Abdominal fat predicts heart disease risk better than BMI
acc.orgAny idiot with a bathroom scale and a measuring tape can do it. And by adulthood, height doesn't change significantly and you probably know it, so you may not even need that measuring tape. Other metrics need specialized equipment, error prone or complex procedures, etc... I don't even know how to make a waist measurement. Where exactly? How relaxed should the subject be? How long after eating?...
That's the value of BMI: simple repeatable. Not the best but enough to get and idea and make statistics.
But height does change in adulthood [0]. On average people living past 40 gradually lose height. At age 80, it's likely height loss will be >=2 inches. This loss is reflected in higher BMI even when body fat content hasn't changed. Average BMI increase isn't large, but think about a person losing 4 or 5 inches of height while maintaining body fat unchanged.
Self-reported height is generally greater than measured height. Adding 1/2 to 1 inch is common (per experience measuring height). "Height inflation" has modest effect on BMI but problematic in research and workup for medical procedures. In the latter cases, measuring height is necessary.
[0] https://www.uhhospitals.org/blog/articles/2024/10/why-do-peo...
I like to think of this as four quadrants around two axes. Low fat/low muscle is simply skinny. High fat/high muscle is the "big guy/gal" look that I associate with laborers. Low fat/high muscle is an athletic look; unhealthy in extremes (bodybuilding) but generally desirable. High fat/low muscle is skinny fat, which I associate with sedentary knowledge workers.
[0] And that, at least somewhat, tracks visual perceptions. Nobody looks at me with a shirt on and believes I need to lose weight, because 10-15lb isn't _that_ much extra on a tall frame. If I were 40-50lb overfat then that would be painfully obvious regardless.
My actual methodology is pretty crude though -- when I was 15lbs lighter I had borderline visible abs and other visual indicators of being around the 15-20% body fat mark, and aside from gaining weight I don't have any reason to believe I've had any notable muscular atrophy since then, so I'm estimating the actual excess fat in that ballpark. It's be easy for numbers to be off 10lb or more, but even then it'd still indicate the overfat surplus being much less than the overweight surplus.
A better methodology uses calipers and various skin measurements to estimate true body fat percentage.
"Overweight" can mean the same thing for weight, but it also refers to those with a BMI specifically between 25 and 30, and those with BMIs greater than 30 are classified as "obese".
Many active gym people have pretty high BMIs but fairly low fat (because muscle is dense), and unsurprisingly have better outcomes than the average person (if you ignore the share that uses/overuses anabolic steroids and co)
E.g. 20% bodyfat at 250lbs is still a lot of fat.
Of course it's difficult to ever get very high on absolute fat if at 15% or below.
Additional muscle is positive for health, but only up to some reasonable threshold. There is no health benefit to having very high levels of muscle, and in fact it may be negative for your health at extreme levels. E.g. many bodybuilders have trouble breathing, sleep apnea etc.
Both people in the example have 60lbs of fat. 1lb of muscle doesn't cancel out the negative health effect of 1lb of fat
1. https://www.cdc.gov/nchs/data/series/sr_03/sr03-046-508.pdf
As for 2, men in the US are getting shorter because of immigration which adds many confounders.
But also short people living longer has so many more possible explanations than less overall fat.
https://medlineplus.gov/ency/article/003998.htm
"People typically lose almost one-half inch (about 1 centimeter) every 10 years after age 40. Height loss is even more rapid after age 70. You may lose a total of 1 to 3 inches (2.5 to 7.5 centimeters) in height as you age."
So people DO in fact tend to lose about 2 inches at age 80 versus their younger selves.
1. https://pubmed.ncbi.nlm.nih.gov/10547143/
2. https://www.mdpi.com/2072-6643/15/21/4694 (referencing the FHS there, the numbers are hard to find on the study's website).
It’s not the fat that kills. It’s oxidated lipids that kill.
https://www.sciencedirect.com/science/article/abs/pii/S24518...
From what I have heard from doctors, there is a clear sequence:
intra-organ fat (really bad) > visceral fat (quite bad) > subcutaneous fat (relatively harmless).
The nasty detail is that some people gain relatively more visceral fat than others. These three fats are correlated, but the correlation isn't the same in every human. Some have better metabolism and don't store as much fat inside as others do.
I’ve been in the overweight BMI category with low body fat by being active at the gym and focusing on diet. It takes some work to get there.
If I check the calculators for the obese BMI range, there was no way I could get there without either gaining a lot of fat on top of the muscle. The amount of muscle required to have an obese BMI with healthy amount of fat is absurd.
