Study: Healthy Habits Can Make Healthy Fatties

A new study shows that “healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index”.  Look, over there…it’s a great big flaming sack of “no kidding.”

Which is not to say that the study shouldn’t have been conducted, but is rather my attempt to point out the utter ridiculousness  of clinging to the idea that getting our bodies to a specific height weight ratio is our best chance for being healthy, knowing the health is not guaranteed, not an obligation, and not a barometer of worthiness, in the face of overwhelming evidence that:

1.  It’s not possible for most people who aren’t in the weight range to get into it

2.  There are plenty of people who fit that height weight ratio who are not healthy

The study looked at the association between 4 healthy lifestyle habits and mortality in a sample of 11,761 people. The healthy habits were:

1.  Eating 5 or more fruits and vegetables daily

2.  exercising regularly

3.  consuming alcohol in moderation

4.  not smoking

As you can see on the chart, being “normal weight” is an advantage if you do not partake in any of the four habits.  However, even one healthy habit cuts the risk down by about half, and subjects who did those four things and were obese have basically the same outcome as “normal weight” people who did all four habits, and a dramatically lower risk than thin people who didn’t participate in the four habits.

This study is not perfect.  While 14 years is a decent study period, 12,000 people could be construed as a  small sample size, and it speaks only to mortality. The study isn’t overarching proof of anything – in fact overarching proof is very rare – that’s why I waded through brain aching statistics classes.

A very smart friend of mine asked me recently if I put the studies that I tout up to the same scrutiny as the studies on weight loss that I tear apart.

The answer is that I do, but I consider something else as well: risk.  I’m familiar with the idea of downside risk from business – I spent years working in business operations as a consultant and my last gig was as CEO of a multimillion dollar locally owned business so I’ve been steeped in business decision making.  Downside risk is a look at worst case scenarios – you can’t just make decisions based on what will happen if your strategy succeeds – you also have to look at what could happen if it fails.

So the worst case scenario for weight loss is that I fail at weight loss multiple times and end up heavier than I started and subject to the dangers of weight cycling which include high blood pressure, high cholesterol, diabetes, depression and cardiovascular disease.

The worst case scenario of healthy habits is that I exercised, ate vegetables, drank moderately and didn’t smoke and they didn’t make me healthier.

Next we have to determine how likely it is that we will experience this worst case scenario:

There is a 95% chance that weight loss will fail according to all the studies that exist. In truth if weight loss were a business decision I would probably never get to a risk calculation since the 5% success rate is within the margin of error and not really worth trying since weight loss doesn’t always come with health improvements – sometimes it arrives alone. But let’s finish this exercise.

Based on this and other research such as that by the Cooper Institute, Wei et. al., and others healthy habits have an excellent chance of increasing health – certainly much better than 5%.

So my decision to focus on healthy habits rather than weight loss is based both on an analysis of the likelihood of success and an analysis of downside risk. It’s also based on common sense – there are “normal weight” people with type 2 diabetes and high cholesterol, and high blood pressure, “normal weight” people get the same health issues that fat people do and “normal weight” people die of the same things that fat people do, so being “normal weight” cannot be a sure cure or preventative.

The only analysis in which weight loss comes out ahead is about what is most profitability for the diet and pharmaceutical industries.

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Published in: on April 19, 2012 at 8:03 am  Comments (26)  

26 CommentsLeave a comment

  1. “Look, over there…it’s a great big flaming sack of duh.”

    LOL, right?? Healthy habits make people healthier! In other news, the sky is blue, grass is green, water is wet, and the Pope is Catholic!

  2. I’m confused as to where you got the “1200 people sample size” number. Earlier in your post it says 11,000+. Am I missing something?

    • That was a typo, it should have said 12,000. It’s fixed now – thanks!

      ~Ragen

  3. Has anyone seen this…I saw an ad for it yesterday evening, and I TENSED UP… HBO doc about “the obesity epidemic…”. Just more media to shame and hurt…

    http://theweightofthenation.hbo.com/

    • Hoo boy.

      I went over and looked at the web page you linked to. Right below the caption “Confronting America’s Obesity Epidemic” there is a box to click on so that people can “Take Action and Host a Screening” of this show.

      I feel like the villagers with the torches and pitchforks can’t be far behind.

      • true dat….

  4. I really like the YouTube video that was attached to my daily dose of Ragen! It was quite interesting. It makes me wonder why I always find a reason not to get my big booty in gear…for just 30 minutes a day. I mean, I take the stairs in the parking garage (or anytime I have to go up or down levels), I park far away from the the doors at the store. But I bet my dog would just love it if I could haul my ass out the door and take her for a 30 minute walk every day instead of making excuses. Thanks for the great post, as usual, Ragen.

