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The Fat Pack Wonders if It's Time to Slim Down


melkor
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I'm sure they exist, but I have yet to find anyone in the obese category who didn't at least have some health problems associated with excess body fat.

How many people have you diagnosed or observed in order to draw this conclusion? The study I saw cited recently in the New York Times involved 25,389 men:

Sedentary men with a rating of less than 27 were at a greater risk for heart attacks, strokes, diabetes and certain cancers than fit men with a rating above 30, according to a study of 25,389 men conducted by the Cooper Aerobics Center in Dallas.

Steven A. Shaw aka "Fat Guy"
Co-founder, Society for Culinary Arts & Letters, sshaw@egstaff.org
Proud signatory to the eG Ethics code
Director, New Media Studies, International Culinary Center (take my food-blogging course)

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I'll suggest that arbitrary threshold levels, wherever they're set, may be a less useful tool than patterns, & a good doctor-patient relationship will focus on the latter & perhaps avert a crisis diagnosis.  That of course requires regular visits to the doc.

It sounds like you have a relationship with your doctor that works. However, there are plenty of people who in your situation would have been given a course of medication to lower their blood sugar. That's when the "epidemic of diagnoses" gets scary.

Steven A. Shaw aka "Fat Guy"
Co-founder, Society for Culinary Arts & Letters, sshaw@egstaff.org
Proud signatory to the eG Ethics code
Director, New Media Studies, International Culinary Center (take my food-blogging course)

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My point was rather that I've rarely met "fit" men with a BMI over 30.

The few people who would be considered obese by body fat or waist to hip metrics in addition to the simple BMI metric are so obviously outliers in the general category of obesity or weight problems, that they are scarcely relevant to the health of most obese people.

Jason Truesdell

Blog: Pursuing My Passions

Take me to your ryokan, please

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My point was rather that I've rarely met "fit" men with a BMI over 30.

The few people who would be considered obese by body fat or waist to hip metrics in addition to the simple BMI metric are so obviously outliers in the general category of obesity or weight problems, that they are scarcely relevant to the health of most obese people.

But, the BMI alone is used to to diagnose and medicate patients in private practice in the United States of America. That is the way the health system is structured.

The United States Military begs to differ. I've met a SEAL or two, and a couple of pilots, and there was that one guy at the O-Club. :biggrin: One or two had a BMI of over 30, in my humble opinion.

http://usmilitary.about.com/od/theorderlyroom/a/bodyfat.htm

Contrary to popular belief, there is no maximum "weight" to join or stay in the military. "Weight" is not the standard. Body-Fat percentage is.

However, it takes more time to measure body-fat than it does to weigh a member. Therefore, each of the services have weight charts that they use to "screen" members. If a military member weighs more than the allowed weight on the chart, they are measured for body-fat percentage.

Body-fat standards are used to determine initial qualification for enlistment/accession and also to determine whether or not a member continues to meet required standards after joining. Military members are periodically weighed (and measured, if necessary) throughout their career. Those found to be over their body-fat limits are entered into a mandatory weight loss program. Those who fail to maintain required body-fat standards are subject to administrative sanctions which can include reprimands, denial of promotions, administrative demotion in rank, and even administrative discharge. (Exception: The Air Force no longer uses weight/body fat measurements, except for initial entry. Instead, a "Body Composition" measurement is an integrated componant of the Air Force Physical Fitness Test).

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Jason, I'm just saying that the people who did that study seemed to be able to find 25,389 men for it. Presumably half of them fell into the fit-but-over-30 category. I'll have to look up the primary source to be sure, but -- and I hate to go down the rabbit hole of anecdotal evidence -- I know lots of big guys who are quite fit. Not me, of course.

Steven A. Shaw aka "Fat Guy"
Co-founder, Society for Culinary Arts & Letters, sshaw@egstaff.org
Proud signatory to the eG Ethics code
Director, New Media Studies, International Culinary Center (take my food-blogging course)

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This goes back to what I said before about BMI: It's useful on an epidemiological basis, because averaged over large populations BMI does tend to correspond to a certain lifestyle, etc. But individuals tend to be individual, and may have mitigating factors.

But there are individual differences. For example, a Lancet study showed that someone with a >30 BMI but who scores in the top 40 percentile on a stress test has better health statistics than someone with a <25 BMI who scores in the bottom 20 percentile on a stress test. However, it is also a fact that we're talking about small populations of people. On average, people with a <25 BMI have a better level of fitness than people with a >30 BMI, and if fitness levels are equal one would expect the <25 BMI population to have better statistics.

So, no BMI isn't the absolute last word. But it's hard to imagine anyone with a BMI of 40 who could be described as fit.

--

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I've certainly read several accounts of studies that indicated physical fitness in overweight or obese people reduces health risks. Not being in research science, I haven't spent much time reading the primary sources, either.

I have certainly found the information a source of encouragement when I've been maintaining an exercise routine, but before the weight came off, of course... in my current struggle, I've been pleased to get my endurance level up to be able to handle 15,000 meters of rowing a few times a week, and my weight training progress has been remarkable, as well. But I don't kid myself into thinking I'm actually hit the right fitness level until my waistline shows more of that progress.

It's also incredibly hard to get to certain levels of physical fitness while obese. I don't think many people at 300-400 lbs. who could walk at a moderate pace for two or more hours without a major struggle, whereas it's nearly essential when I'm out of the country traveling. And a 30 minute fitness test is one thing, as a baseline of health, but high intensity or high endurance physical activity is another.

Even with a little excess weight, as soon as I cross a certain boundary of exercise intensity and frequency, I start losing fat, and that's true of most obese people who exercise regularly and eat sensibly for their size.

