A Study Worth Reading

Huge thanks to Twitter follower @shellymc for introducing me to this great study!

The goal of the study was to see if BMI, waist circumference, and abdominal adiposity (how much fat you carry in your mid-section) were good predictors of cardiovascular disease.

They looked at information for people who did and did not develop cardiovascular disease to see if one or a combination of those measurements could have reliably predicted their disease outcome.

What did they find?

In their words:  BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.

In my words:  They found that just looking at body size and shape was not worth doing if you could use actual measures of health.  Which we can.

But I think the real question is – when did we become so medically lazy that we require a study to tell us that?  And when are doctors going to stand up and say that they got into their profession to practice medicine, not guessing and body shaming? (Edit:  Some readers have taken this paragraph to mean that I don’t think that the study was necessary. To be clear, I’m all for the science, what I’m trying to point out is that we’ve abandoned actual medicine in lieu of staring at people fully clothed and making guesses about their health and we shouldn’t require a study to tell us that’s stupid and lazy.)

I would be remiss if I didn’t point out that this is what happens when studies are not funded by the weight loss industry.

I’ve said it before I’ll say it again, body size is NOT a diagnosis. This study points to what should be face-palmingly obvious:  The only thing that you can tell from someone’s size is what size they are.  If you’re looking at someone’s size and drawing conclusions other than what size they are then congratulations – you’ve discovered your prejudices and preconceived notions and what a great chance for you to choose to work on those!  Especially if you happen to be entrusted with that person’s health and well-being.

Published in: on July 31, 2011 at 9:14 am  Comments (24)  

24 CommentsLeave a comment

  1. Yay, thanks so much for this. I couldn’t quite permeate the language myself! :)

    • You are welcome, thanks for introducing me to the study!

  2. Of course weight is not a diagnosis alone.

    I will say though that it often should be taken in consideration, fat or thin (overweight or underweight), along with a list of other factors.

    For example, with a woman who is anemic her low weight that is to be considered underweight is one indicator of her disease, along other things like dizziness, puffy eyes, chronic fatigue, etc.

    • In most cases I would say that there is no need to take body size into account. There are definitive tests for anemia, there’s no reason to use body size in the equation, Also, people of all sizes get anemia so using body size as a criteria could lead a diagnosis in the wrong direction. I would make the argument that unexplained changes in body size should be taken into account in a diagnosis but absent an unexplained change, the size of a person is rarely a good diagnostic tool.

      ~Ragen

      • I agree. Stuff like this is why I don’t let anyone weigh me unless they need my weight to calculate doses of anesthesia or the like (and even then, for my last surgery I made the nurse weigh me facing away from the display and told her not to tell me the number). I can tell if my weight changes suddenly by how my clothes fit, and that’s pretty much the only weight-related symptom that is relevant.

      • I see your point. I think it’s something I’d like to look into – why doctors are so all about weighing you to help diagnose a problem.

  3. In my more generous moods, I think part of the reason (at least in the US) why doctors use guesswork based on observable body shape/size clues is possibly because of insurance companies. They don’t want to pay for *anything* if they can get away with it, and doctors are human like anyone else. They’ve been sucking up the “fat = disease” kool-aid being forced on society for so long that it seems logical to, like Ashley above, declare a “diagnosis” of poor health based on that clue rather than fight with the insurance company to get reimbursed for testing. Or get denied reimbursement, and then fight with the patient to try and get them to pay for a test that they may not be able to afford.

    Course, that’s my generous and charitable moods speaking. The rest of the time I suspect they’re just being lazy.

  4. I’m glad that you are once again pointing out that we need to be looking at who PAYS for a study before declaring the results to be “truth”. When I was studying for my Master’s degree to become a speech pathologist, one of the first classes I took was in regard to determining the validity of a study. We were taught that if it the study was paid for by any company or for profit organization, we’d probably be best to throw it out. (There were other things we were taught to look for to dismiss a study, but those things don’t add to the discussion here.) What I came away with is the knowledge that MANY studies are flawed and we cannot take conclusive evidence from any of said research. Unfortunately, many people do so because it is what they want to hear or it would make their job easier (and I’m just talking about speech and hearing disorders here!).

    I didn’t get this information until I was studying in a post graduate program. Why??!!! It’s important! Why wouldn’t it be in standard curriculum for a four year degree or even high school? The concepts aren’t that hard.