I think this is greatly exhaggerated.
Yeah you can put on as much muscle as Arnold and have a FFMI of about 27 then maybe have a BMI of 34 if you have 20% body fat.
But a very gifted natty might cap out at maybe 24 with a BMI of 30 at 20% bodyfat. But let's be realistic. This is not "many active gym people". This is the guy winning the local strongman meet.
Yes a couple of years training for most people can add a couple of points to BMI but I think people exaggerate how much this is. Go look at a 20lb brisket at costco - you don't see people with that much extra muscle all that often.
At 6 feet / 183 cm that it takes 184 lbs / 83 kg to be overweight. From what I could find, for regular gymgoers the typical weight for people around 6feet is 180-190lbs, which put many people around the overweight threshold. I am myself at 24.9, and while not skinny I am definitely in the skinnier half of the people at my local gym.
Yeah really well muscled guy being BMI 27 is probably ok but by 30 it's not natural muscles that are making the scales go up.
And obviously genetics matter, but it look at master level soccer players: athttps://pmc.ncbi.nlm.nih.gov/articles/PMC6239137/
The people most obsessed with "BMI isn't accurate" are overweight people making excuses for themselves.
I often wonder far from the median I am in this regard. I was under the impression that it was pretty accurate for assessing populations, but fell apart very quickly at the individual level. How many "normal"/otherwise healthy people do fall outside BMI's numbers?
BMI is easily misunderstood by people who know just enough to see that it’s imperfect, but not enough to understand why it’s still a valuable screening tool.
I’ve been in the “overweight” BMI range with low body fat before. It’s not too hard to get there if you’re lifting weights and paying attention to your diet consistently for years, but it takes a lot of work to get there. It doesn’t happen accidentally except for people who win some genetic lottery to build a lot of muscle and keep body fat low without trying.
Getting all the way to the obese BMI range while having healthy body fat is only happening for people with an extreme dedication to body building and diet (and let’s be honest, a lot of the people in this category are manipulating hormones too).
Yet whenever BMI comes up some people try to dismiss it as too flawed based on these possible edge cases. The edge cases for BMI exist, but that doesn’t mean it’s not useful. It’s a good general purpose screening tool with numbers that are available. If someone has more precise measurements available, those should be used instead. BMI is a really good first pass screener to determine if a closer look should happen.
People tend to think in absolutes. Even perfectly rational people fall logically foul to not considering outliers.
I am only 6' and only an intermediate lifter. I'm overweight, but BMI makes me look obese. It really only takes a normal person a year or so to get to three plates on squat with no supplements other than chicken broccoli and rice if they don't skip workouts. Assuming no injuries. That level of strength easily distorts bmi wildly if you are even a little taller than average.
And sumo wrestlers.
The line seems to be drawn at (effortful) activity level more than anything else. And BMI doesn't say anything about that.
I think the vexation comes from the focus on an attribute that is not directly mutable, per one's agency, because that's easier to sell things related to. Versus action that you have a lot more direct control over (social or physical circumstances notwithstanding).
(from https://en.wikipedia.org/w/index.php?title=Sumo&oldid=136533...), so I'm not sure this is a counterexample.
Anything to pretend they aren't too heavy.
In other words, for my height, I have a very long torso and very short legs. I think it should be relatively obvious that an inch of leg weighs significantly less than an inch of torso, so at a given level of body fat percentage, I'm going to weigh quite a bit more than someone my same height with more typical proportions, and thus my BMI reads me as more overweight than it otherwise would.
My point is not that BMI is bad or useless or anything else. My point is that it was designed as a population statistic and that it can be fraught when one tries to apply it to any individual with no nuance. A high BMI should cause one to consider and examine your health and weight. But it should not over-ride specific details about your physiology that point in the other direction.
It still functions well as a measure of load on your circulatory system, joints, you name it.
Your body is working harder than a typical 6'2" person, even if you have a great waist-to-hip ratio.
(But you'd still be better off with a smaller WTH ratio!)
Did you do that as a natural lifter? It’s hard for me to imagine most guys being able to get into the “overweight” range at < 15% body fat without some assistance.
It's specifically a high level of visceral body fat.
Genetics determines which parts of the body gain fat first as you gain fat overall, and some people have the unfortunate genetics to gain it first viscerally and some people have the fortune to gain it there last (and everything in between).
This means that you can have different people with the same body fat percentage but drastically different disease risks.
But yes this was also known already.
That's why it's been recommended to take a waist measurement alongside BMI to get a much more informative screening tool. Waist-to-height ratios are another alternative.
