Obesity Paradox ~ Can Losing Weight be Bad?
From Heartwire (free reg): Obesity paradox strengthened by new SCAAR data in ACS. Lest the acronyms drive you nuts, they are not mine (for a change!).
SCAAR = Swedish Coronary Angiography and Angioplasty RegistryACS = Acute Coronary SyndromesFrom the article:PCI = Percutaneous coronary intervention (coronary angioplasty, angioplasty)
Those who were deemed overweight or obese by body-mass index (BMI) had a lower risk of death after PCI than normal-weight or underweight participants up to three years after hospitalization ...
"In patients who have a chronic disease, obesity seems to have some kind of protective effect—what this is we don't know, it's difficult to say," coauthor of the new research, Dr Kristjan Karason (University of Gothenburg, Sweden), told heartwire. ...
Drs Stephan von Haehlin, Oliver Hartmann, and Dr Stefan D Anker (Charité Medical School, Berlin, Germany) agree that this research strengthens the existing evidence for the obesity paradox. They conclude that weight loss in patients with chronic illness and a BMI of <40 a="a" always="always" and="and" bad="bad" blockquote="blockquote" chronic="chronic" exists="exists" fact="fact" illness="illness" in="in" is="is" kg="kg" live="live" longer.="longer." loss="loss" m2="m2" makes="makes" not="not" patients="patients" single="single" study="study" suggest="suggest" that="that" to="to" weight="weight">Things that make you go hmmmmm. One caveat, this study doesn't address one's risk of cardiac disease that may be due to obesity/overweight. But once you're sick? It seems plausible that the excess weight = energy = perhaps endogenous DHA source and/or losing weight at this point causes more stress-induced negative impacts than benefit. I'll still be trying to avoid any need for PCI ;-)
Comments
http://healthcorrelator.blogspot.co.uk/2012/06/lowest-mortality-bmi-what-is-its.html
When people lose weight and keep it off it is because being leaner makes them happier. They look better, can wear different types of clothes, don't feel embarrassed when they have to squeeze into the seat on an airplane or at a theater, enjoy it when people tell them how good they look, are able to participate in more physically demanding activities.
Also, maybe Grandmother was right after all: children should not be skinny.
Asides:
The tight control Type 2 Diabetes study which was stopped due to deaths indicated that the body achieves a homeostasis even in 'disease' conditions. A stressor applied in the sense of tight glucose control upset this and too many patients died.
I think plump people in general push themselves to exercise more and to eat more healthy diets, while thin ones feel like they don't need to worry about their health. In most minds thinness equals healthiness.
A bit on the plump side appears to be protective.
Also, it appears as people age, they do get thinner. When they start thin they have no place to go except the grave.
OTOH, @paleotwopointoh, the centenarians tend to be lean (and active). When my mom rehabbed for her knee replacement she was in a nursing home for a few weeks. Her unit was not really segregated from the rest of the residents and she had lunch with a variety of residents during her stay. I also got lost quite a lot b/c of the confusing floor plan so wandered through other wings and general gathering areas. I didn't see a single obese person, and only one or two overweight. Most were on the thin/frail side. So what does that mean? The obese/overweight have died out before making it into a nursing home, or they fare better in declining years? Dunno ....
In particular, while obesity clearly accelerates diabetes in those genetically predisposed and/or some level of metabolic derangement in many, there are many healthy overweight and obese people. There's some sort of fuzzy threshold (unique to each), however, where excess adiposity is almost universally detrimental. When it effects mobility, immunity, breathing, sleep, etc. it effects overall health.
My grandma doesn't look emaciated at 92, but she is not plump any longer, I noticed no one obese resident in her nursing facility. My mother-in-law looked emaciated, but my shorts size 12 fitted her well in waist.
It appears that the sense of smell and the sense of taste declines with age in most people. Appetite becomes somewhat modified. Therefore if the diet is nutritional sound, then eating less as the metabolic requirements decrease with age results in a lowering of body fat stores. Which accounts for why those who live long lives slim down bit by bit as they age.
The majority of people do not become centenarians. There is more to their long life than whether they ever carried a few 'extra pounds'. One study of 100 and plus year old Ashkenazi Jews indicated very high HDL levels for example. This appeared to be a hereditary tendency because the diet was not geared towards elevating HDL. Oftentimes these oldsters have children in their 80s, grandchildren in their late 50s and great grandchildren in their 30s, and long lives 'run' in the family.
Furthermore adverse life circumstances do not appear to have a huge impact on the life expectancies of these people. I have personal aquaintance with women who endured not only concentration camps, but endured pregnancy and childbirth in slave labour camps during WW2. They are over 90 years old now and going strong. They most certainly didn't eat a Paleo diet.
Then there are centenarians who are STILL smoking!
