems to be assuming that the incompetents he believes are generally running everything had no idea, until this BRILLIANT and SHOCKING piece of research, that being underweight was a really bad thing. The problem is, they did. Ask any health professional and they'll tell you. It's not as if the risks of bulimia / anorexia and so on are exactly unknown or under-publicised.

The reasons that, overall, obesity gets more focus / attention are pretty bloody simple and not affected at all by this study. One, there are a lot more obese people than underweight people. Two, obesity is much more 'normal'; people who are obese occasionally have really serious physical/mental problems, but usually they're just the usual 'eat too much, don't exercise enough' suspects. Obesity is much more susceptible to being addressed by general hectoring in the press, tweaking of policies on food tax and labelling and exercise, and mild intervention in the course of GP visits and that sort of thing.

People who are underweight are much much more likely to be suffering from a serious medical condition. You can't really put out a press release saying 'there's an anorexia epidemic! People should eat more and puke less!' and expect to get anywhere. They're utterly different issues subject to utterly different approaches. Lewis and zillions of others love to believe that The Government, health professionals, and really everyone but them is either incompetent, hoodwinked, evil, or otherwise Resistant To The Truth, but sadly for them, the fact is that health professionals do actually know what the hell they're doing most of the time. I know that doesn't make such a sexy story. Sorry, Lewis.

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MJI
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As an overweight person

This is good news, but I still need to lose weight, but office jobs don't help.

My blood pressue is OK and no diabetes

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Unhappy

Re: As an overweight person

Same here. Overweight and have to work to keep it down to that, but my doctor assures me I am fitter than a lot of much thinner people.

As opposed to my brother who developed Chron's Disease a few years ago and is very thin and unwell, though getting better since the diagnosis allowed the condition to start to be managed. I offered to donate my body-fat to him for a transfusion, but they don't do that, apparently :-(.

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Anonymous Coward

Re: As an overweight person

It's the crohns that makes you thin*, not thinness that gives you crohns, so I think you have the argument the wrong way round.

Crohns sufferers (I am mild one), tend to eat less subconciously as it reduces the pain, or so I have been led to believe.

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Boffin

Re: As an overweight person

I didn't say he got Chron's from being thin. He almost wasted away from developing Chron's, as you said.

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Boffin

Re: As an overweight person

And therein lies a potential source of huge bias in the study: there are plenty of serious diseases (Chron's is just one, there are many others e.g. emphysema, some cancers, some thyroid diseases, some heart diseases) which make people thin. Those serious diseases can significantly reduce the life expectancy of the sufferer. So what the study *may* be showing is that thinness is an indicator of existing serious life-threatening disease, not that thinness is in itself in any way causal.

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Anonymous Coward

says health prof Anthony Jerant,

tucking into his fourth course.

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Pirate

Well, as a fatty...

I'm not 100% convinced of the utility of BMI for the reasons Lewis points out above - when I tell people HOW heavy I am most don't believe it - I must carry it well!

Am I overweight? Well, according to my BMI measurement I have to lose 9 stone to get to a 'normal' level - and let me tell you if I did I'd look like I'd just escaped from a concentration camp, yet this is the measurement doctors use to classify you (and other medical tests like life insurances).

Surely there's a better way to measure this? Build types (I'm quite wide across the shoulders, not something that is measured by BMI) should be taken into account.

Overall? I'm a fatty.

Skull and crossbones, cos I'd be a skeleton at my perfect BMI.

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Re: Well, as a fatty...

Can't tell without pics.

All I can say is I used to think the same as you. After dieting for a while and losing 6 stone I realised, hmm actually maybe this BMI thing is pretty accurate after all.

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Anonymous Coward

Re: Well, as a fatty...

I can't agree more.

Other studies say that a good percentage of us will also get Cancer. I was diagonsed with Leukaemia a few years ago. My doctor said that thanks to me being overweight I'd have a better chance of surviving than if I'd been underweight. I lost 5st in fighting the disease. If I'd been a skinny person where would those fat reserved used by the body to help fight the disease come from then?

And tomorrow another study will tell us that we are all living in a dream.

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FAIL

Re: Well, as a fatty...

There are certain recognised body types, you sound like an endomorph or mesomorph (http://www.muscleandstrength.com/articles/body-types-ectomorph-mesomorph-endomorph.html)

The whole BMI thing is crap. at 6' 6" and about 16.5 stone, I'm overweight. Not badly, but still overweight. I work as a web developer so I'm generally not that active during the day, but I also train in powerlifting, go climbing regularly and have a 30" waist, so not a lot of it is excess fat. Still, doctors recommend that I lose weight.

