F.E.A.S.T's Around The Dinner Table forum

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neverloseheart
There was a new study in the journal JAMA today that showed the people who are overweight (BMI 25-30) live longer, though those who are obese do not.  Here is a short quote:

Relative to normal weight, obesity (all grades) and grades 2 and 3 obesity were both associated with significantly higher all-cause mortality. Grade 1 obesity was not associated with higher mortality, suggesting that the excess mortality in obesity may predominantly be due to elevated mortality at higher BMI levels. Overweight was associated with significantly lower all-cause mortality

This very good study shows that thinness does not help people live longer.  This is not the first study of it's kind either so evidence is accumulating on the relationship between higher weights and good physical health.

Many treatment providers (and new parents) may think that it is fine for our kids to aim for the lower BMIs with a misguided idea that being just above the BMI of 18.5 is healthy.  Most of us have observed the relationship between a higher weight and mental health and realized that the weights need to be much higher than BMI of 18.5 in an adult.  Now we can add reassurance that not only are higher weights better for mental health, they may be better for physical health as well.  

I will say this is good news for me too as I did put on a few pounds during 
refeeding myself!
Neverloseheart
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Foodsupport_AUS
I took heart from this too. There was also mention in a brief excerpt from the article saying that probably 18.5 is too low for good health and may increase mortality. Would like to see the details of this. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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sinkorswim_usa
I have issues with bmi. I think of it as a BMI of 18.5 is not truly the criteria for normal to underweight. 18.5 is where it slips from underweight to critically underweight.The dsm suggests for anorexia a 85% of ideal body weight =18.5. My experience is that normal really starts around a BMI of 22. And for my the Ed thoughts don't start diminishing until I hit BMI of 24 to 26. Anywhere outside that and it's a wreck in the works. I really feel the whole system is quite flawed anyway as it doesn't account for frame and muscle composition. Clear as mud isn't it?!
Sink or Swim
Pacific Northwest USA
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Anorexic Mom and 5 year old Anorexic daughter
Fighting ED together!
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RAWR12

I, like sinkorswim, have issues with the BMI system. However, I am not in full agreement with the whole idea of '18.5' slipping from underweight to critically underweight.

Everyone is built differently - some people have smaller frames and naturally may be a low BMI but still healthy.

I know my younger sister is one of them - although her healthy BMI is probably 19-20 rather than as low as 18.5.
My mother is also similar... but I also think it's due to the fact she is a fussy eater and does not really like meat. 
One of my daughter's friends from a young age has always been quite thin - but eats like a horse! Although she's put on some weight since hitting puberty and is still growing, I'm pretty sure that she'll have quite a naturally low BMI too.

Then again, apparently, Asians have lower BMI standards (we're all Chinese):
http://aadi.joslin.org/content/bmi-calculator
http://www.who.int/nutrition/publications/bmi_asia_strategies.pdf

And also, some people have larger frames so may look ill at BMI of 22 - take my daughter's Russian friend for example (who was also diagnosed with AN). The target weight set by the treatment centre was just 53-54kg, leaving her at a BMI around 19-20. However, she looks a whole lot healthier now although she is 70kg and clinically classed as 'overweight'.

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mec
Do you have the link to this study? Would love to have it.
21 year old daughter who was DX with RAN at 9 years old. The work of recovery is ongoing. 
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AnnieK_USA
Some pertinent links, to the study itself, and some articles/opinion pieces about it:

http://jama.jamanetwork.com/article.aspx?articleid=1555137

Our Absurd Fear of Fat

 Study Suggests Lower Mortality Risk for People Deemed to Be Overweight

Best to be overweight, but not obese? Higher levels of obesity associated with increased risk of death
Daughter age 28, restrictive anorexia (RAN) age 11-18, then alternating RAN with binge eating disorder and bulimia with laxatives, is in remission from EDs for 3 years after finally finding effective individual therapy. Treatment continues for comorbid disorders of anxiety, ADD and depression. "Perseverance, secret of all triumphs." Victor Hugo
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WeNWinning
Thanks so much for sending these links Annie K.

I am going to send them to the Professor who put 2/3 of my D's med school class on diets and pushed the anti-obesity campaign.  She's heard this same message in many of her classes, about those who are overweight are at higher risk for many medical conditions.

I'm glad this study is out and I hope that they not continue with this very destructive message about the importance of having low BMI's to her med school class.
WenWinning (formerly wenlow) - a Mom who has learned patience, determination, empathy, and inner strength to help her young adult daughter gain full remission after over a decade of illness and clinician set inaccurate weights
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IrishUp
I'm reposting the Op-Ed in today's NYT by Paul Campos, who I love like a lovey loved thing with lovely bits hanging off on the topic of public health and obesity. Warning, if you do click over to the NYT webpage, reading the comments is likely to blow through an entire week's allotment of Sanity Watchers points! 

Our Absurd Fear of Fat

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ACCORDING to the United States government, nearly 7 out of 10 American adults weigh too much. (In 2010, the Centers for Disease Control and Prevention categorized 74 percent of men and 65 percent of women as either overweight or obese.)

Sam Island

 

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For Op-Ed, follow@nytopinion and to hear from the editorial page editor, Andrew Rosenthal, follow@andyrNYT.

Readers’ Comments

But a new meta-analysis of the relationship between weight and mortality risk, involving nearly three million subjects from more than a dozen countries, illustrates just how exaggerated and unscientific that claim is.