BMI has known biases in gender, age, and race. It misclassified Asians, women, elderly w sarcopenia, and people with high body fat to lean tissue ratio.
How does one determine if one has an excess of visceral fat?
You want to make sure you measure under similar conditions, like in the morning after relieving yourself (for example).
If it's too high, losing a ~0.5-1 lbs per week while strength and endurance training with progressive overload will get it down sustainably.
https://www.barbellmedicine.com/blog/visceral-fat-waist-vs-w...
https://health.ucdavis.edu/sports-medicine/resources/dxa-inf...
BMI was never meant to be used as a diagnostic measure. BMI is just a rough filter for large data sets, and entirely dependent on the average height and habits of that population.
Anyone taller than about 6'3" could tell you the recommended weight according to their BMI has always been absurdly low. If it's a printed chart on the wall, they might not even be on it.
Using your 6 3" male as an example, they are significantly more likely to be clinically obese (using waist circumference, body fat % etc) at a weight lower than BMI cut-off of 240 lbs.
It's really good at catching people who are obese who are overweight.
The "ideal weight" of a person is proportional to height to an exponent somewhere between 2 and 3. Simple physics would say 3 but because tall people are not just scaled up copies of small people, it is closer to 2 in practice, maybe around 2.3, but we say 2 because it is easier to calculate.
The downside is that BMI overestimates the "ideal weight" for short people and underestimate it for tall people. But BMI is not great at capturing exceptions anyways, so there is little interest in "fixing" this.
Somehow American Heart Association and its European counterpart are in denial, and still pushing dinasour screening mechanism with very low accuracy for heart disease risk prediction.
The standard risk model for CVD based on PREVENT (US) and SCORE-2 (Europe) like parameters are very poor as reported in the recently published paper on the their accuracy performance by the Swedish team [1]. As all CVD risk stratification with cardiologist review (expert-in-the-loop), the most important accuracy metric is sensivity/recall (avoiding false negative that will escape review) of PREVENT and SCORE-2, 26% and 48%, respectively.
The paper alternative proposal increased the sensitivity to 58% by performing clustering instead of conventional regression models as practiced in the PREVENT and SCORE-2.
These type of models including the latest proposal performed very poorly as indicated by their otherwise excellent and intuitive display of graphical abstract results [1].
[1] Risk stratification for cardiovascular disease: a comparative analysis of cluster analysis and traditional prediction models:
https://academic.oup.com/eurjpc/advance-article/doi/10.1093/...
(Edit: This is intended to be sarcastic. I agree 100% with the comment)
(Edit 2: Added the smiley face)
A lot, probably. You could sell people on the idea that it should be a part of your yearly health screening.
"And if you really care about your health you should do them every 3 months to catch problems early!"
or some such.
An ECG if it was just part of the normal yearly panel of things that get looked at I don't think ppl will stop doing it just because it doesn't find something right away
I do not consider the average HN commenter to be average.
You could say that it’s almost as if their model has a home-field advantage. Because of that fact alone, you can’t really conclude anything about the comparative performance of their models versus the existing ones from this paper.
Getting an ECG, EKG, TTE, CAC, carotid duplex US, lipid panel, CMP, TSH, 25-OH Vit D, B12 + folate were what my cardio recommended before appointment #2 on hypertension. Both of us are data guys.
Those are the same thing, did you mean to type something else?
https://www.mayoclinic.org/tests-procedures/heart-scan/about...
https://www.mayoclinic.org/tests-procedures/ct-coronary-angi...
Emphasis on non-invasive diagnostic screening as invasive testing like angiogram need to be operated by specialist and can take months to be arranged, and only done after incidents e.g heart attack.
ECG is excellent for generic top level CVD anomaly conditions for examples arrhythmia and ischemia.
My dad’s doctor said he should get one, Medicare denied it, but he paid out of pocket to get one anyway. He found out he was 95% blocked pretty much everywhere and had a quadruple bypass. It likely added many years to his life and avoided a heart attack.
If you’re under a certain age (I want to say somewhere in your 50s), there isn’t any guidance for what normal is. If you’re in your 20s or 30s, I wouldn’t run out and get one. But if you’re in your 40s with a family history, or up into your 50s and beyond, it’s worth thinking about. I’ve also heard you’re only supposed to get them every 2-3 years, it’s not a yearly thing, due to the radiation.
(I am not a doctor)
The time to take action is long before you have a CAC score. e.g. Start tracking ApoB regularly, see if you have genetic LPa exposure, and avoid the foods that increase your exposure while ignoring the grifters telling you it's a nonissue.
