According to some folks out there, smokers and fat people are either: 1) a burdensome group sinking everyone with their medical costs, or 2) a dispensable group we should all just let die early. Welcome to the health care debate that’s taken Twitter by storm. The fight over applying lifestyle penalties is raging as lawmakers hash out details of the Affordable Care Act. With those two “high-risk” groups tallying about $243 billion in annual health care costs, some argue that “willfully unhealthy” people should be left alone to die early and save the system money, rather than being taxed or penalized. Others say smoking control and anti-obesity measures have proven effective and should be continued. Can’t we all just have a smoke and a pastry and get along?
Being overweight can extend life rather than shorten it, according to a major new study that runs counter to widespread medical assumptions and years of warnings about the fatal implications of our expanding waistlines.
It sounds too good to be true, coming at the end of the season of excess, but after one of the largest reviews of research ever conducted, doctors say that carrying a few extra pounds may actually reduce the risk of premature death. Experts have repeatedly warned that obesity would soon exact a greater toll than smoking and the current generation could be the first to die before their parents.
However, the new study shows that people who are modestly overweight have a 6pc lower rate of premature death from all causes than people of ideal, “healthy” weight, while even those who are mildly obese have no increased risk. Overweight is defined as a body mass index above 25 but below 30. For a man of 5ft 9in, that is between 12 stone 4lb and 14 stone 6lb, or for a woman of 5ft 6in, it is between 11 stone 3lb and 13 stone 4lb. Ideal, healthy weight is defined as a BMI between 18.5 and 25.
Mild obesity (those with a BMI between 30 and 34.9) brings a 5pc lower premature death rate, according to the study. Although this was not statistically significant, it suggests there is no increased risk of premature death attached to that weight range.
The news will seem heaven sent to those contemplating a new year diet, and contradicts the received wisdom that being fat reduces life expectancy. It is the second time that research studies led by Katherine Flegal, a distinguished epidemiologist from the National Centre for Health Statistics at the Centres for Disease Control and Prevention in Maryland, US, have studied the link between obesity and mortality.
In 2007 the same group caused consternation among public health professionals when they published the results of a similar analysis that also showed being fat does not shorten life. Walter Willett, professor of nutrition at Harvard School of Public Health, dismissed the finding as “rubbish”.
Dr Flegal decided to conduct a second, larger, study on the same theme to counter the sceptics. She and her team examined results from 100 studies from around the world, involving three million people and 270,000 deaths.
The results are published in the respected Journal of the American Medical Association, which also published the earlier study. They show only the severely obese, with a body mass index above 35, have a significantly increased mortality, up by 29pc. Otherwise, extra weight appears to be protective. Underweight people, meanwhile, have a 10pc higher rate of premature death than those of normal size, according to earlier research. “There is already a lot of literature showing that overweight is linked with lower mortality,” said Dr Flegal. “It is not an unusual finding. But authors tend to shy away from it. They tend to underplay it or try to explain it away.”
There were warnings today that the research should not be taken to mean that there were no negative health implications associated with being overweight or obese. Tam Fry, spokesman for the UK National Obesity Forum, said: “Katherine Flegal is an extremely good researcher and I would respect her. But I am flabbergasted. The sum total of medical expert opinion cannot have got it so wrong. The consequences of people taking this research and deciding ‘let’s eat and be merry’ will be catastrophic. Mortality [the death rate] is one thing but morbidity [the disease rate] is another. If people read this and decide they are not going to die [from overeating] they may find themselves lifelong dependents on medical treatment for problems affecting the heart, liver, kidney and pancreas – to name only a few.”
Dr Flegal herself stressed that findings are not a licence to eat cream cakes. “We were only looking at mortality – not health. We are absolutely not recommending people overeat. We intended our research to give a little perspective – to counter the view that if you weigh a bit less you will live forever or if you weigh more you are doomed. The relationship between fat and mortality is more complicated than we tend to think.”
Possible explanations for the findings are that fat – adipose tissue – may protect the heart, carrying a few extra pounds may help individuals withstand periods of illness or hospitalisation when they lose appetite, and the distribution of fat on the body is more important than the amount, with extra on the hips being good while extra on the stomach is thought bad.
It may also be that the health risks of being overweight are declining with advances in medicine. Drug treatments to lower blood pressure and cholesterol have contributed to a dramatic fall in heart disease deaths. Fitness, too, may be more important than fatness. People who are overweight, smoke, eat junk food and take no exercise are heading for an early grave.
