Tag: obesity

Keep Living Fast …

If you are overweight or obese your chances of dying of any cause are raised.

From – Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. Aug 2016.

If you were one of the nearly four million people in this study the best weight to be was the one that put your Body/Mass Index under the red arrow. As it goes up or down so too do your chances of dying. It’s a J curve.

If you are young and obese you have the most to gain from losing weight. It is not easy but some succeed. You can give it a go or you can shriek about fat shaming and stuff another ice cream in your face.

If you’re obese and really lucky you may be metabolically healthy. It’s true for a minority. On the other hand some people of normal weight fall prey to those ills we associate with obesity, the dreaded metabolic syndrome. It does rather complicate the decision regarding the ice cream.

But wait it gets worse.

If you are a baby boomer or, my goodness, even older there are a number of confounding issues. Declining muscle mass being replaced with fat can bring all the disadvantages of obesity at a normal or not greatly elevated BMI. Add to that the fat distribution – middle aged spread tends to go around the middle where it does more harm than subcutaneous fat. You may be in more trouble than you think … or less.

I’m still exactly the same height I was lying about when I was 18 but some people have shrunk. This would increase their apparent BMI even if they haven’t put on a gram in the meanwhile. (Do I get extra consideration for bow legs?).

Next thing to consider is the obesity paradox. If BMI is plotted against all cause mortality in the elderly a different picture emerges than the one above. A higher BMI can appear to be protective. The simplest explanation for this is that death is fairly common in this age group and is often preceded by a period of wasting. Alternatively it may be because those most susceptible to the ills of obesity have already been eliminated from the cohort.

So if unintentional weight loss clouds the picture is intentional weight loss safe or not?

Intentional weight loss, even when excess fat mass is targeted also includes accelerated muscle loss which has been shown in older persons to correlate negatively with functional capacity for independent living. Sarcopenic obesity, the coexistence of diminished lean mass and increased fat mass, characterizes a population particularly at risk for functional impairment …. Miller & Wolfe.

Failed weight loss in a sedentary population invites the worst of both worlds – lose fat and muscle regain only fat. Weight loss in the elderly regardless of intentionality also  carries an increased risk of subsequent hip fracture.

No surprise then that health care professionals are divided on whether weight loss should be recommended to their elderly patients.

This little essay draws heavily on a review paper by Gill, Bartels & Batsis.  Their conclusion is fairly positive …

The number of older adults is projected to increase substantially in the coming decades and addressing obesity is essential for the health of this rapidly growing population. Though the “obesity paradox” has contributed to a lack of attention to addressing obesity as a major health problem in older adults, weight loss and improved fitness in obese older adults has been shown to improve function and multiple health indicators. Though physical activity and diet alone can improve outcomes, randomized controlled trials showed better outcomes when they were combined. The process of activity prescription should be patient-centered in order to develop a plan that is relevant to the older adult’s goals and achieve the overarching purpose of improved quality of life.

If you’re no spring chicken and thinking of shedding some weight it’s worth a read. A chat with your doctor would also be a good idea. Diet and exercise beats either alone.

My choice was to start cycling coupled with resistance training and a low-carb diet taking care to keep the protein intake up. All appears to be going well, the hips are still intact (you’d need oxy-acetylene equipment to get through one of them).

Previous failure has taught me that it ain’t over until the fat lady is singing about how much weight she’s lost but cycling is low impact compared to running and the keto diet involves little will power compared to calorie restriction diets. Confidence remains high.

Live Fast …

… Die young. I have no particular objection to the first half of that particular motto but even as a youngster didn’t feel a great affinity with the second half. Nor has it been popular generally – not dying young is the reason we have a population that is on average getting older.

But, as I’ve said before, if I can have some extra please insert it in the middle not add it on the end. Anywhere in the healthspan will do fine just not on the lingering tail of the lifespan.

Increased life expectancy has largely been the result of public health measures, road safety legislation, improved medical services and an avoidance of widespread warfare. It’s all about keeping us from dying. Enjoying good health is quite distinct from merely surviving. This is where the user pays principle in healthcare cannot be avoided. It’s your body.  You will pay for what you do with it.

As a community we have shown a willingness to look after ourselves. Our intentions are good. We have, in the main, listened to good advice and reduced our smoking. We have also listened to dietary advice. Consumption of those things that we have been urged to reduce has gone down but nonetheless our weight has gone up. I think US data is good for Australia as well.

And the timing of the obesity pandemic is a bit suspicious …

If I were defending the guidelines I’d be quick to point out that correlation is not proof of causation but hey, saturated fat was convicted on flimsier evidence than this.

So was it bad advice or simply an unequal battle against sugar – cheap, addictive and toxic? Nowhere in the guidelines did it say eat more calories but that is indeed what we’re doing.

Or is it, instead, a function of our ageing, a collective middle aged spread? If we turn our heads one morning, catch sight of our belly in profile and achieve enlightenment what should we do about it?

William Banting …

Good old King George lll died at Windsor Castle at 8.38 pm on the 29th of January, 1820. He’d  been completely out of his mind for about a decade. He was buried in St Georges Chapel in the castle on the 16th of February. The undertaker was 5 feet 5 inches tall and about 5 feet 5 inches round.

These are the sort of details you have come to expect of McGee, though I confess that I made up the last one although it might have been close to the mark.

