The Reality Of Serious Weight Loss, Ctd

A reader writes:

I read with some consternation the reaction of one of your readers to the admonition by a physician that there is no “healthy obesity”.  It is worth pointing out that contrary to your reader’s unsupported assertion, clinical data does not support the idea that obesity in the absence of metabolic abnormalities (high blood pressure, high cholesterol, diabetes, etc.) is as safe as being normal weight.  Specifically, a recent systematic review and meta-analysis (that is, an analysis that looked to combine data from multiple independent studies) appeared in the Annals of Internal Medicine (here is the link to the abstract). The study combined eight studies that looked at 61,386 people in all and found that otherwise healthy obese individuals had about a 25% increased risk for death or cardiovascular events (heart attacks and strokes) compared to healthy normal weight individuals.  To quote the conclusion: ” Compared with metabolically healthy normal-weight individuals, obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight.” [emphasis mine] Here‘s a NYT blog entry on the study.

I am very sympathetic to your reader’s assertion that eating healthily and exercising regularly doesn’t always result in weight loss, and the reader is certainly correct that doing those things will result in health independent of whether it affects weight loss.  I also cringed at the way the physician reader’s tone.  But he is also correct; all else being equal, an obese person is at increased risk for bad health outcomes.

Another reader is much more blunt:

That obesity is tied to many terrible and debilitating physical aliments is not merely opinion, and to point to the very few healthy exceptions to this norm is not an argument worth a damn.  And unfortunately, too few doctors even bother to make the recommendation to lose weight to their patients anymore, opting instead to prescribe drugs like statins or insulin, or surgical therapies, like gastric bypasses.  Why some overweight people think taking a palmful of drugs with potentially dangerous or even deadly side-effects or having part of their guts chopped out is more desirable than losing some weight through managing their eating habits and exercising regularly is mind-boggling.  Weight loss is not a complicated process, but it does mean the dieter cannot continue to eat like a spoiled child.  It means denying oneself everything one wants to eat, yes, okay, so suck it up or accept the fact that you are making a trade off: chose self-indulgent eating or health, mobility, and extended lifespan.

But I sigh because for anyone to claim obesity doesn’t matter or isn’t the health burden it actually is is ludicrous.  My own health has been greatly improved through weight maintenance and regular exercise.  I have been able to reverse my strong family history of heart disease – my father, who did not exercise or watch his weight, had a triple bypass by my age whereas my current risk of heart disease is rated extremely low.  Meanwhile, one of my siblings who disregarded proper weight management and regular exercise has also had a triple bypass. Sorry, but obesity and sloth make a huge negative impact on one’s health and anyone who argues otherwise is just nuts.

Another looks beyond health problems:

People who are obese may not have the issues that are often correlated with it, but there’s something to be said about the social impact and your ability to be mobile. I’ve lost 120lbs in about two years so far and I’ve seen both sides of this issue. The fact was, I was getting winded going up two flights of stairs. People wouldn’t sit next to me on the bus. Jokes were made at my expense. I could barely sit in seats and booths at restaurants. So if I didn’t have diabetes, heart disease, or high blood pressure, all of this would be okay?

After my weight loss I’m seeing doors open up to me. I’m getting solicited by men, and at my job I am getting more recognition for my hard work. They’re even talking about letting me travel; something they’ve never brought up to me before my weight loss.

Whether this is right or not is certainly a discussion, but at this moment it is the reality. Why artificially limit yourself in these ways because you want to convince yourself being obese is healthy somehow? It sounds like surrender.