GP was talking about screening though, not diagnosis. Coronary angiography are specialized, expensive and require intravenous constrast. Doctors aren't going to order them for everyone who shows up for a routine consult.
There are many related research work with excellent results, patent, etc by biomedical researchers around the world that I'd care to mention, including yours truly. Biomedical researchers even has yearly global competition organized so called CINC that used ECG as one of the main input for heart disease risk prediction since it's readily available [1].
In particular check out work by Prof. Friedman on ECG [2]. Somehow his excellent work is mostly being ignored by AHA and their counterparts because apparently these standard risk prediction models in US and Europe are not including it as part of their parameters.
[1] Computing in cardiology (CINC):
[2] The Electrocardiogram at 100 Years: History and Future:
https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.1...
(previously at https://news.ycombinator.com/item?id=45857053)
Cutting saturated fat to under 15g per day and increasing intake of viscose fibre (e.g. beans) will reduce your LDL particle count in a few weeks, which reduces your CVD hazard ratio. You can measure your LDL and look up the papers yourself. Statins will reduce it a lot too (potentially with side effects). Replace solid fats like butter with liquid fats like olive oil.
Literally any amount of regular exercise, including walking, will decrease CVD HR. The more the better (up until quite a large amount e.g. professional athlete). The more your heart is steadily pumping during exercise the better. Every bit helps reduce CVD risk. Movement is medicine.
For the love of God do not smoke. Literally one of the surest ways to die a horrible death. Stopping smoking reduces CVD risk by a large amount.
Do not give yourself diabetes by eating vast amounts of sugar. If you are doing this, stop. Not having diabetes decreases CVD risk.
Other factors you probably can't change so focus on these.
Doctors, if I got anything wrong please correct me.
This can help sustain a high level of exercise (the more the better). Certainly don't if you're sedentary, but the sugar during exercise is really helpful for getting in 10+ hours/week of exercise.
https://link.springer.com/article/10.1007/s13668-026-00740-w
> habitually drinking... sugar-sweetened-beverages
Yes, terrible idea, avoid!
(When I say sugar, I mean things like gummies, gels, and sugar-sweetened beverages. If sedentary people habitually eat these, it does increase their T2D risk.)
overall, it sounds like some of the concerns about sugar metabolism aren't necessarily buffered because you metabolize it faster or exercise more, but the evidence isn't really there to know anything much.
0. https://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)...
Not eating vast quantities of sugar is good advice, but it's not the direct cause of T2 diabetes. The best evidence suggests that T2 diabetes is caused by the accumulation of fat in the liver and pancreas. See the twin cycle hypothesis. To prevent diabetes, one needs to maintain a weight low enough where the body isn't storing fat in the liver and pancreas (everyone has their own individual threshold for this). If you're pre-diabetic, lose enough weight and most people will regain insulin sensitivity.
https://en.wikipedia.org/wiki/De_novo_synthesis#Fatty-acid_(...
https://link.springer.com/article/10.1007/s00018-018-2860-6
https://pmc.ncbi.nlm.nih.gov/articles/PMC6213738/
https://drive.google.com/file/d/13sQiOt1tVKDYe8h3bSOL_sazalL...
https://link.springer.com/article/10.1007/s13668-026-00740-w
If I'm reading that right, it sounds like obesity (and therefore BMI) is still a better predictor for all-cause mortality. Perhaps waist circumference is better at predicting cardiovascular risk but BMI is still useful.
It is what is called “skinny fat“.
It's just a particular type of abdominal fat so obviously the more abdominal fat that you can see it means you also have more of the type that can't see as well... It's not that complicated
They need to figure out a way to reliably Measure OXLDL.
"Resistant starch intake facilitates weight loss in humans by reshaping the gut microbiota"
https://pmc.ncbi.nlm.nih.gov/articles/PMC10963277/
Edit: Ah, HN submission 2 years ago: https://news.ycombinator.com/item?id=39592367
Baer, David J., et al. "Dietary fiber decreases the metabolizable energy content and nutrient digestibility of mixed diets fed to humans." The Journal of nutrition 127.4 (1997): 579-586.
this is a great study if you are an overweight/obese adult without overt metabolic disease, willing and able to consume 90 g/d of starch supplement within a controlled diet, and living in Shanghai with similar baseline fiber intakes endemic to that population. it is extremely not generalizeable to you or even me though I fit more of those characteristics than I care to admit
stay skeptical of small studies like this, friend
sample size is 37, number of authors 29
But there's already a general advise on this: eat more fiber.
https://med.stanford.edu/news/all-news/2017/08/hunter-gather...