    Oh, and p.s. I took stats as well, and it really does make you look at “news” articles about how this study or that “has proven” something…when the statistics they refer to are pretty far away from significant. You definitely tickle my BBA when you start talking about risk and ROI. If you break down each minute of exercise as a share in You Inc., the EPS is pretty damned high too.

    • You might consider doing a 5 minute walk a day to start. You can stop after 5 minutes, but you can also keep walking. It’s a trick I use to get myself to do something I am procrastinating about. I tell myself that I just have to do it for 5 minutes and then I can stop. But by then I am into it and usually have the momentum to keep going. And your dog will thank you!

      • i do that too! that’s actually a problem i’ve had with switching from the “weight loss” mentality to HAES- with weight loss, you have concrete goals like “lose X lbs by some date” but with HAES, the goal of overall health can seem broad. so i end up doing short-term motivation like that where i sort of trick myself into exercising or not bingeing. nice to know other people do that with stuff.

  5. Really? Healthy habits make people healthier? That should be headline news….oh wait, it’s true and isn’t panic worthy or giving into the diet industry. nevermind.

    I love a big flamming sack of duh.

  6. The thing is, with all the “oh noes obesity!11″ terror that is promulgated in the media constantly, if you go to any list of risk factors for heart disease, diabetes, or high blood pressure, you find pretty much the same top two risk factors: 1) family history of the condition; 2) being over age 45. You can’t change either of these.
    Since we know changing one’s weight is a sisyphean task, even though they all recommend it (out of habit, I suppose), they also all recommend a number of other positive steps to take: exercise regularly; healthy diet (varied, includes some vegetable and fruit on a regular basis, light on the red meat); don’t drink like a fish; DON’T SMOKE.
    All of these things are a voluntary choice for people. One’s shape, for the most part, is not. So change what you can in a positive direction and if you’re already doing those things know you are doing your best for your health and we live in an imperfect world where people sometimes become sick.
    The ugliest thing about the new healthism is how sick people are kicked when they are down. Doesn’t anyone realize what an ugly person it makes them it is to tell someone who’s just found out they have a chronic, incurable condition that could have serious complications “well see, it’s your fault because you couldn’t put down the fork, fatty!” I don’t care how thin, healthy and attractive someone thinks they are – if they behave like that, they are ugly and sick. And I see it every day.

    • Amananta: genetics and ageing are the biggest risk factors for cancer, too. (Which doesn’t get linked to being fat quite so often, but some specific types do, so these invariables do need to be stressed.)

      Re cancer, and re kicking people when they’re down, I heard something on the radio yesterday that annoyed the heck out of me. Basically, research now suggests that breast cancers should be subdivided, in genetic terms, into about ten sub-categories, which all develop in slightly different ways and so require different treatment. Which is a plus, if it means treatments can be more effectively targeted. But then the guy on the radio started talking about determining which types are more affected by lifestyle factors and, yep, you guessed it, obesity…

      And I’m thinking, we’re talking here about cancers that women already have. Saying ‘Your cancer was caused by you being fat’ really is absolutely no help. It might be understandable if weight loss had been proven to prevent or suppress tumor growth (as per the NCI’s website, it hasn’t), and if permanent weight loss were possible anyway (and good studies indicate it isn’t). So why go there at all?

      I believe the culture of morality and blame around health is all about money. Make out that someone ‘brought it on themselves’ by poor health habits, and it’s that much easier to justify not paying for their treatment. When people who actually work in medical fields start thinking this way, it’s a bad sign; it points to a loss of compassion, and if you don’t have that in healthcare, where are you?

  7. I always wonder when I read these studies if they want someone like me to subtract ‘healthy living’ points because I cannot abide alcohol in any form & never touch it. I had two abusive alcoholic parents & I also hate the smell & taste of alcohol, so I don’t drink. I pretty much do all the other stuff & have done all the other stuff ever since I can remember, as well as being a fanatic with my dental hygiene & having good sleeping habits, &, in my case, adding in such things as having two healthy pregnancies & deliveries & spending nearly 3 years nursing. I don’t even drink coffee, but do drug 4-6 mugs of black & green tea daily, which are also supposed to have health benefits. So I think that I will give myself a pass as ‘acceptable’ on the not-drinking thing.

    I have good genes, especially from my mother’s side of the family, which is definitely not anything I did. My mother WAS an active alcoholic for some years, inhaled my father’s second hand smoke for over 43 years & spent the last 30 years or so of her life dealing with emphysema, yet, because of the genes from HER mother, lived to be 85. I also have to say that no one in my family ever was much for counting fruit & veggie servings & we have always been a family fond of our red meat.

