e.g. I was just reading:

The correlations between higher weight and greater health risk are weak except at statistical extremes. The extent to which those correlations are causal is poorly established. There is literally not a shred of evidence that turning fat people into thin people improves their health. And the reason there’s no evidence is that there’s no way to do it.

So saying “let’s improve health by turning fat people into thin people” is every bit as irrational as saying “let’s improve health by turning men into women or old people into young people”. Actually it’s a lot crazier, because there actually are significant health differences between men and women and the old and the young — much more so than between the fat and the thin.

http://meganmcardle.theatlantic.com/archives/2009/07/americas_moral_panic_over_obes.php at The Atlantic.

Saying it over and over again doesn’t make it true, no, really.

Mr. “Cardiologist,” how dare you contradict a dietician who has spent her life studying these things! For all I know you’re a shill for bariatric surgery companies! For shame.

1) Obesity has definitely been associated with increase mortality, independent of exercise (see reference).

Association is not causation.

And even if it were proven that obesity was causally related to increased mortality — which, except possibly for the most extreme cases, it has not been — it still wouldn’t follow that weight loss diets are a good idea. For most people, they don’t work. There’s no point addressing a real problem (if it is real) with a non-working “solution.”

2) I agree weight loss diets have not shown consisent long term mortality data. However, people usually don’t follow these diets long term and the cost of a trial to do so is exceedingly expensive.

It’s certainly true that most people don’t stay on most weight loss diets long term, but that’s just another reason why it’s a bad idea for doctors to prescribe weight loss to their patients; it’s a bad idea to suggest a program that you know from experience most patients will be unable to stick with. (Too many doctors blame patients when this happens; I say that if the doctor assigns a program with a proven record of failure, and it fails, blame the doctor!)

That said, reasonable weight-loss diets also haven’t been shown to cause much long-term weight loss even among patients who don’t drop out. Certainly not enough to turn an obese person into a “normal” weight person, for instance.

Obesity is associated with an increase in diabetes, bad cholesterol, high blood pressure, gallstones, arthritis as well as psychological implications. Therefore, losing weight should reverse these and only give benefits over time — not during short term trials that have been done so far.

Again, “association” is not causality. There are many other possible causes — not least of which is the repeated failed weight-loss diets that many fat people put themselves through.

For the large majority of fat people, weight-loss diets don’t work. Therefore, any plan of treatment that is based on weight-loss diets won’t work, either. A more rational treatment for those problems you mention is to look at preventative efforts that might actually work for most patients, such as regular exercise, or shifting to a diet richer in veggies and the like. (I won’t get into the argument over whether it makes more sense to reduce carbs or fats, other than to point out that this is a very live controversy among researchers, and not a settled question).

For those who already have diabetes, high blood pressure, etc.., there are treatments for these conditions that are effective — exercise, change in diet, medication, etc.. Harping on weight loss is pointless, because you don’t know how to make most people lose a lot of weight in the long term. No one knows how to do that.

Again, I’m asking that doctors stick with programs that have been proven to work, rather than emphasizing a program that has not been proven to work. Why is that unreasonable?

Finally, I find it ironic that you cite “psychological implications” as a problem of being fat. Being fat doesn’t cause “psychological” problems; rather, bigoted and anti-fat attitudes cause psychological problems for fat people.

3) Bariatric surgery yields 50% weight loss and has yielded significant mortality benefits, and has decreased all of the above medical complications.

Bariatric surgery also has a higher mortality risk than obesity, not to mention many other complications. Plus, it’s almost always prescribed in concert with diet changes (not just “eat less,” but also eating healthier food) and a regular exercise program, making it hard to separate where the benefits come from.

Finally, there’s also the “over what term” problem. As you probably know, a substantial number of bariatric surgery patients eventually regain much or all of the lost weight. For those who do regain, the downside of having had serious surgery almost certainly is greater than the upside of being thin for several years.

4) Finally, it is silly to say that scientists and doctors who have studied this all their lives are wrong.

But not all “scientists and doctors who have studied this all their lives” agree with your view. As you should know if you follow the peer-reviewed literature on this, there is significant controversy over whether or not weight-loss diets should be recommended.

What there is no controversy over is the fact that no weight-loss diet has been shown to work for more than a small minority of patients over the long term. And you present absolutely no evidence in your post to convince a skeptical fat person that a weight-loss diet is likely to turn her into a “normal” weight person. As a fat person myself — and one with significant health problems — I think my most logical course is focusing on health plans that have some evidence of effectiveness. Again, let me ask: does that seem unreasonable to you?