    (Of course, I have to laugh at myself as I right this: I ‘ve known this for 10+ years but only recently have begun questioning these “health” studies in regard to weight loss. Well, I guess when you’ve been “brainwashed” for as long as I have it takes a while for the deprogramming to work. Thanks Ragen!) :)

    ~ManDee
    http://www.chubbygirlcomics.com

    • Unfortunately I think many people don’t learn these kinds of things. I learned something about it in my bachelor’s level biology studies. The worst thing is that none of this is hinted at in the news. The reporters read a story based on the press releases,which contain whatever conclusions the study authors want to report. People think they are hearing facts but they’re not; only the interpretation of facts, which leaves a lot of room for, um…creativity.They don’t realize they’re not hearing about actual results but only the conclusions the study authors have come to, which may in fact NOT be indicated by the actual data/results. Add to that the fact that the data can only be as good as the methodology used to gather it. It’s not so hard to manipulate study procedures to derive the results you want. So I roll my eyes every time a reporter says, “A new study found that…” You can’t trust science reporting, there’s just no context for critical thinking.

  5. Can I ask if anyone has any views on weight as regards breast cancer? I’ve read that if your cancer is estrogen-positive (which mine was) then being overweight can be a health risk as more fat = more estrogen being produced in your body. Would be interested to hear anything on this.

    • As a cancer registrar, I’ve come across this one frequently. But, as a doctor I work with told me, if you’re talking estrogen exposure, a way bigger risk factor today is reproductive choice. We start having babies later (or in my case, not at all), we have fewer of them, and a lot of us opt for HRT later on. Those all add up to way more estrogen exposure over the course of a lifetime than our grandmothers would have had, but you never hear anyone telling us we need to have more babies for our own good!

      Also, it’s never been proven that weight loss decreases risk or improves survival for any cancer (and I’ve heard anecdotal evidence from some doctors that being fatter can improve survival, but there don’t seem to have been any studies done on that either.)

      Hope that helps…

      • Thanks for your reply. I keep reading that going for a 30-40 minute walk several times a week seems to cut down your risk of cancer recurrence, so keeping active seems to be the sensible thing to do. :0)

  6. It’s another case of confusing association with causation. Obesity may be associated with diabetes and other bad outcomes, but that doesn’t mean it causes it. Nor does it mean that everyone with one associated condition automatically has all of them.

  7. The book in your graphic – if that is not already a Thing, it needs to be.

    Sunflower

  8. Yes Yes a thousand times yes!!!

  9. Regan, I stumbled across your blog some time ago, and it has taken me some time to find the courage to post (The amount of comments you get for a single post is quite staggering sometimes), and I just wanted to add a little to this, regarding “lazy diagnosing”.

    In Oct of ’08 I was diagnosed with Intracranial Hypertension (please refer to http://www.ihrfoundation.org for more info on this). When looking it up online, I kept finding that it only seems to happen to women of child-bearing age that are slightly obese. Now, there are quite a few problems with this: 1) It does not only affect women (sorry guys), 2) there are teens and younger children that have been diagnosed with this condition as well, 3) if there has been little overall research done on it and such a wide variety of people all over the world have this condition, how can one say that being overweight causes it?

    I have always had headaches, even when I was young and thin, and they have only gotten worse as I grew older. I did hit a bought of depression the year before I was diagnosed, but looking back, many of the symptoms were already present. I had a lumbar puncture done, which relieved the headaches and vision problems almost immediately. Having generally been told that I was fairly healthy (except by my father, who for some reason felt it was necessary to make me as miserable about my body as he was of his, but that’s a whole ‘nother topic) imagine my surprise when one of the first things the doctors told me I needed to do was lose weight! At 22, I was about 5’5″ and 195 lbs, and had been for a while. They told me that ALL I had to do was lose about 40 to 50 lbs for it to go into remission, and that it would be best to do this before the end of the year. Buying into this, but refusing to even attempt to lose that much that quickly knowing that that would do me more harm than good, I have tried both changing my diet and my activity level to achieve this (at one point for 7 months I was working 12 hr shifts in a factory where I walked probably at least 10 miles on a good night) and nearly burst into tears every time I weighed myself and found that the scale hadn’t changed despite my clothes fitting better and I was feeling better.

    Now, 3 years later, I still have not dropped any of that weight, and it’s only just now that my symptoms are starting to return.

  10. *THANK YOU*!!! This is such a great tool to have!!
    After an MD ignored my hip pain (Turned out to be bilateral psoas muscle injury) and told me to take a lot of Ibuprofen and lose a lot of weight, I found a proper medical practitioner who diagnosed and prescribed a proper regimen of Physical therapy and exercise specific to my injuries and they are getting better, and will soon be healed.

    MD focused almost solely on my weight and age (50) and didn’t even attempt to find the *cause* of the injury. (Blood work later discovered ALL my levels are dead center “normal”. )

    This is SO good to have – thank you!!!
    If I *never *hear the term “Heart-attack fat” again, it won’t be too soon.

  11. “BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries *when additional information is available* for systolic blood pressure, history of diabetes, and lipids.”

    What it’s saying is that knowing someone’s BMI does not tell you any more *if* you already know their blood pressure, cholesterol levels, and diabetes status. It *doesn’t* say that being fat doesn’t cause or exacerbate high blood pressure, cholesterol, diabetes.