What scientists are trying to figure out is what keeps these people going and going. There is a great variety in life styles, diets,etc.
I don't obviously have the biggest sample size, but in my practice, all of the oldies are very attached to famiy and friends. They live because they love.
There is a website, Waters of the World, which provides comprehensive information and can be cross-referenced based on mineral, country, etc.
Meantime in North America the emphasis is on 'purity' of water. I.e. the lowest ppm of dissolved minerals! It seems to be syptommatic of the Puritanical attitudes. There are people who go to extremes by drinking distilled water. Purely bonkers.
Meantime there are young women who have not much fat in the hips and rumps but their distribution is belly fat and thick necks. These are the ones who are in most danger for developing Type 2 diabetes and severe sleep apnea, heart disease, stroke.
These days I'm noticing an epidemic of PCOS. When I'm out shopping, I see many young women with the telltale hump of fat in the C8 area. Fertility clinics will have lots of business.
Related to this, as the study is for Sweden and paleo and low carb diets are pretty popular there, it would be nice if the researchers would test whether the more obese people in the study had a more paleo type diet. It could be that people with higher weight are faster to pick up such a new idea. (I know am not supposed to say this here ;-) )
I will always be at higher risk :(
What Galina says is true in many cases. Equating thin with health and overweight with disease is overly simplistic, and naturally leaner people can "get away" with a lot more -- on the bathroom scale anyway.
This is what makes the whole diet/weight thing so dicey. For example, sugar consumption -- even soda and candy -- can be metabolically innocuous when not in hypercaloric context.
Here's where I feel very conflicted. You have all these paleo types looking in people's carts and thinking all these other people are feeding themselves and their kids "wrong" and that it's their business because health costs impact all of us. They are upset that sat fat intake is currently still stigmatized as bad. What they don't realize (though I suspect they do) is that stigmatizing other food groups, and entire macronutrients (how many times have you heard sugar is sugar is sugar and it's rat poison or like shards of glass flowing through your veins) is not the solution.
People often look for a reassurance for being relaxed about their life-style choices. I remember Paula Dean used to say in interviews that she could eat any food because her cholesterol numbers were excellent.
Some evidence of that: https://www.ncbi.nlm.nih.gov/pubmed/16824844
"CONCLUSIONS:
Most patients with NSTE ACS are overweight or obese. These patients receive more aggressive treatment, and, except for the extremely obese, have less adverse outcomes compared with underweight and normal-weight patients. Although obesity appears to be a risk factor for developing ACS at a younger age, it also appears to be associated with more aggressive ACS management and, ultimately, improved outcomes."
I'd also wonder if the fatter ones get triaged quicker, getting troponin and EKG testing when "time is muscle" and so got to the cath lab faster than the thinner ones.
Also, did the analysis control for age or not? The article at theheart.org doesn't mention so.
That was my second thought, Gabriella. That might be these people, from the study abstract:
http://www.ncbi.nlm.nih.gov/pubmed/22947610?dopt=Abstract
"In patients with significant CAD undergoing coronary artery by-pass grafting and in patients with no significant CAD, there was no difference in mortality risk in the overweight groups compared with the normal weight group."
Perhaps those patients have something unusually bad going on, maybe they are very prone to plaque rupture/erosion, and being fatter didn't provide any protection. After all, the thinner people don't get ACS as much as the fatter ones do, so why did the thinner ones have ACS? Maybe they're hyper-inflammatory or whatever and that is more deadly post-event.
Taking the above quote again with different emphasis, "In patients with significant CAD undergoing coronary artery by-pass grafting and in patients with no significant CAD, there was no difference in mortality risk in the overweight groups compared with the normal weight group".
Why would fat supposedly be protective for post-PCI but not for post-CABG? (Yep, it's pronounced as 'cabbage' :)
With all of the ambiguity involved, it's way out of line for the study authors to be claiming that guidelines should be claimed - they sound like advocates to me.
http://www.myhealthywaist.org/documentation-centre/index.html?no_cache=1&tx_stdoccenter_pi1[mod_type]=3&tx_stdoccenter_pi1[uid]=55
6 minute video
"The study showed that for any given BMI category, patients with an increased waist circumference had a much higher risk of death at one year than patients with a low waist circumference. Finally, Dr. Philip Barter and Dr. Paul Poirier explain that the obesity paradox may at first appear confusing, but when the data is further examined on the basis of abdominal obesity and not only BMI, it is clear that BMI alone no longer predicts mortality."
Take note that the 'skinny fat' do worst of all. However, from the graph of the Rico Survey data shown, there is still something going on which needs to be explained wrt fat being possibly protective - which I doubt but you never know.
P.S. The myhealthywaist.org group has names like Libby, Ridker and Balantine so whether they're right or wrong, those are the the big time.
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