The undertaker in question was William Banting (1796 – 1878). He was much troubled by his weight, in 1863 he wrote …

Few men have led a more active life—bodily or mentally—from a constitutional anxiety for regularity, precision, and order, during fifty years business career, from which I have now retired, so that my corpulence and subsequent obesity was not through neglect of necessary bodily activity, nor from excessive eating, drinking, or self-indulgence of any kind, except that I partook of the simple aliments of bread, milk, butter, beer, sugar, and potatoes more freely than my aged nature required …

He had tried diet and exercise and a number of treatments we would find odd today such as taking the waters at various spas. At one stage of his life he was rowing a boat on the Thames every day before work but it made him so hungry it was doing more harm than good. Eminent doctors were consulted but to no avail.

Obesity seems to me very little understood or properly appreciated by the faculty and the public generally, or the former would long ere this have hit upon the cause for so lamentable a disease, and applied effective remedies, whilst the latter would have spared their injudicious indulgence in remarks and sneers, frequently painful in society, and which, even on the strongest mind, have an unhappy tendency …

Not a lot’s changed really.

Enter Dr William Harvey of Soho Square who prescribed a diet …

The items from which I was advised to abstain as much as possible were : —Bread, butter, milk, sugar, beer, and potatoes

By the time William was ready for bed he’d eaten about a pound (0.5 kg) of various dead animals, one serve of vegetables other than potato and a couple of ounces of dry toast. He’d drunk unlimited quantities of tea with no milk or sugar, half a dozen glasses of claret and a brandy, the first known keto diet published in the English language.

He tells us that he was 5 feet 5 inches tall and weighed 202 pounds (BMI 33.6). The weight and the girth dropped off. The undertaker to royalty was delighted …

I have not felt so well as now for the last twenty years.

Have suffered no inconvenience whatever in the probational remedy.

Am reduced many inches in bulk, and 35 lbs. in weight in thirty-eight weeks.

Come down stairs forward naturally, with perfect ease.

Go up stairs and take ordinary exercise freely, without the slightest inconvenience.

Can perform every necessary office for myself.

He tossed an extra fifty quid in the direction of Dr Harvey to use for the benefit of various hospitals and wrote and published a pamphlet, distributed free of charge so that others might share the benefits.

The Letter on Corpulence, Addressed to the Public ran into several editions and can still be downloaded. Subsequent editions were updated with further weight loss, reaching 46 pounds from a starting point of 202. He lost a little over 12 inches from his waist. (BMI 26).

I put on my former clothing, over what I now wear, which was a thoroughly convincing proof of the remarkable change. These important desiderata have been attained by the most easy and comfortable means, with but little medicine, and almost entirely by a system of diet that formerly I should have thought dangerously generous.

 

A Lifestyle Diet …

When people find out that I’m a vegetarian they often ask whether I did it for health reasons or for ethical reasons. The answer is very simple. My conscience became slowly more troubled by the fact that animals suffered and died in order for me to eat. I stopped eating dead animals. I eat eggs and dairy produce and yes, there are questionable practices there but I still had to live in the real world.

Gayle was traveling a similar journey but we were actually in different parts of the country when the final straw was put on the load. For Gayle it was the sight of sheep awaiting live export at Portland during a strike that held up their embarkation. They were held in appalling conditions. For me it was a few weeks among some vegos having no trouble with a meat free diet, something that I had hardly felt possible.

That was more than 25 years ago. We had kids to fees, we fed them meat. We feed the dog meat. There are some internal contradictions there but it does prove one thing. A major change in lifestyle diet is possible.

A vegetarian diet has to overcome some real deficiencies.

  • We have the gut of an omnivorous animal. Herbivore guts are longer and equipped with large caecums to ferment fibre.
  • There are nutrients that can only be obtained from animal sources such as B12.
  • Animal protein is complete in the essential amino acids whereas the balance is different in plant proteins  and a plant based diet is generally poorer in the proportion of protein.
  • Omega-3 fatty acids are poorly represented in a plant based diet.

It surprises me that there is an assumption that being vegetarian is more healthy. But there are studies that show lower rates of all cause mortality and lower rates of heart disease for example <Here> and <Here>. I do wonder whether a fair comparison has been made here. We all know what a non-vegetarian is don’t we?

Vegetarians, vegans and the plant plus fish pescatarians have all made conscious adjustments to their diet, they take it seriously. The non-veg folk may have just gone on eating what their mother fed them as kids adding things that they found delicious on the way. We may have compared a thoughtful diet with the Standard American or Australian Diet (SAD for short either way) that has seen the money spent on processed food double since 1982 while spending on meat and veg has fallen. Pass me another energy drink, will you, I’m hypoglycemic.

For the first time in history the poor are fatter than the rich.

And I’m fat too. How did that happen? I avoided saturated fat, abandoned butter, got my calories from whole grains, ate my bread, 6 serves of fruit and veg a day. I followed the guidelines. I was good.

What is this stuff called insulin?

Obesity is not a disease …

Recently the fire service had to demolish two walls of a house in south Wales so that a 63-stone teenager could be taken to hospital. This required more than 40 emergency service workers at an estimated cost of £100,000. Over the past five years, fire services have been called to more than 2,700 incidents to assist ‘severely obese’ people, including some who had got stuck in the bath. Rescuing fatties is now a routine operation, with its own entry in the Fire Brigade incident reporting system (filed under ‘bariatric persons’).

More people are now fat and fewer of them care. Read all about it <HERE>.