Who are you and what are your credentials. For all we know, you could work for McDonalds in an effort to confuse the public.

Talk about an ad hom — as well as an argument from authority! You must realize how weak your arguments are if you’re resorting to these tactics.

It’s illogical to suggest that an argument is wrong or right depending not on the argument’s strength and support, but on the credentials of the person speaking. Throughout history, many well-credentialed people have made terribly wrong arguments in defense of a mistaken status quo.

(And for the record, no, I don’t work for McDonalds. Yeesh!)

1) Obesity has definitely been associated with increase mortality, independent of exercise (see reference).

2) I agree weight loss diets have not shown consisent long term mortality data. However, people usually don’t follow these diets long term and the cost of a trial to do so is exceedingly expensive.

Obesity is associated with an increase in diabetes, bad cholesterol, high blood pressure, gallstones, arthritis as well as psychological implications. Therefore, losing weight should reverse these and only give benefits over time — not during short term trials that have been done so far.

3) Bariatric surgery yields 50% weight loss and has yielded significant mortality benefits, and has decreased all of the above medical complications.

4) Finally, it is silly to say that scientists and doctors who have studied this all their lives are wrong. Who are you and what are your credentials. For all we know, you could work for McDonalds in an effort to confuse the public.

References:
Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med. 2004 Dec 23;351(26):2694-703. PMID: 15616204

And a shout-out to BStu, who writes an awesome FA blog. :)

But I do not agree with most diet gurus that it’s about cutting back on fat and calories. I think that in most cases of serious obesity, either you are looking at a thyroid issue (hyperthyroid, or insufficiency of thyroid hormones or response to same) or you are looking at a high blood insulin issue. More often it’s the latter, especially given our current Type 2 diabetes epidemic.

The thing is, you don’t have to be fat to have hyperinsulinemia. We’re seeing people out there with high blood pressure and arterial plaque who are either not overweight or not more than twenty pounds over. But in most people with this problem, they DO gain excess weight.

I won’t go into the biology of all of this in a comment. You’re a big boy and you know how to read; you’re going to laugh at me for recommending this, but I think you should read some of Dr. Atkins’s books on the subject, because diabetes treatment was one of his passions and he learned a LOT about the physiology of same.

But the point is that the low-fat dogma is hurting a lot more people than it helps, and I don’t think it coincidence that we have so many more overweight people now (including me, and diabetes also runs in my family) at a time in which we view fat intake as unhealthy. We wind up making up for the dearth in fat calories with an increase in sugar and starch carbohydrates. Insulin resistance is on the rise as a result.

I’m not doing anything about my particular problem yet but I do have a game plan in place which I will be starting soon. If anyone asked me what I thought they should do aside from ignoring their health, I would say do these things if you eat a lot of carbs, regardless of your weight and especially if you have blood pressure issues:

1. IF you can afford a doc or have insurance, go get a five-hour glucose tolerance test done with insulin levels. If that’s normal, go to step 3. If it isn’t normal, go to step 2.

2. Investigate and seriously consider adopting a controlled-carbohydrate way of eating. Not temporary diet, a *permanent* change. If you’re scared of Atkins–and a lot of people are, unjustifiably (READ THE BOOK to see what I mean–check it out of the library if you don’t want to buy it)–even South Beach is better than nothing. This will involve cutting back on starch and sugar carbohydrates in favor of vegetable and fruit carbohydrates. Yes, even if it’s Atkins.

3. Exercise. Even if your bloodwork is normal, exercise maintains your cardiovascular health and keeps your muscles and bones happy. Weight-bearing exercise or the lack thereof, actually, is a larger deciding factor in the risk for osteoporosis than almost anything else; you can’t utilize the calcium you intake to the utmost if you’re not stressing your bones. (And you still want to watch your fruit and vegetable intake and increase it if necessary.)

IF YOU ARE TAKING CARE OF YOURSELF and still overweight then don’t stress about it, by all means. Be happy with who you are. If you are NOT taking care of yourself and you’re overweight, the weight may be a symptom of something going on with your health. In that case a healthy body image is still a good thing, but how can you have a good body image if you are not taking care of your body in the first place? We don’t tend to form good images of things we ignore.

(For what it’s worth, I think these people you mention who die after going on a diet are doing so because they DID have hyperinsulinemia and started eating MORE carbohydrates, made it worse and totally fucked their cardiovascular health, NOT because they lost a few pounds. But it goes back to reading what Atkins had to say. Again, you’re all growed up and you can read. Please do.)