We're a great ape, our body evolved to process a lot of fiber from fruits and starches. It's the modern fiber-deficient diet that's really weird.
90g/day of fiber is similar to the Hadza tribe diet, where they can consume 100-150g of fiber per day.
While they're not essential in short-term survival, they're essential for long-term health:
https://www.ncbi.nlm.nih.gov/books/NBK559033/
We have enough peer-reviewed studies on this.
We’ve already known fruits and vegetables are healthy. Fiber is the reason why eating an orange is good, but drinking a glass of orange juice is about equivalent to a bottle of coke. That’s not an exaggeration, by the way, it’s about the same sugar content.
If you want to eat the recommended 35g of fiber a day, you won’t be able to reach it with just supplements. You need to be eating fruits and vegetables at every meal. For my entire life, everyone has been saying to eat fruits and vegetables at every meal in large quantities.
Also savannah human diet is chock full of fiber too: baobab pulp, grass seeds, tuber plants, etc
fiber is great and under-consumed (especially soluble) and is very well-studied on modern populations [0]. we don't really need to make mechanistic reasonings about evolutionary adaptations that occurred hundreds of thousands of years ago or rely on studies of a small, homogenized population whose lived realities are far from yours and mine
plus, following the the hierarchy of evidence, mechanistic guesses are considered extremely low quality, only ranking above things like mouse studies [1]
[0] https://www.uptodate.com/contents/healthy-diet-in-adults#H61... [1] https://en.wikipedia.org/wiki/Hierarchy_of_evidence
https://prebioticassociation.org/resistant-starch-research-u...
Several of those are reviews themselves.
But obviously, most people are a lot more interested in finding a magic food which does this rather than a proven calorie deficit, which is highly effective.
I've lost weight through forcing myself into a calorie deficit, and it works really well, but it's not particularly fun.
For the "eat to get slimmer" claim, I think we're at the point where "extraordinary claims require extraordinary proof."
What do you mean by "these foods"? Just buy unprocessed food and 99% of the problems disappear. There is no fake, no people trying to sell you these out of malicious intent. Just buy local food people had access to in 1900 and you'll cure all your problems.
Sure but food doesn't have to equate to consume large quantities of junk food for it to be pleasurable.
We can learn to have a healthy meal with a reasonable portion that is as satisfying.
How are you defining highly effective? In the sense that a body will definitely lose weight when starved? Or in the sense that counting calories is broadly effective as a weight loss strategy?
The former is painfully obvious and entirely unhelpful, and the latter is provably false.
If your maintenance calories are 2700kcal and you eat 300kcal less than that, is eating 2400kcal starving for you?
Most people cannot tell a difference if they eat 100-150kcal less in a day.
>Or in the sense that counting calories is broadly effective as a weight loss strategy?
Yes, it is, and the reason people fail with it is not because calorie counting doesn't work, but because people's maintenance calorie estimates are often poor.
Deficit = maintenance calories (TDEE) - calorie intake
In this, even if your calorie tracking is on point, a deficit requires you to have a decent estimate of maintenance calories.
To throw a monkey wrench into all this, your maintenance calories often shift downward as you progress in your "diet" journey.
It's already factored in our algorihtm: https://macrocodex.app/knowledge/macrocodex/smart-calorie-bu...
I would have thought that it would mostly be because they can't resist that extra snack.
Or 'optimistically' underestimate the calories in the not pre-packaged food.
Serious question: Is there a significant variability in how the food calories are absorbed? Maybe different combinations are not absorbed equally efficiently (like with water/oil-based vitamins)
Anyway what's cute about this is that this isn't novel phenomenon. There are lots of parallels to this in other fields where often effective solutions do exist, but at a system level don't seem to work.
Telling people to diet doesn't fix population level obesity. Telling people about personal financial management doesn't stop people from accruing too much high interest debt. Telling teenagers to stop idolizing instagram influences doesn't fix body anxiety issues. Telling people to stop smoking/drinking doesn't fix addictions. 3-2-1 data backups absolutely work but people lose files all the time.
"general population doesn't have the discipline for it" — only that this feels somewhat condescending.
Let's agree that counting macros or going for calorie deficit is hard if it is not someones job. General population has other jobs, family, social life, other hobbies they enjoy more than fitness. It is not "just eat less" it is "spend considerable amount of time thinking about and planning your eating".
Nonsense. It doesn't take any more time. Just buy unprocessed, basic food, fruit and veg. When you open your cupboard, cook something tasty from what you have.