The meta-analysis, published this week in The Journal of the American Medical Association, reviewed data from nearly a hundred large epidemiological studies to determine the correlation between body mass and mortality risk. The results ought to stun anyone who assumes the definition of “normal” or “healthy” weight used by our public health authorities is actually supported by the medical literature.

The study, by Katherine M. Flegal and her associates at the C.D.C. and the National Institutes of Health, found that all adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals. If the government were to redefine normal weight as one that doesn’t increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.

To put some flesh on these statistical bones, the study found a 6 percent decrease in mortality risk among people classified as overweight and a 5 percent decrease in people classified as Grade 1 obese, the lowest level (most of the obese fall in this category). This means that average-height women — 5 feet 4 inches — who weigh between 108 and 145 pounds have a higher mortality risk than average-height women who weigh between 146 and 203 pounds. For average-height men — 5 feet 10 inches — those who weigh between 129 and 174 pounds have a higher mortality risk than those who weigh between 175 and 243 pounds.

Now, if we were to employ the logic of our public health authorities, who treat any correlation between weight and increased mortality risk as a good reason to encourage people to try to modify their weight, we ought to be telling the 75 million American adults currently occupying the government’s “healthy weight” category to put on some pounds, so they can move into the lower risk, higher-weight categories.

In reality, of course, it would be nonsensical to tell so-called normal-weight people to try to become heavier to lower their mortality risk. Such advice would ignore the fact that tiny variations in relative risk in observational studies provide no scientific basis for concluding either that those variations are causally related to the variable in question or that this risk would change if the variable were altered.

This is because observational studies merely record statistical correlations: we don’t know to what extent, if any, the slight decrease in mortality risk observed among people defined as overweight or moderately obese is caused by higher weight or by other factors. Similarly, we don’t know whether the small increase in mortality risk observed among very obese people is caused by their weight or by any number of other factors, including lower socioeconomic status, dieting and the weight cycling that accompanies it, social discrimination and stigma, or stress.

In other words, there is no reason to believe that the trivial variations in mortality risk observed across an enormous weight range actually have anything to do with weight or that intentional weight gain or loss would affect that risk in a predictable way.

How did we get into this absurd situation? That is a long and complex story. Over the past century, Americans have become increasingly obsessed with the supposed desirability of thinness, as thinness has become both a marker for upper-class status and a reflection of beauty ideals that bring a kind of privilege.

In addition, baselessly categorizing at least 130 million Americans — and hundreds of millions in the rest of the world — as people in need of “treatment” for their “condition” serves the economic interests of, among others, the multibillion-dollar weight-loss industry and large pharmaceutical companies, which have invested a great deal of money in winning the good will of those who will determine the regulatory fate of the next generation of diet drugs.

Anyone familiar with history will not be surprised to learn that “facts” have been enlisted before to confirm the legitimacy of a cultural obsession and to advance the economic interests of those who profit from that obsession.

Don’t expect those who have made their careers on fomenting panic to understand that our current definition of “normal weight” makes absolutely no sense.

<nyt_author_id>

Paul Campos is a professor of law at the University of Colorado, Boulder, and the author of “The Obesity Myth: Why America’s Obsession With Weight Is Hazardous to Your Health.”

IrishUp
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gobsmacked_US
I just spit out my coffee with "sanity watchers points." You made my day there Irish!
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Stubbornmum
Irshup, yes he is lovely!

Since you bought up the subject, I am going to slip in my little anecdote from another lovely man.

Watching the cricket as one does here in Australia in the hot weather, and a segment was aired on the batting fitness training required to keep those young men running fast between wickets...( stay with me all you American folks...it's like running between bases in baseball)

The vacuous and empty headed reporter at the end of the segment turned to a respected senior cricketer and said, " would the fact that some batsmen are overweight be holding back their careers"

This wonderful man paused and replied, " NO, there is a weight at which you are your strongest, when I was a professional player, I was overseas in India, the heat caused me to loose weight and I was WEAK."

" there is a weight at which you are your strongest, and that's what you should be"

That man is now my second favourite ever.


Courage is being afraid, but going on anyhow ( Dan Rather)
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JangledUSA
Don't worry. A contradictory study will be released in a few weeks.
A dad.
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neverloseheart
Another nice quote from the study or from the commentary (sorry not sure which one!)

"Also, the NHLBI's classification of normal weight as a BMI 18.5 to 25 kg/m2 obscures the fact that people with a BMI between 18.5 and 22 kg/m2 have been found to have higher mortality than those with a higher BMI of 22-25 kg/m2. Lumping them together raises the mortality rate for the normal-weight group, which could explain why their observed mortality is similar to those with grade 1 obesity."

I have seen other studies from all over the world with the same data.  Would be nice if the public health authorities could review the actual data from all these studies and realize that there is a consensus among many studies on this topic and admit they are a bit off base.  
Neverloseheart
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Foodsupport_AUS
Stubbornmum that is just so true. Too thin don't have enough grunt to do what we need, fall down etc.. Too big can't quite move fast enough. Just right though, we are at our peak. Wasn't it mama bear who was just right?

NLH I was thinking that this does confound the study too. Although reading the study when those that looked at BMI 20-25 there was only a modest difference. No one looked at 22 -25. You must be a scientist to be putting all those units in, too hard for me I am afraid. 

It is a pretty large meta analysis, so it will be interesting to see what comes next.
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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