Saturday, June 27, 2009

Chubby people, health, and all that

Maybe I should say first, in the spirit of blogging, that I'm a skinny person, and I've returned to my younger even-skinnier look of about 160 lbs (say age 30) since I started running in 2005.

A new study suggesting that being a little overweight is good for you has made it into the mainstream media--in this case, the Toronto Star.

A new study of Canadians' body mass index and mortality adds to existing research suggesting that people who are overweight live longer than people of normal weight.

Risk of death was significantly higher during 12 years of followup for people who were underweight and very obese, but overweight people had a lower risk of dying than those of normal weight.

This is right up the alley of Sandy Swarc at Junkfood Science: a study that shows that what most people consider "healthy habits" may confer no real or lasting health benefits at all. Of course, the Star doesn't repeat other amazing conclusions of similar research: the worst off people are those who lose weight and keep it off--even a fairly small amount; the very thin may be worse off than the obese. Not only that, the Star suggests that while fat people may enjoy protection from complications of illness, just because of their fat, they may have more illnesses, or more discomfort, or something, compared to other people. Swarc says of similar studies: "Who had the best prognosis and lowest mortality risk? Those who gained weight and became fat." "Gaining weight" here means accepting the kind of normal or natural weight gain of middle age--a pound a year or so beginning at age 40. Slightly obese people may have a bit more high blood pressure and diabetes than others--but they handle these conditions better than thin people. Overall they may have fewer health issues, not more. Those who lose weight will see certain risk factors--blood pressure, blood sugar, and cholesterol--improve for a while, but they usually return to where they were, if they do not move to new and worse levels, and in any case they do not help with overall mortality. The whole popular idea that losing weight is good, is wrong. Those who lose weight are worst off, and those who simply stay thin may not be much better.

Many well-meaning people promise that if we intervene in what would otherwise be normal aging, and practice prevention (including weight loss) this will somehow keep us healthier, and thus reduce health care costs. The idea is that we'll have fewer doctor visits. The problem with this is that if it actually works, we will have an even more aging population than we do now, and the evidence is that an aging population costs more, not less, for health care.

The same people who focus on fitness and nutrition often get caught up with pretty aggressive exercise, and this can lead to specific kinds of prevention and/or medical care for injuries: yoga, Pilates, sports therapy, physical therapy, and chiropractice. These services may not show up in "health care costs" in the same way that visits to MDs and emergency rooms do, since patients may pay out of their own pockets, but they are expensive nonetheless. The Obama Administration now says they favour evidence-based medicine to control costs; there is some evidence that they are likely to encourage weight loss and other things that are fashionably considered to be healthy. If these things are not healthy, they actually will reduce costs--by causing early mortality.

Get people to quit smoking, they live longer; get them to run, and you may reverse the first tendency.

As a further note: we have experience of family doctors in Canada leaving their practices, and setting up a practice in "alternative therapy" where they can basically charge what the market will bear, and make a lot more money. One MD went into laser therapy, I think for fat reduction and such rather than eyes; then he expanded into Botox. Our present MD is doing family practice at a second location, in addition to the one near us, and she has an expert in acupuncture and chiropractice coming in to that location. We are uneasy that she will quit working for the single-payer government, with set fees, and go entirely into the private sector of alternative therapies.

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