    We certainly don’t have a great deal of control over how long we live or exactly what diseases we get. Maybe the things some of us do help some. However, regardless of how fat we are, or how we live, we have a right to full ownership of our own lives & bodies, to have full access in the world, to be treated with respect, & not to be told that, if we are ever sick, it is “our own fault.” It isn’t our ‘fault’ if we get sick, any more than it was the ‘fault’ of the skinny guy doing the Bayer aspirin commercial who says he is in ‘perfect physical condition, a marathoner, & I had a heart attack.”, so he now takes aspirin daily. He didn’t ‘deserve’ a heart attack, but neither does anyone else.

  8. I was excited to see this study, though you are correct it’s what many of us have already known for a long time :). It’s a bummer they weren’t able to tease out exactly which of the 4 habits were most important, I would have liked to see that. I’d say I’m about 2.5-3 out of the 4 (rarely get in all those fruits and veg, exercise moderately most of the time but sometimes have a hard time in winter months). Not bad though :)

    • When I clicked on the link to the study that Ragen gave, it let me see the full text PDF for free. It includes a table with risk for each of the habits individually. It’s too much to sum up here, but basically not smoking benefits a weight groups (duh!) whereas the other habits benefit all BMI groups, but some more than others.

  9. Thanks for everything you do – I feel like you are such a helpful dose of sanity!!

    God forbid we do things that make us healthier and feel better – if it’s not making you thinner, what is the point? That kind of thinking makes me want to slam my head against the wall repeatedly.

    (Also, I’ve watched your tape – you look fab on the floor. Good turns, girl! I love it!)

  10. Ragen, this is off topic, but I just wanted to say thank you for being you and writing and keeping this blog. It truly keeps me sane some days. Inevitably, in my internet musings I ALWAYS stumble onto an article or a conversation with rampant and abusive fat shaming, and my old solution to these occurrences was to get depressed and belittle myself. Now I come here, read your blog, and remember that I AM a whole person… even if some people will always refuse to see me that way.

  11. It is always so reassuring to see Actual Science (presented wonderfully, too!) backing up the things I think. So often I am told “you’re making that up to suit your own purposes” (uh-oh, not the Fat Agenda!) that it can be quite moving to see that science and maths is actually on my side.

    Thanks for sharing this, Ragen. :)

  12. I have seen that one before & overall it is pretty neat, aside of course from him labeling ‘obesity’ as a health problem &, since it is lumped with drinking, smoking, being sedentary, a ‘behavior.’ What I got from watching that is that the single most important factor in overall better health & longer life is getting regular moderate exercise. He even considers it more important than not smoking, though I admit that I personally would consider avoiding tobacco to be the single best thing anyone can do to improve health & lengthen life. He did manage to give a smiley face to ‘obesity + exercise’, once more pretty much asserting that fat people who exercise are as healthy as thin people who exercise. It is good to know that I have not been spending all these countless hours walking & doing other exercises for the past 53 years for nothing.

  13. I like how you laid it all out–the benefits of concentrating on being healthy rather than cycling with the dieting. But one thing you didn’t mention—one of the biggest health benefits of doing it the “right way” (that WE think is the right way), is the stress it reduces for us. Dieting is so damn stressful! Not being on a diet, not worrying about calories or fat or carbs, and just paying attention to yourself….that has to have a positive affect on your mind and your body. It probably helps the heart disease factor too! Stress is no good for your heart!

  14. I wonder whether anyone has done a study about how a person’s beliefs about the cause(s) of her or his illness affect the treatment outcome. Specifically, if stigma and discrimination can cause health problems like high blood pressure and depression, they probably worsen other health conditions. For example, if you had cancer and believed you somehow brought it upon yourself (and “deserved” to be sick), that belief might make you sicker or make the treatments less effective.

    • I cannot give you specific studies, but as a clinician I know first hand (and I’ve read a myriad of studies) that what we think becomes reality – and our perspective often gives way to BIOLOGICAL changes in our bodies and brains. One of the reasons prayer and spirituality are proven healthy coping strategies – because we BELIEVE. Cognitive Behavioral Therapy is based on the “what we think we feel, what we feel we act on” notion. Self esteem and a healthy self view is just about 90% of the battle to a healthy life…

  15. Is there possibly a link to these studies/sources that could be made available?

    • Hey Lizzie – the links to the studies are all in the post, I think. :)

      • Oh durr sorry! I didn’t notice that. :P

  16. I know this is an old post and although I follow you periodically I’m on kind of a drive-by today (great roundup on this study, BTW!) -but I saw you mentioned the Cooper Institute.

    FYI, I’ve had an ongoing argument with them regarding BMI testing in schools – while they almost have the right idea in terms of teaching nutrition and movement, they are definitely supporting a fat-unfriendly environment in our culture, while covering it up with platitudes like “fit at any size.”

    Be happy to offer more info as you like, see their program Fitnessgram for more information. (What I object to, specifically, is the measurement of BMI in school by PE teachers, and the sharing of that number as inside or outside the “healthy fitness zone with children too young to understand what it means.)


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