When you go to the supermarket, just don't walk into the aisles with snacks. Don't buy anything laden with sugar and fat.
Get into the habit of drinking black coffee instead of Starbucks' calorific drinks; it takes less than a week for your taste buds to adjust.
It's not rocket science. Just most people don't want to admit that every excess 100 calories they eat adds 11 grams of fat to their middle. Which adds up week by week, year by year.
But even with this kind of food, if I figure "sure, lemme have a sugary ice-cream", two hours later I'll be looking around the fridge and cupboards for some "quick bite".
Just don't buy this crap. I find it's much, much easier to have none at all than to hope to be "reasonable" and only eat a bit.
If you turn things into individual discipline problems then surprise you get population level issues. As you pointed out people have other things to focus willpower on thats not this.
The fault, as it often does, lies in marketing. Turns out heavily marketed, hyper palatable food, designed to be minimally satiating so you maximally over eat is great for profits and terrible for obesity.
Short term "diets" are nonsense. The solution is permanent lifestyle changes.
Purely behavioral lifestyle interventions have the lowest long term success rates of all available treatments for obesity. It's especially unreliable if you have weight loss targets higher than 15%.
They are of course still widely recommended due to numerous benefits other than weight loss, but "highly effective" is just wrong in the context of obesity treatments.
What? Surely changing one's behaviour - particularly the parts of behaviour that caused the obesity in the first place - is a sure way to stop being obese.
Behavioural changes work, the issue is that most people don't actually change their behaviour.
It's funny how proposing an healthy diet is unrealistic and watching fatties eat themselves to death is the new normal, complete value inversion and looser mentality
It's just that you should probably suggest other treatments in addition to the lifestyle changes that have relatively low long term efficacy.
Of course, that assumes your goal is to actually help the fatties instead of judging them.
I don't believe that's possible. They have to choose a healthier lifestyle by themselves.
It's not that people are fat because no one told them to eat healthy and exercise sometimes. They're fat because they have ignored that advice for a long time.
They aren't missing information about diet and exercise, they're missing diet and exercise.
I wonder what changed in between? Maybe our food and our relation to it? Who knows right?
You believe incorrectly.
> They're fat because they have ignored that advice for a long time.
Ah yes, the medical equivalent of "works on my machine".
You've now shifted from "how effective is this treatment" to "whose fault is it when the treatment doesn't work".
You will be able to help the fatties when you shift back into asking the question that matters.
But you are right with the fact that at the end, it mostly doesn't work. But those who stick with regime, it works 100% and positive changes in life, quality, happiness etc are massive.
The real solution - treat underlying mental issues. They are always there with obese people, they are massive (no pun intended), and they manifest as obesity, among plethora of other mental issues.
Mental issues is a broad category as well. Are food cravings a "mental issue", or a "physiological/hormonal issue"? No clear difference between those two, and given how GLP-1s quench cravings in general - not just food cravings, plenty of people on those report losing their compulsive behaviors, even such as gambling or shopping - the hormonal variant sounds quite plausible.
Which may be actually good. We are a lot better in treating hormonal issues than mental issues.
No. Even nearly a decade of intensive behavioral treatment has highly variable results.
Here's what the numbers tend to look like in practice:
~26% weighed more than at baseline
~23% lost >0% to <5%
~23% lost 5% to <10%
~16% lost 10% to <15%
~11% lost ≥15%
> positive changes in life, quality, happiness etc are massive
This is generally true. Eating better and exercising will improve your life.
But will you lose weight? How much weight? Those are far more difficult questions.
perhaps you can elaborate on how systemic death spirals are funny?
If you opt for it, then yes of course, abstinence-only sex education is a sure way to stop ten pregnancy.
Similarly, if you opt to change your lifestyle and start living healthier, and follow through, it will work.
If someone tries to force you, of course it will fail (in both of these cases). There is no way to stop someone else from being fat. We can only change ourselves.
Being fit and maintaining the normal weight is not the same thing as reaching a BMI of 50 kg/m² then losing it. I've seen fitness influencers take up that challenge only to find that "changing oneself" is significantly harder than it used to be when they were fit.
If you change your lifestyle temporarily, the effects are temporary.
If you change your lifestyle permanently, the effects are permanent.
Not quite.
If the lifestyle deteriorates, then weight regain is expected. However, people might regain only a fraction of the weight lost. It is possible for some of the weight loss to be permanent.
Also, even temporary changes in lifestyle can produce benefits that outlast the intervention, like lower risk of disease such as diabetes. Exercise is notable for providing numerous benefits that persist even if weight is completely unmodified.