A voluptuous history: Fat through the ages
Until abundant food and sedentary lives combined to form mass obesity, plumpness was often coveted, flaunted as an indicator of health and wealth.
To stone-age man, the Venus of Willendorf – a voluptuous sculpture with enormous breasts and a bulbous belly – was worthy of celebration. Today, she would probably be put on a weight-loss programme.
Famously, Rubens, the 16th-century Flemish painter, preferred the fuller figure, depicting fleshy, large-bottomed women as the life-giving goddesses of beauty, sexuality and fertility in The Three Graces (1635).
Though portliness could be bad when it demonstrated other vices (cartoonists decided that George IV’s extravagance was most easily shown in his girth), generally, the modern-age dislikes fat. The fashion industry sells its garments on skinny models: in 2009, Kate Moss was estimated to have a BMI of 16.
Yet not all societies, even now, accept this. Samoans, Puerto Ricans and Tanzanians still celebrate largeness and six out of 10 black South Africans are clinically obese. Even in Western societies, there are differences. In a survey by Northwestern University Medical School, Chicago, white women were found to worry about their weight when their BMI hit 25, black women when it nudged 30.
With obesity straining health services, “fat phobia” is on the rise. A third of US doctors thought obese patients weak-willed, sloppy and lazy. This latest study suggest that we may need to take a broader view.
– Jeremy Laurance
Don’t eat a pie – Eat a Skinny Guy!
Obesity is now a bigger killer than starvation!
There are many reasons for this and they’re not just to do with eating too much and having a heart attack or choking to death on doughnuts…for example, fat people often find it hard to escape from a burning car or shimmy down a vine when being chased by jungle animals.
It is true that less and less obese people are dying of starvation…but that’s is only part of the reason!
Whatever the cause, fat people are in serious danger and that’s just not fair!
One way to reduce fat is to eat a diet that is high in fibre, and that’s where revolutionary new research may inadvertently solve two problems at once!
Starving people are mainly skin and bone, not an ounce of fat, they’re also very miserable.
Fat people are hungry and miserable.
The answer then is to feed the starving people to the obese people thus eliminating world starvation and obesity in one go!
Digesting all the bones and gristle of a starving person will soon help the fatties shift a few pounds, and less starving people will make a number of governments look good and leave more food for the other starving people to eat.
And lets not forget that humans taste like pork!
A team of obese men have been sent out to various parts of the third world to put this theory to the test.
In the interests of common decency they will begin by eating dead starving people, but if the results are promising then living ones are on the menu, provided they’re happy to volunteer for the program.
In return for feeding yourself to a fat person your family will be given food and iPads!
A mouthwatering prospect we think you’ll agree.
The direct cost of treating people who are obese and overweight is almost €400 million annually, the report – to be launched by Minister for Health James Reilly – says. This is equivalent to the current overspend in Dr Reilly’s department. Indirect costs, in the form of illnesses, absenteeism and premature deaths, account for the remaining €700 million cost.
The report, commissioned by State-funded health promotion group Safefood, is critical of the fact that the taxpayer rather than the food industry pays these costs.
“The food sector is tightly regulated in terms of food safety, but not in terms of health,” said Ivan Perry of University College Cork, one of the principal authors of the study.
This is the first time researchers have put a price tag on the cost of obesity.
The report says the cost of dealing with obesity and weight issues in Northern Ireland is almost €500 million.
Dealing with the problem accounts for 2.8 per cent of total health spending, about the same as in many other developed economies, but short of the 5-6 per cent of health spending recorded in the US.
“When you look at today’s children, of whom one-quarter are obese or overweight, we’re projecting significant increases in rates over the next 20 to 30 years,” said Prof Perry.
He said the figures in the report were conservative, as they didn’t account for mental health costs and made conservative assumptions about the number of years of life lost due to weight-related problems.
In the light of the report findings, he said, it was clear there was much greater value for money to be had from infrastructural projects, such as the introduction of cycling routes or measures to promote walking, than had previously been thought.
Prof Perry said the report showed food choices weren’t just an issue between food producers and consumers, because the costs affected all taxpayers. “There’s a huge emphasis on personal choice in relation to what you eat, yet this report shows there are wider societal costs,” he said.
The report revisits the recommendations made by a previous government’s national taskforce on obesity, dating back to 2004.