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Study: Fat people benefit the most from healthy habits

Another quick link.

There's a new study out in the Journal of the American Board of Family Medicine: Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals. It's from a research group at the Medical University of South Carolina. The link above leads to the full study.

Here, "Healthy Lifestyle Habits" are defined as

  • eating 5 or more fruits and vegetables daily,
  • exercising regularly,
  • consuming alcohol in moderation, and
  • not smoking.

From the abstract:

When stratified into normal weight, overweight, and obese groups, all groups benefited from the adoption of healthy habits, with the greatest benefit seen within the obese group.

This table is from page 13 of the study. At the bottom are the number of healthy habits (out of the four above) that the subjects followed. The hazard ratios along the side are the comparative risks of dying early, with a BMI 18-25 person with four healthy habits set as "1". Anything above one is a higher risk.

Two things really jump out at me. First, the more healthy habits we have, the more our life expectancy matches the life expectancy of thin people with the same habits. When we've got all four, the gap is pretty much closed. Second, it's only the fat people with no healthy habits who have a dramatically reduced life expectancy in comparison to thinner people.

This is a strong confirmation of what HAES advocates have been saying for years.

CBC: a HAES story on Ontario Morning | Diabetes Expert Disses Weight-Loss Programs

richie79's picture
January 5th, 2012 | Link | Fascinating stuff, not least

Fascinating stuff, not least because it also seems to confirm that those in the 'overweight' range (who in recent years have been conflated with the BMI 30+ category under the umbrella term 'obesity' in order to provide scarier-sounding headlines) have the lowest risk of premature mortality in all but the '0' group.

Even taking this at face value then, the public health gurus should be revising their advice to us to pursue a BMI between 25 and 30. For this reason alone, and quite aside from its undermining of the now almost universally accepted belief that weight rather than lifestyle is the single biggest risk factor for early death, this will inevitably prove to be one more study that will be deliberately ignored by a media with a particular narrative to sell.

Of course, the concept and language of 'healthy habits' is itself hugely problematic. Different levels of smoking confer varying risks, and not alll smokers ultimately succumb to smoking-related conditions. The 'five-a-day' recommendation was not evidence-based but plucked from thin air because it was a nice round figure, and definitions of 'regular' exercise and 'moderate' drinking are also open to challenge and modification.

My final concern is that this could be used to further justify the trend of dividing 'the obese' up into 'good' and 'bad' categories. Whilst I accept that weight is distinct from health, I diverge from HAES practitioners in the belief that we have some sort of social duty or obligation to prioritise (a definition of) health and the pursuit of longevity, particular when given the low esteem in which older people are held and correspondingly scandalous standard of geriatric / end-of-life care in the UK, the prospect of the latter is not one to be relished.

"What is right is not always popular and what is popular is not always right" - Albert Einstein

DeeLeigh's picture
January 5th, 2012 | Link | You make a really good point

You make a really good point about the "healthy habits." What are they really measuring - what are they correlated to that the study didn't control for*, and what might be helping to create their beneficial effect? Higher income and educational levels, for example? On the other hand, I wouldn't be at all surprised if each of those four things does have an independent and beneficial effect on longevity.

Any time you talk about health or in this case, longevity, the good/bad fatty thing comes up. But the fact is, this study is just measuring correlations between BMI, longevity, and four habits that are generally considered healthy.

Are people who live longer automatically better people? Are people who want to maximize their life expectancy better people? Not in my ethical universe.

*edited to add: it controls for age, race and sex, it's not clear if it controls for education, and socioeconomic status isn't mentioned

TigerHawk310 January 5th, 2012 | Link | One thing that strikes me as

One thing that strikes me as very odd is the conflation of those four very different "healthy habits," followed by the relative lack of difference between the bars in the 2-4 habit categories. It's much, much easier to not smoke and to drink in moderation than it is to exercise with the frequency in that study, and much easier to do that than eat 5 fruits/vegetables a day. It would be useful to know how each individual habit breaks down.

In the "2 habit" group, the highest mortality is for the "normal weight" group! So...if you don't smoke, drink in moderation, but don't worry about good nutrition or exercise, it's better to be fat? Cool!