> If you change your lifestyle permanently, the effects are permanent.
No. It improves your odds of success, but does not guarantee it.
Body adapts significantly over time when subjected to weight loss. There are compensatory physiological adaptations that favor weight regain, such as changes in energy expenditure and appetite. Even with sustained effort, maintaining the initial weight loss may become progressively more difficult because of those changes. This shows up in research as results like mean weight loss of ~9% at year 1 and ~5% at year 8.
For the love of god or any other deity I can't grasp this, its trivial for me to muster a tiny fraction of discipline and simply change direction from now on. But people out there are vastly different than me, thats pretty obvious, ie many people detest sports or even sweating. Addictions, and over-eating is an addiction (or some form of stress-coping mechanism) have a way to grasp core of one's existence and not let go.
My wife sees such overweight folks with not-so-much-time-remaining-on-earth as GP regularly. As she says - they basically over-ate themselves into mental disorder (or started with it and their body over time aligned with behavior). To actually fix this, that mental disorder needs to be tackled, no gastric operations or wegovy injections provide permanent solution. But they sure make pharma companies richer and give this warm fuzzy feeling of achieving actually something visible, even if temporary.
Running a marathon a month is a sure way to improve your health. However, less than 1% of people would be willing to do that. So it’s not an effective solution.
It’s an effective solution if we just ignore life, sure. But solutions are rooted in pragmatism.
It's the same thing for the mental issues epidemic... you can't build a completely hostile environment to human life and well being and then say "welp, I guess we need drugs to make you feel normal now", now they'll sell us the drug and the cure, and you'll be clapping and thanking them for saving you, truly amazing.
Henry VIII might have a word for you on that one, as would many other of history’s aristocrats. The only thing that’s really changed is the cost of food that used to be reserved for kings.
When I lived, in my childhood, in communistic Bulgaria/Czechoslovakia, nobody was starving. Yes, we did not have bananas and Argentinian steaks, but there was enough basic food, including the protein-rich one (eggs, cheese, even meat, although the best cuts were 'under the counter'). Still, few people were really obese; those were obviously sick.
Nowadays, there is plenty of junk food. The food is not really cheap (especially with the recent inflation), even the junk one. Still, being obese is (almost) the new normal. You can see that everywhere.
Yes, people spend more time indoors - but even in the old times people tended to spend a lot of time behind TV.
My hypothesis is that the junk food just does not have enough real nutrients, just mostly empty calories. So the body signals 'I need more nutrients', to which the typical response is 'here you have more empty calories'.
The quality and type of food also completely changed, you can't ignore that.
5% of supermarket aisles are food, the rest are treats and comfort food you should have less than once a week at best
What really changed is the foodscape. And quite thoroughly so. Even basic agricultural products like wheat, corn or fruit are different from the variants 50+ years ago, there was a concerted effort to make them bigger, pesticide-resistant, more sweet, more energy-dense...
I remember the apples of the 1980s. Nowhere near as sweet as today, some were thoroughly sour. And these are considered the healthy choice now.
"The only solution is behavioural, everything else is cope."
This is like, your opinion, man. An opinion that can make you feel smug, but that is no victory. In practice, GLP-1s are doing what a generation of preachers like you could not - making people more thin and healthier.
In a sense, it is you who is coping hard and defending a "solution" which provably never worked on a population scale.
Alright, then let's continue making food worse and worse over the years, let's keep building a system that is less and less viable for humans. When we'll all be on GLP-1, + depression + ADHD drugs to just cope with days to day life maybe we'll finally wake up and ask ourselves how we ended in such a shit show.
You’re right we didn’t evolve since the 80s. But our food has certainly changed. It’s not like some God from above put laziness in peoples brains just now. No… people were always lazy.
It’s just that you could be accidentally skinny before. You can’t be accidentally skinny now, it has to be intentional.
Many jobs used to involve physical labour, huge number of us now are desk jockeys. Decades of prioritising motorists and increasingly large vehicles over active transport mean walking, cycling are a fraction of what they used to be [0].
[0] e.g. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2010.... , https://la.streetsblog.org/2023/04/17/exactly-how-much-less-...
I seem to remember a meta analysis a decade ago or so finding that the particulars (high protein, atkins, paleo, whatever) didn't really matter so much as the the willingness and commitment to the change.
A good dietician is worth a few consults if you don’t have the will power to just fast. And as a bonus you don’t lose muscle mass as well because they’ll focus on keeping protein up.
Fasting is like using a nuke where a bullet would do.
How will a dietician measure your maintenance calories? How will they continuously update your macros and calories when your maintenance calorie change week to week?