Unfortunately for the average software worker (my day job), it takes a pretty serious commitment to exercise to stay "fit"... anything short of 4 days of exercise a week, and I tend to start gaining weight, and generally not the right kind. Combined with a love of food and the rather limited ability to recognize external cues that I, like most Americans, have, sedentary behavior virtually guarantees that I won't be fit or thin.

This article was interesting:

http://www.msnbc.msn.com/id/23449358/

It's pop health journalism, of course, but it does make a few good points: Learning to stop eating when a particular food stops being as exciting as it was six or seven bites ago, rather than eating it because it's still on the table, is another tool I've found useful to reduce unnecessary consumption. Eating more slowly, as I tend to do when I'm traveling, also makes it easier to recognize satiation signals, though last night I managed to consume an insane amount of food without triggering them.

Jason Truesdell

Blog: Pursuing My Passions

Take me to your ryokan, please

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I don't think many people at 300-400 lbs. who could walk at a moderate pace for two or more hours without a major struggle

I don't know. I'm not quite up at 300 pounds but in the 250-270 range where I've been most of my adult life I've never had trouble walking two, three or four hours around New York City, Paris or wherever. I can walk to dinner at Nobu no problem and often have -- that's about a 7-mile walk from where I live. And I don't consider myself particularly fit. (I can't power-walk home on a full stomach without feeling pretty awful, though.) And like I said, I know lots of guys in my size range who engage in a variety of strenuous physical activities from hiking to swimming to whatever.

Steven A. Shaw aka "Fat Guy"
Co-founder, Society for Culinary Arts & Letters, sshaw@egstaff.org
Proud signatory to the eG Ethics code
Director, New Media Studies, International Culinary Center (take my food-blogging course)

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I'll suggest that arbitrary threshold levels, wherever they're set, may be a less useful tool than patterns, & a good doctor-patient relationship will focus on the latter & perhaps avert a crisis diagnosis.  That of course requires regular visits to the doc.

It sounds like you have a relationship with your doctor that works. However, there are plenty of people who in your situation would have been given a course of medication to lower their blood sugar. That's when the "epidemic of diagnoses" gets scary.

I couldn't agree more. Too many docs will just write an Rx & see the next patient. And this is not the forum discussing the reasons for that so I'll say no more.

Thank God for tea! What would the world do without tea? How did it exist? I am glad I was not born before tea!

- Sydney Smith, English clergyman & essayist, 1771-1845

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I'll suggest that arbitrary threshold levels, wherever they're set, may be a less useful tool than patterns, & a good doctor-patient relationship will focus on the latter & perhaps avert a crisis diagnosis.  That of course requires regular visits to the doc.

It sounds like you have a relationship with your doctor that works. However, there are plenty of people who in your situation would have been given a course of medication to lower their blood sugar. That's when the "epidemic of diagnoses" gets scary.

You know, I'm sorry, but personal responsibility could also include doctor shopping to find the one you can communicate with. It DOES happen.

Basil endive parmesan shrimp live

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Roquefort meat squirt blue beef red alert

Pork hocs side flank cantaloupe sheep shanks

Provolone flatbread goat's head soup

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And a vichyssoise and a cabbage and a crawfish claws.

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I'll suggest that arbitrary threshold levels, wherever they're set, may be a less useful tool than patterns, & a good doctor-patient relationship will focus on the latter & perhaps avert a crisis diagnosis.  That of course requires regular visits to the doc.

It sounds like you have a relationship with your doctor that works. However, there are plenty of people who in your situation would have been given a course of medication to lower their blood sugar. That's when the "epidemic of diagnoses" gets scary.

I've been of this thread for a little bit and am jumping back in here.

If this is the case that meds are prescribed as a first line approach for borderline to mild diabetics, this is simply bad medicine. Bad medicine, unfortunately happens, but this is not the norm. People who are borderline diabetic should never be treated with meds off the bat or even at all, unless they rise above borderline and the basic standards of diet and exercise are not working. One element that this discussion has erroneously been focusing on in relation to diabetes is the assumption that a static blood glucose is significant. It isn't. What is of much greater significance is blood glucose over time as measured by the hemoglobin A1C test.

As someone who tries to keep my blood glucose reasonable but is not obsessive about it, I actually was relieved by the American study you cited, Steven, that showed no benefit to tight control and possibly even harm so much so that the study was stopped. Interestingly though, those results were contradicted by an even larger on-going European study, so who's really to know at this time? Despite that and assuming that the American study is correct, that does not mean that diabetes is not a significant nor a growing health issue. What it says is that trying to keep blood sugar very tightly normalized in diabetics may be more risk than it is worth for any number of reasons that are as yet unknown. So I continue trying to maintain reasonable blood glucose levels, but don't worry about every little thing I eat. I think sometimes, the stress of worrying about things is worse than the items worried about in the first place.

People who are diagnosed as mild or borderline diabetics should not freak out about it. The value of an early diagnosis is that perhaps those people can do something positive to prevent a full-blown course before it is too late. That should not mean medications unless the disease has worsened and conservative measures haven't helped.

John Sconzo, M.D. aka "docsconz"

"Remember that a very good sardine is always preferable to a not that good lobster."

- Ferran Adria on eGullet 12/16/2004.

Docsconz - Musings on Food and Life

Slow Food Saratoga Region - Co-Founder

Twitter - @docsconz

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  • 3 weeks later...

Just read the article today in Hebrew, in Haaretz Weekend edition (translated and crediting NYT).

It came in while I'm in the midst of changing habits and creating a new controlled calorie exchange. So far bloging mostly in Hebrew, but maybe its time to work on the International side of Foodha's Gourmet Diet:

Foodha (aka) Boaziko

"Eat every meal as if it's your first and last on earth" (Conrad Rosenblatt 1935)

http://foodha.blogli.co.il/

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