Finally, we have the same "results don't completely fit the conclusion/abstract" issue common to weight loss research. It would be equally accurate to write in the abstract, "When controlled for healthy lifestyle factors, disparities in mortality by weight are only significant for those leading the least healy lifestyles." Or perhaps, "obese people exhibiting all four healthy lifestyle behaviors have substantially better mortality rates than any other subgroup exhibiting three or fewer such behaviors." But of course the reported conclusion is "doctors should counsel obese patients more on healthy lifestyle behaviors." (as an aside, are there really that many smoking, sedentary, alcoholic fat people visiting doctors? I'd expect that group of people to not see doctors...and also to be extremely poor, another possible explanation for the disparity).

DeeLeigh's picture
January 5th, 2012 | Link | So funny... I find it easy

So funny... I find it easy to eat lots of fruit and veg (I love them) and to exercise regularly (I have a pretty high energy level and get restless if I don't), but I don't always have fewer than seven drinks a week and I smoke occasionally. So, the "don'ts" are harder for me than the "dos."

And if you're thin, I guess you're better off having four bad habits rather than three.

DeeLeigh's picture
January 12th, 2012 | Link | I was curious about the

I was curious about the impact of individual behaviors and looked at the study in more detail,

• Regular exercise - even if it's less than 12x a month - cuts our (fat people's) risk of early death by 30%.

• Smokers double their risk of early death, regardless of BMI.

• Heavy drinkers who are also catagorized as obese almost double their risk of early death. Since alcohol metabolizes to sugar, I suspect this has something to do with diabetes. Heavy drinking has little effect on the longevity of people with BMIs under 30.

• Eating a lot of fruits and veg only increases your life expectancy if you're meeting or exceeding 5-a-day. Even then, it has less of an effect than regular exercise.

Viola's picture
January 12th, 2012 | Link | Does consuming alcohol in

Does consuming alcohol in moderation include not consuming it at all? I know there are some health benefits linked to certain kinds of alcohol, but I'm assuming they are specifically saying not to be a heavy drinker, but I found the wording "consume alcohol in moderation" interesting, like it could almost suggest not consuming it is detrimental.

I've never smoked, but I do drink occasionally. I might go weeks without drinking, then have wine daily for a few days, have a few beers, whatever. Kind of like I eat vegetables. Actually eating real vegetables, some days I do lot of it, some days I eat almost nothing. Although, honestly, if I counted the vegetables in pasta sauces, and things like a bowl of roasted sweet potatoes, onions, garlic, if I counted avocado, olives, thing things I might put on a sandwich like sprouts, lettuce & tomatoes, then I do eat a number of fruits and vegetables. I feel like one's diet should be mostly fruits and vegetables with other stuff thrown in, but I end up eating more concentrated foods with fruits and veggies added on as a bonus. Today I've eaten half an avocado and a leftover burrito I made for dinner a few nights ago: it had onions, black beans, ground turkey, spices and tomatoes wrapped in a tortilla. So my feeling is I haven't really had any veggies today, but some people might count the onions, black beans and avocado. I've found in some nutritional sources, things like tofu and beans are counted as veggies, so maybe I eat more than I realize.

Avocado is a fruit, but it's so fattening. Still, it has useful compounds, and for my kids, I count it as a fruit that they are eating. For myself I feel like I need to eat more cruciferous veggies, and I feel like if I'm not eating a big plate of plain steamed vegetables, or leafy greens, I'm not really doing it right. But honestly, maybe I still have this healthy food is a punishment for enjoying non-healthy food thing going on in my head. Maybe it's actually OK to chow down on some greens that you've roasted in the oven with olive oil, and not think that because you aren't eating it all raw, it has no value.

SuzyBear's picture
January 22nd, 2012 | Link | Even fruits are no-no's for some people

As we Boomers are aging, our cholesterol levels are naturally rising a bit. Luckily my own doc is willing to try some alternative methods of lowering them before resorting to powerful statin drugs with those just as powerful side effects.

I eat a mostly vegan diet and do enjoy the many tasty meals I make. It's by no means a reduced calorie food plan with weight loss in mind. My total cholesterol, HDL, LDL are all fine, but my triglycerides don't want to go down to the lowest of low levels on diet alone, so now my doc tells me to cut out ALL fruit, that I can get all the Vitamin C, anti-oxidants and fiber from vegetables. I cut down to 1 or 2 pieces a day for now, but no way will I give up all fruit!

I think I can live with my trigs 10 points above the "normal" range without suffering any dire consequences, especially when I see older lab slips I have in my drawer had the normal reference range 50 points above what the latest lab slips show. Using the old scale I have a nice healthy trig level eating all the fruit I want.

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