Newly Published Study Debunking the Idea of HAES

Gallowmere1984

https://academic.oup.com/eurheartj/article-abstract/doi/10.1093/eurheartj/ehx448/4081012/Separate-and-combined-associations-of-obesity-and

It's becoming more and more clear all of the time, that there's no such thing as "health at every size", but of course, this will not deter the most hardcore zealots.

That said, I'm not the greatest at reading population based information, so does anyone here find flaws in this particular study's methods?

GottaBurnEmAll

I take it this is the study I heard about on the news this morning while I was foam rolling? The one that supposedly debunks the myth of fit but fat or "perfect bloodwork"?

I too await hearing from people who know how to dig into the data better than I do.

mandrewes

There is a good analysis of this on the NHS choices website at http://www.nhs.uk/news/2017/08August/Pages/Fat-but-fit-people-may-still-be-at-risk-of-heart-disease.aspx which is often a good place to look for a sober analysis of medical stories in the (British) media

As if says the message is really the other way around - being not fat but metabolically unhealthy is a considerable risk.

Being fat but metabolically healthy is a slightly raised risk

Looking at the abstract it is considerably better to be "healthy and obese" than "unhealthy and normal weight". Secondly the analysis effectively discounted diet and physical activity (as well as things like smoking) so those with a good diet, physically active, good metabolic markers but obese MAY be better off than who are normal weight but have a bad diet, bad metabolic markers , inactive and with a poor diet.

Perhaps intriquingly those in the obese but healthy category were only very very slightly worse than the overweight but healthy.

Of course bad metabolic markers tend to be highly related to weight so there may be somewhat few who are obese or at the higher end of overweight with good metabolic markers. Reducing weight is highly highly likely to improve them.

This only looked at cardiovascular disease. Not death from all causes. This tends to show U shape with often those in the (middle of the) overweight category dying least. From memory a recent study from Copenhagen showed those with BMI of 27 died the least - up from 23 in previous years. Despite this I think it is best to aim for a BMI in the normal weight category.

But the message seems to be
1. Get thinner - this should improve your metabolic health.
2. Improve your metabolic health.
3. If you can't lose weight at least improve your metabolic health.

lemurcat12

That's consistent with the link in the OP:

* we defined obesity and overweight using body mass index (BMI)
* metabolic dysfunction (‘unhealthy’) was defined as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference.

Compared with metabolically healthy normal weight people (reference), hazard ratios were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.

The first thing that strikes me is using BMI for obesity/overweight, as we know that many people who are technically a healthy BMI are technically overweight by body fat, so I'd be curious to know what percentage of those with healthy weight/not metabolically healthy fall into that category. With such a large study you need to use BMI, though.

I'd also like to know how the numbers change with physical activity.

My own thoughts are:

1. Get thinner - this should improve your metabolic health. Plus, the usual things that people do (controlling diet, eating less, exercise) tend to improve metabolic health.
2. At the same time, increase physical activity/exercise if you can, at least if you are not already active. From other studies I've seen, this also should help.
3. If there are other things you are aware of (diet, for example) that could improve the specific issues with your metabolic health, try them too. This will somewhat depend on the test results (the waist one suggests overweight/obesity at a normal BMI).
4. If you are normal weight but inactive, a huge help might be increasing activity.

lexmb1

Can't stand the word debunk. Everyone's using it now.. Urgh.

yskaldir

It's sad we have to spend the time and money to debunk HAES

MrsLannister

It actually seems to confirm it. Only slightly higher risk at higher worked with healthy markers, but significantly higher risk at low weight with unhealthy markers.

VeronicaA76

Well duh.

Basically it states that metabolic health is key to knowing overall health status. BMI is very inaccurate, particularly with athletes. Example: Dwayne Johnson (the Rock), his weight has put him into "obese" but metabolically he is healthy. It then states that simply because one does not have current health issues (diabetes, high blood pressure, etc) and normal blood work does not equate to metabolic health. Very high fat percentages in combination to relatively low muscle mass (the typical obese and extremely underweight persons), even without current health problems, are not metabolically healthy.

The synopsis: if someone is underweight with a low muscle mass (very common - only a handful of exceptions exist for underweight and good muscle mass), or overweight with a high body fat relative to muscle mass: they are NOT healthy.

VintageFeline

BMI isn't inaccurate, Dwayne is an exception, a huge (literally and figuratively) exception. It's even less likely for a female to be an outlier.

mmaegan973

lexmb1 wrote: »

Can't stand the word debunk. Everyone's using it now.. Urgh.

Right? How dare they? I blame the mythbusters for making it sound cool

Gallowmere1984

VintageFeline wrote: »

BMI isn't inaccurate, Dwayne is an exception, a huge (literally and figuratively) exception. It's even less likely for a female to be an outlier.

He also runs gear, which puts him even further outside of what would apply to most of the population.

