[ajross]

I don't know that that's very informative, clinically. How many obesity cases are there that don't have one of those two issues in some co-causal way? Likewise how do you treat these people to reduce their insulin swings in such a way that they... would fail to lose weight?

It seems almost like a joke, but "hyperinsulinemia and inflammation" seems more or less identical with "chronic overeating", right?

[tomjakubowski]

You're missing the other direction: those people who have insulin resistance and inflammation and aren't clinically obese.

https://www.ahajournals.org/doi/10.1161/circ.128.suppl_22.A1...

[Metabolic syndrome] doubles the risk of all vascular complications in patients often erroneously considered at lower CVD risk because of their normal BMI.

[pessimizer]

> How many obesity cases are there that don't have one of those two issues in some co-causal way?

You can't imagine there are a few million people like that out of the billions in the world, and that we might want to give effective medical care to those people also?

> Likewise how do you treat these people to reduce their insulin swings in such a way that they... would fail to lose weight?

Is this an actual question asking about the state of the research, or do you think that it's unimaginable that science could ever be able to directly manipulate people's insulin levels?

I get the impression from most of the top level comments on this thread that some people would be upset if fat people's mortality could be reduced or normalized without weight loss. Like there's an urge to see fat people punished rather than happy and healthy.

[ajross]

That's a very unfair strawman.

The linked article is about an epidemiological measurement often used to flag health risks. And it's pointing out that the real causality is likely due to other factors. I'm pointing out that those other factors are hopelessly conflated with the first anyway, so we might as well keep measuring BMI and treating it as a risk factor.

Are there other things we should measure? Of course there are. Propose a test and let's look at the tradeoffs. I'm just saying let's not stop treating BMI as informative, because it still is.

[evol262]

> You can't imagine there are a few million people like that out of the billions in the world, and that we might want to give effective medical care to those people also?

There's not a good reason to think that those people are not already getting effective medical care. Medical practitioners are interested in their patients' health and longevity. Obesity and good long-term health outcomes have negative correlations. Here is one of many studies:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963496/

If there is such a population comprising even 1% of the world population (and that figure has almost no backing in any literature unless you include age 18-30 in that cohort, who are broadly too young to have seen longitudinal health effects from obesity affect their health yet), it's unfortunate that occam's razor may impede the quality of their care, but this is very much a hypothetical question without any meaningful evidence to the contrary.

> Is this an actual question asking about the state of the research, or do you think that it's unimaginable that science could ever be able to directly manipulate people's insulin levels?

Uh, that's what insulin pumps and injectable insulin do. We really don't have to imagine it. But beta cells in the pancreas can literally get worked to death in type 2 diabetes, and type 1 diabetics never produced enough (or any) in the first place. So exogenous insulin is administered because without it (and sometimes with it), glucose will acidify the blood and cause neuropathy or ketoacidosis in the worst cases, and it impedes healing, so reduced feeling causes a small injury which heals more slowly to lead to an enormous ulcer and infiltration which the patient still may not feel, until amputation is a necessary lifesaving measure.

Science can directly manipulate lots of hormone levels, but it all has side effects versus letting your body manage itself, most of them profoundly negative.

> I get the impression from most of the top level comments on this thread that some people would be upset if fat people's mortality could be reduced or normalized without weight loss. Like there's an urge to see fat people punished rather than happy and healthy.

I don't think anyone in this thread wants to see fat people punished instead of happy and healthy. Rather, it's that obesity and being happy and healthy are incompatible in the long term, and this study doesn't change that at all. There's no moralizing or proselytizing in this thread, just a "hey dude, this isn't gonna work out in the long run, and you shouldn't fool yourself or others that it is".

If this were a study indicating that lung cancer actually wasn't linked to smoking, but was instead due to some environmental effect, and people were out here saying "wait, wait -- the study says that it was actually elevated levels of blood CO that caused it, but the number of people sucking on exhaust pipes is so low it doesn't move the needle, and this doesn't change COPD, heartattack, etc", nobody would be saying 'it's like there's an urge to see smokers punished rather than happy and healthy".

I used this as an example because the obesity rate in the US is that kind of public health crisis, with side effects that bad. Impotence, amputation, and blindness (among others) are nothing to minimize.

[andrewmutz]

I am not a nutrition expert but I believe inflammation can be a problem without high BMI. For example, eating lots of highly processed foods but staying within your calorie limit, would have this outcome.