    So if you know someone’s blood pressure, cholesterol, and diabetes status, you can make just as accurate a prediction about their risks of heart disease no matter what you know about their size/BMI. But it doesn’t say that being big has nothing to do with those three things.

    This should not be interpreted as “being overweight has no correlation with risk of heart disease”.

    • Keith,

      I never said “Being overweight has no correlation with risk of heart disease” so I don’t know where you’re quoting that from. However, in the month of August ice cream eating is correlated with murder but I don’t think that banning ice cream sales in August will cut down on murders. That’s because the first rule of research is that correlation never ever implies causation (for information about that here: http://danceswithfat.wordpress.com/2011/07/20/correlation-is-killing-us/).

      You are correct that there is no information from this study about whether or not being fat causes or exacerbates high blood pressure, cholesterol, or diabetes, this study didn’t test for that. We do know that people of all sizes get all three conditions as well as heart disease. From their results we can say that if we can test blood pressure, cholesterol and diabetes status as a part of routine healthcare then we’ll get accurate predictions. This is important because many fat people have normal blood pressure, cholesterol, and do not have diabetes; while many thin people have high blood pressure, high cholesterol and diabetes and so diagnosis by body size does a disservice to everyone. Happily, as shown in this study – it isn’t necessary.

      ~Ragen

  12. Yes, all this!

    For years, every study (not funded by a diet company) I’ve read regarding health: weight stated that the healthiest weight is constant, and that rapid weight loss or gain should be treated as a *symptom* of something else.

    As an example, let me use the fatty bugbear, diabetes II. My mom’s family are all thin people regardless of diet/exercise, and my dad’s side are tall and stout. my dad’s side is also of native american descent– my grandma grew up on reservation and had diabetes II (family history + native american lineage= my fat ass has nearly a 50/50 chance of developing diabetes II regardless of other factors sometime in my lifetime. I get tested yearly as a precaution) so I try and keep up on diabetes II research (which is becoming exceedingly hard to find that’s not diet-company-backed). More and more of the studies are showing that diabetes II is mostly genetic, age, and sheer bad luck, with unknown -if any- environmental influences. Further, more and more studies show that weight gain is a *symptom* of diminishing insulin function that then aggravates the diminished function (NOT the *cause*, though it becomes a viscous cycle), and that weight loss is a sign long-term diabetes II is becoming under control (NOT the *cause* of the control). And not every diabetes II person is fat. (oh, and that there are probably a number of “average” weight people in their 40s+ with diabetes that don’t get diagnosed because it is a “fat” disease).

  13. I just got into an argument with a coworker about BMI because another friend and I were discussing how it is outdated and screwy science. Her words, “If you’re obese, you need to lose weight to be healthy.” (FYI, she is within a target BMI weight for her height, but she eats processed food and a list of junk food that would make a teenager queasy.) I gained weight over the past couple of years (mostly due to eating my emotions through a stressful time), and at the beginning of the year made strides to change my diet to a more natural diet and attend Zumba classes. I feel better than I did when I was 40 pounds lighter, so I don’t buy it. It just frustrates me when I try to share HAES information and am met with OMGDeathFat speeches. I’m the boss of my shrinking underpants (a positive effect of my lifestyle changes), but I’ll never fit into the BMI model.

  14. I love that my polite but dissenting reply is still “awaiting moderation”. If that’s how you run things, that’s the last I’ll be reading of your blog. Perhaps you should add a disclaimer “Only those who agree need bother replying.”

    • Keith,

      I hadn’t gotten to your reply yet. I’m not a professional blogger – I’m the CEO of a group of companies as well as being in training to win a World dance title so I get to the comments when I can get to them. Comments for some people are auto-approved, the others have to wait for approval. Yours has been in moderation for less than a week. Perhaps you should check your assumptions and have a little patience. Since you “love” that your reply is in moderation I’m tempted to leave it there but I’ll reply in a moment.
      ~Ragen

  15. I still remember when I had to endure an immigration medical exam in order to receive a visa to study in New Zealand (I am German). They measure you and take your weight to determine your BMI, and they also measure your waist. If you are over a certain BMI and/or a certain waist measurement, you have to do a blood test for diabetes. I am a vegetarian who eats incredibly healthily, but I am considered obese and was a staggering 2 cms over the allowed waist limit. So I had to do the diabetes blood test and pay for it, even though diabetes has never run in my family. If I had been only, say, 5kg under my weight then – no blood test. What the heck? How is that scientifically accurate?
    Of course, my cholesterol turned out to be as perfect as it can be, yet I was still lectured on my high BMI and advised to lose weight so that I don’t “burden” the New Zealand health system. Bottom line: Fatties not allowed in. Shocking!


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