When I start running blast cycles of 600-1000mg of Test-E per week, I'm sure that I'll become a pretty notable outlier as well.

stevencloser

VeronicaA76 wrote: »

Well duh.

Basically it states that metabolic health is key to knowing overall health status. BMI is very inaccurate, particularly with athletes. Example: Dwayne Johnson (the Rock), his weight has put him into "obese" but metabolically he is healthy. It then states that simply because one does not have current health issues (diabetes, high blood pressure, etc) and normal blood work does not equate to metabolic health. Very high fat percentages in combination to relatively low muscle mass (the typical obese and extremely underweight persons), even without current health problems, are not metabolically healthy.

The synopsis: if someone is underweight with a low muscle mass (very common - only a handful of exceptions exist for underweight and good muscle mass), or overweight with a high body fat relative to muscle mass: they are NOT healthy.

Most athletes go barely into overweight if even.
Michael Phelps, Usain Bolt, Ronaldo, Messi, Mayweather, McGregor, Chris Froome, Klitschko (both of them), Kobe, LeBron, all are worldclass athletes, all normal BMI or barely into overweight. Even Yao Ming at 141 kg is only overweight because he's huge.
The only actually obese athletes I could even think of and find were Mike Tyson and Shaq and who knows if the weights google told me were their weights when they were active or now that they're retired. And probably American Footballers.

Actually I just found that Shaq was a 22 BMI when he debuted so there's that.

dutchandkiwi

A the athletes BMI statement back again - Yes there are some Most often mentioend are the top Rugby players. (See the All Blacks often mentioned in NZ for that)
Sure they are outliers for BMI, but also outliers for endurance, training intensity, support teams and mental health. Thre are not many general guidelines that apply to these people That does not mean that the guidelines are inaccurate. It means that thee people are special athletes that do not follow the general population guidelines. Otherwise all the general guidelines would result in a world population of All Blacks and they don't

Angel49kitty

Gallowmere1984 wrote: »

https://academic.oup.com/eurheartj/article-abstract/doi/10.1093/eurheartj/ehx448/4081012/Separate-and-combined-associations-of-obesity-and

It's becoming more and more clear all of the time, that there's no such thing as "health at every size", but of course, this will not deter the most hardcore zealots.

That said, I'm not the greatest at reading population based information, so does anyone here find flaws in this particular study's methods?

The summary of the study results is that, regardless of body mass index (a calculation to estimate someone's body fat), people who were metabolically unhealthy (metabolism being the chemical processes in your body that maintain your life) were much more likely to have heart disease, but those who were overweight were much more susceptible as their bodies are working too hard to maintain them. ie Even if you have a strong metabolism, those who are overweight are still more likely to get heart disease -- but the most important factor is your metabolism.
The concept of 'fit but fat' is basically BS.

crackpotbaby

In my job I get to see the coronary arteries of lots of different people.

Many overweight people have minor to critical disease.

Many 'healthy' looking people have minor to critical disease.

Obesity is just one cardiac risk factor, albeit a modifiable one along with smoking, cholesterol, oxidative stress etc.

Non modifiable factors such as age, gender, genetics play a big part too.

............

One thing I do find interesting from the imaging I see is that many people with no known history of high blood pressure who are sure their blood pressure is 'fine' have curly twisty coronary arteries typical of chronic hypertension.

crackpotbaby

To add, a finding that challenges a hypothesis is hardly 'debunking'.

lemurcat12

Angel49kitty wrote: »

Gallowmere1984 wrote: »

https://academic.oup.com/eurheartj/article-abstract/doi/10.1093/eurheartj/ehx448/4081012/Separate-and-combined-associations-of-obesity-and

It's becoming more and more clear all of the time, that there's no such thing as "health at every size", but of course, this will not deter the most hardcore zealots.

That said, I'm not the greatest at reading population based information, so does anyone here find flaws in this particular study's methods?

The summary of the study results is that, regardless of body mass index (a calculation to estimate someone's body fat), people who were metabolically unhealthy (metabolism being the chemical processes in your body that maintain your life) were much more likely to have heart disease, but those who were overweight were much more susceptible as their bodies are working too hard to maintain them. ie Even if you have a strong metabolism, those who are overweight are still more likely to get heart disease -- but the most important factor is your metabolism.
The concept of 'fit but fat' is basically BS.

Metabolically unhealthy does not mean weak metabolism.

It means varies indicators (such as IR, high cholesterol, high blood pressure, fat around the middle) that are identified in the article.

Being fat without these indicators is slightly more risky than not being fat without them.

Having the indicators and not being fat is quite a bit more risky than not being fat without them.

So to the extent that lifestyle affects your propensity to get metabolic syndrome (which it probably does) you ARE far better off to be fit (i.e., exercise, eat a better diet) while still fat than not to, but of course it's better to also lose weight and doing those things tends to result in weight loss anyway if you also pay attention to how much you eat.

CipherZero

Overfatness increases risk of a host of diseases unnecessarily. Wonderful science, but you can't educate out stupid, only ignorance.