[evol262]

The percentage of people with normal BMIs and type 2 diabetes or prediabetes is so small that is irrelevant from a mass health perspective.

There are a plethora of studies correlating a change in diet with improved blood markers for fasting blood glucose and insulin response. Sugar "problems" are resolved by diet, and resolving diet goes along with reversing weight loss. It cannot be any other way.

There is no evidence that obese BMIs are negatively correlated to mortality, only the opposite. Obese BMIs still come with increased arterial plaque, complications in anesthesia and surgical healing for medical interventions, fatty liver disease, ocular pressure, lung function, cardiovascular health, and so on.

Obesity is up with smoking as a cause of preventable death. Let's not try to put a pretty face on it. A spade is a spade.

Insulin resistance/high fasting glucose and obesity are inseparable peas in a pod.

[pessimizer]

> The percentage of people with normal BMIs and type 2 diabetes or prediabetes is so small that is irrelevant from a mass health perspective.

Then my father is irrelevant, being diagnosed with prediabetes at 6', 165lb.

So is it really irrelevant numerically, or is that hyperbole? Does your irrelevance include millions of people?

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edit:

> There is no evidence that obese BMIs are negatively correlated to mortality, only the opposite.

TFA mentions that it is negatively correlated when you control for two things that are positively correlated with BMI. So, while the study doesn't say that high BMI reduces mortality (it in fact observes the opposite), nobody claimed it did.

But in finding the negative BMI correlation when controlled for insulin, it does make a very good case that

> Obese BMIs still come with increased arterial plaque, complications in anesthesia and surgical healing for medical interventions, fatty liver disease, ocular pressure, lung function, cardiovascular health, and so on.

are largely irrelevant to the mortality of the obese relative to the thin, and inflammation and insulin resistance are decisive.

[evol262]

> Then my father is irrelevant, being diagnosed with prediabetes at 6', 165lb.

BMI is a population-level metric, and population-level analyses of health risks, from an epidemiological perspective to inform healthcare providers and public health officials of risks, frankly, don't care about your father.

Yes, it's irrelevant numerically, and it's irrelevant numerically because there's little evidence that any significant portion of the population (much less millions of people) falls into this category, whereas we are one of the fattest countries on Earth, which has absolutely no need to minimize or downplay the health effects of that.

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Edit (ugh):

> TFA mentions that it is negatively correlated when you control for two things that are positively correlated with BMI.

Kinda the point is that TFA is mathematical gaming which doesn't yield any actionable results for healthcare providers.

> So, while the study doesn't say that high BMI reduces mortality (it in fact observes the opposite), nobody claimed it did.

You did, a bit:

> It also means that if we can control people's reactions to sugar, their weight becomes irrelevant (or possibly even protective.)

There is a range in which increased BMI provides increased survivability from catastrophic events, since the body has energy reserves and some protection from trauma, but then it drops off a cliff. It's not going to be "irrelevant" for health outcomes, much less protective very far outside of the overweight range.

> are largely irrelevant to the mortality of the obese relative to the thin, and inflammation and insulin resistance are decisive.

Yeah, ok. I guess a bunch of things which every significant health organization on Earth calls out as leading causes of mortality and linked to obesity are actually due to inflammation and insulin resistance, which must also have an effect on how hard it is to push a tube into an obese patient's throat, to find a vein to get a line in, the amount of pressure their weight exerts on their lungs, the amount of medication it takes to keep them anesthetized, how much fat accumulates in their liver, plaque buildup inside arterial walls, etc. Definitely just inflammation.