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by smcl 1296 days ago
This is where it starts to become complicated. I am not the best person to properly enumerate these complications so if this comment made you curious, check the podcast Maintenance Phase and their episode "Is Being Fat Bad For You?"[0]. However I can briefly try to summarise some of them for your curiosity:

- it is received wisdom that if you are fatter you are "unhealthier" and this is reflected in a lot of data whenever this is studied

- however this tends to not get controlled for some important factors (e.g. lower income people are generally more unhealthy overally than those on higher incomes) for a whole variety of reasons that aren't necessarily related to weight or whether you're categorised as overweight

- a very undeappreciated problem is that if you're "overweight"[1] you tend to be quite under-served by doctors currently. So it's common for an "overweight" person to go to the doctor with a problem - heart pains, gastro-intestinal problems, whatever - and to be told "lose some weight, you're overweight". While someone thinner would get some more attention even though they may both have a weight-agnostic root cause . This is not very well studied or measured, but this type of treatment is widely reported problem whenever you survey "overweight" people

- people with eating disorders like anorexia and bulimia are often excluded from these studies with the intent to get untainted data. These eating disorders are usually only diagnosed for people below a certain BMI, when in fact they are still definitely present among higher-BMI individuals and have a similarly detrimental effect on their health. Sustained dieting can have pretty serious effects on your body, and if you go to a doctor because, say, you're a woman on a diet who has stopped menstruating ... well, see the previous bullet point, you're just just get told "lose some weight"

There a few other additional issues, but I hope this is enough to make you stop and think that while yeah there's possibly increased health risks it's potentially less than we might realise and is a pretty complex subject that deserves careful study and to be treated with more nuance than it usually is.

[0] - the answer is "kinda yes, but not as much as you think and not in every way and it's more complicated": https://www.stitcher.com/show/maintenance-phase/episode/is-b...

[1] - Aubrey Gordon, a host of the podcast I mentioned, has suggested she doesn't like "overweight" etc euphemisms, but I chickened out of using just "fat" like she does ... but I still think "overweight" possibly incorrectly suggests there is a correct weight you should be - so I surrounded it in coward-quotes :) I do know for a fact that "obese" (and morbidly obese) are heavily frowned-upon and tbh not particularly helpful categorisations, I saw them floating around elsewhere in this thread.

1 comments

This is very interesting, thanks for the detailed list. I will check out the podcast.

That said... this is one of those cases where I have to defer to the experts here. Basically every expert I've heard on this topic has said that being obese is unhealthy. And while you (summarizing the podcast) raise a lot of interesting points, I don't think I'm in a position to disagree with the scientific consensus here. And it's not like the people studying this stuff haven't thought about a lot of these objections themselves.

Also, anecdotally, it seems fairly common sense that people who are obese are less healthy in many ways. I know that's just an impression, but c'mon, it's a pretty strong one, to me at least. I've seen so many people go from finding it hard to walk much without breathing hard when overweight, to being fine after. Just as an example of someone famous with many health problems that got much better- Penn Jillette.

Yep sorry it wasn't my intention to hide that - the consensus is that being very fat is bad for you in various ways. But specifically how fat and how much worse in which ways is a bit of a crapshoot because it seems some of the research on it is a bit methologically flawed or inconsistent or ideologically driven (the ep references a bit of back/forth between Katherine Flegal and Walter Willett on that which was very interesting).

But yeah does feel right (as an anecdotal aside I feel "healthier" at 84kg than when I was 94kg) and as I said in the extreme it does seem to be correct - the same is true for very thin people. But we're mistreating thin and fat people alike by boiling down a lot of health problems down to a single dimension and saying those who fall on one side of a line are healthy and those on the other aren't. I'm not suggesting you were doing just that - you seem to appreciate the nuance to it - but many people do and I'd be lying if I said that I wasn't that kind of person at one point in my past.

Oh I don't think you were hiding anything, I'm just saying a single podcast is not enough to convince me of anything.

That said,I started listening to it... It's fantastic. They've made really great points so far. A bunch of questionable stuff too that I disagree with, but lots of great points.

And even not just about obesity. I think they made some analogies that will stick with me about correlations.

I have no idea who these are, but I'm super thankful you introduced me to them I'm definitely going to try more of their stuff.