I am making a claim here: most dietician will not be able to track your maintenance calories better than MacroCodex's algorithm.
Many dieticians simply rely on BMR/TDEE static formulas, and the limitation of this approach is that it cannot reliably track a user's actual maintenance calories well through the span of their dieting journey.
It definitely is not "you can just go on a calorie deficit", that is how jo-jo effect works.
For average person that has children, full time job, and whole range of adult responsibilities it is hard. Not impossible but hard, this is why people are looking fo easier solutions.
I've lost weight and kept it off by making sure I don't have sweets and other types of food that I know I'll down in ten minutes. But if I don't have any on hand, I won't eat any.
Ditto for normal food: if I increase the portion of filling, low-calorie foods (think salads and other greens), with a lot of protein, I know I won't have cravings later in the day and feel full longer. But if I buy fatty sausage, with a hefty helping of salty cheese, I'll eat until I explode.
If when I'm hungry I have a choice between "a quick bite" of something very palatable, calorie-rich but nutritionally poor, and a "good" meal, I know I'll make the wrong choice. But if my only choice is the good meal, I'll eat that and stay on track.
This also has a positive feedback effect: after a while, not only did I stop craving various junk foods, but they actually don't register as food anymore when I see them in ads or similar. Which, of course, makes it easier to stick to the "diet". Now, when I'm hungry, I crave "actual" food. The other day I couldn't have lunch on time, and all I could think of was a fat bowl of lettuce with some roasted chicken breast and yogurt. Walking in front of the local McDonald's peddling their latest mystery burger didn't do anything to me.
But changing lifestyle is virtually impossible for parents who also work, and have a bunch of issues here and there. Remaining the current lifestyle without dropping to a worse one is difficult enough.
https://en.wikipedia.org/wiki/Waist%E2%80%93hip_ratio (hip to waist)
BMI
Waist circumference (WC)
Waist to hip ratio (WHR)
Subsequent risk of nine cardiovascular/mortality outcomes in >260,000 people followed for ~20 years
To make it even more useful they should have included DEXA scan bodyfat%.
Also, BMI becomes somewhat biased at height extremes because body mass doesn't scale exactly with height². Humans aren't geometrically scaled copies of one another and empirical scaling exponents are often somewhere between 2 and 3. Conventional BMI tends to read relatively high in very tall people and relatively low in very short people. But changing the exponent would only fix one relatively small limitation of BMI
For better height adjusted replacement for BMI itself, one option is Trefethen’s BMI
WHR and WC is positively correlated to bodyfat% but this may get distorted for strongmen or sumo wrestler who tend to have much higher than average lean mass, may also have higher WC and WHR but difference maybe waist to shoulder ratio, they tend to have much bigger and powerful shoulders.
what's interesting is, for sumo wrestlers specifically, WC still correlates strongly with BF% one study reported r ≈ 0.86
There is a category in fitness called "skinny fat" where you are at low bodyweight (so low BMI) but your fat mass is relatively higher when compared to lean mass, so higher bodyfat%
Many skinny fat people refuse to believe they carry higher bodyfat% because they think they've low bodyweight so they can't possibly carry higher fat, which is wrong.
If you are interested in knowing more about bodyfat, this may help you: https://aretecodex.pages.dev/knowledge/measure/bodyfat
just got statin at 44 :(
i am not fat and workout ( although diet can use some improvment)
Thirty years after we learned that abdominal fat distribution matters, large-scale longitudinal evidence shows that waist measurements meaningfully reclassify cardiovascular risk beyond BMI alone.
For example, I’m 45yo/178cm/93kg and am obese by BMI measurement. However, my body fat is 20% (Dexa), VO2 of 50 (lab) & have the aerobic fitness to run a half marathon after work and not care.
I’m not surprised that you need other metrics like hip/waist ratio, measured body fat, visceral fat, etc to better understand the composition of someone’s body and how it might relate to health outcomes like heart disease.
And these aren't merely hypothetical bodybuilder edge cases. A systematic review found BMI had only ~50% sensitivity for detecting obesity when compared with body-fat reference methods—i.e. it missed roughly half the people classified as obese by adiposity.
More importantly, the 2025 Lancet Commission on clinical obesity explicitly recommended that BMI be used only as a population-level risk surrogate or screening tool, not as an individual measure of health. For individual assessment they recommend actually confirming excess adiposity with waist measurements or direct body-fat measurement.
Which is basically what this study is demonstrating again: where the fat is contains substantially more useful cardiovascular information than the number you get from dividing someone's mass by the square of their height.