It should be based on a combination of height, body weight, body fat percentage and body type, as well as various blood markers.

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Re: Well, as a fatty...

I would say perceptionally you are deemed skinny, if you are around your perfect BMI. Under it and you would look positively anorexic. Also people who don't believe that someone is over 9 stones overweight, probably need to go to spec savers.

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Paris Hilton

Re: Well, as a fatty...

BMI is a silly measurement to base health from - It is however a good general indicator of good health.

But doesn't take into account muscle mass an other things. i.e.

Fat guy 15 stone 5"9 BMI 40+

Body builder 19 stone 5"9 BMI 50+

Paris because her BMI is -1

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Re: Well, as a fatty...

The body builder is perhaps a bad example as he is probably no "healthier" (you could probably outrun him...).

A pro rugby player may provide a better example of a fairly "healthy" heavy person (if you discount sports injuries in your measurement of "health"...)

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MJI
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Re: Well, as a fatty...

Well when I was 20 or so I was still nearly overweight despite having very little fat.

Now I have ballooned out through inaction and two operations with recovery time in one year I am heavier than ever. Yet I can walk fine. I do not eat much, healthy diet, just that programming is not a muscle using job.

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MJI
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Re: Well, as a fatty...

Fat guys

Well a lot of fat peoples extra weight is not from fat, but extra muscle mass in the legs to move the fat, mine is mainly belly and front. But legs do not feel fat at all.

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Devil

Re: Well, as a fatty...

Hum, I had a friend in college who considered himself fat. I just considered him large, which he was. Turned out that he was somewhat fat. Prison took some weight off, but he was STILL large!

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Re: Well, as a fatty...

Yes, but statistically at 6'6" and a powerlifter, you're an outlier anyway. If you're just saying "BMI is a crock because look, the numbers don't work for Peter Dinklage or Yao Ming", then you're missing the point. The point of BMI is that it's easy to calculate and for most people it'll give a reasonable answer.

If a doctor's recommending you losing weight, they *should* be looking at body fat percentage. If they just base it on BMI, you've got a bad doctor.

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Silver badge

Re: Well, as a fatty...

It's easy to calculate how fat you are.

If you are at the pool and someone of the appropriate sex younger than you walks past - how much do you have to breath in?

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Anonymous Coward

Re: Well, as a fatty...

One of the best ways to figure out whether someone is fat or not is girth measurements. A friend of mine told me recently that an insurance company measured his girth around his gut and another girth around his arse. They considered gut > arse to be overweight and gut < arse to be normal. Obviously the same measurement doesn't work for women, but I believe similar tests exist.

To make BMI more useful you should switch to a measure called RI (Rohrer's Index - http://en.wikipedia.org/wiki/Rohrer%27s_index) which is weight divided by height cubed. It has been shown (in peer reviewed journals) to have a more linear relationship to health and health care factors. I suspect the ideal measure is actually somewhere between the two. It should be relatively easy to figure out an ideal measure though. If diabetes and hypertension are the predominant factors that affect fatties, just perform a regression analysis against weight/height^alpha and see what the best fit coefficient is. My suspicion is you will find somewhere around 2.5 < alpha < 3.

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Anonymous Coward

Re: Well, as a fatty...

"One of the best ways to figure out whether someone is fat or not is girth measurements. "

Glad you went on to clarify that statement. I'd like to know that insurance company though as I have a hint of a belly but fortunately a big arse.

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Happy

I for one...

Would like to welcome our new bacon and cheese covered overlords...

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Happy

Having fun

Well, lets put the health aspect aside, as mentioned, if you remove all unhealthy people from the obese sample they are doing fine. I am sure the skinny ones also do fine if you account for aggravating circumstances, such as eating disorders or chemotherapy.

But who is happier? The fat ones surely have lots of hunger hormones and get a different kick from eating, but the stairs are surely more fun for us small guys.

And stop worrying your your weight! Yes, Lewis, I am looking at you!

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Re: Having fun

Stairs are more fun??? You need to get out more. Try a restaurant.

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Anonymous Coward

Re: Having fun

@Gritpants. Lots of things that are far more fun for men and women with flexible and energetic bodies, however much those whose main idea of fun is found a restaurant like to live in denial. Schulz was just being kind by only mentioning the stairs.

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Re: Having fun

Yes, This http://england.shelter.org.uk/get_involved/events_and_challenges/vertical_rush was fun.

In fact I would recommend signing up for the next one.

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Anonymous Coward

Re: Having fun

Denial? Hell; half the reason I walk to work and work-out is so that I can eat the food I enjoy without being fat!

Thin != Does not really, really enjoy food.

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