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PaperclipPerfector  11mo ago (text post)   26472 thread views

Culture War Roundup for the week of January 15, 2024

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Yes. His dad lived to 94, and while he is much fatter than his father was there is mixed evidence on whether being overweight is actually all that bad for you if you’re very elderly.

It is bad, but most of the elderly ills make you lose a lot of weight. So the thin population is bimodal. I think the hierarchy is something like old thin healthy, old fat, old thin sick. Being old and fat may mean that at least some of your machinery is working as expected. Where as some population of the old thin - nothing is working - so this skews the results a bit.

True, and you do have quite a few people who make it to 100 with a paunch, after which point getting thin is usually a bad sign (I recall the late queen thinned out pretty dramatically in her last couple of years).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831285/

However, the question as to whether BMI may predict prognosis in patients with metastatic cancer remains open. We therefore designed the current retrospective study to investigate the potential association between BMI and overall survival (OS) in patients with distant metastases (DM) and a favorable performance status. Between 2000 and 2012, a total of 4010 cancer patients with DM who required radiotherapy (RT) and had their BMI measured at the initiation of RT were identified. The relation between BMI and OS was examined by univariate and multivariable analysis. The median OS time was 3.23 months (range: 0.1–122.17) for underweight patients, 6.08 months (range: 0.03–149.46) for normal‐weight patients, 7.99 months (range: 0.07–158.01) for overweight patients, and 12.49 months (range, 0.2–164.1) for obese patients (log‐rank: P < 0.001). Compared with normal‐weight patients, both obese (HR = 0.676; 95% P < 0.001) and overweight individuals (HR = 0.84; P < 0.001) had a reduced risk of all‐cause mortality in multivariable analysis. Conversely, underweight patients had a significantly higher risk of death from all causes (HR = 1.41; P < 0.001). Overweight and obesity are independent predictors of better OS in metastatic patients with a good performance status. Increased BMI may play a role to identify metastatic patients with superior survival outcome and exhibit a potential to encourage aggressive management in those patients even with metastases.

Well, if you're dying of cancer, all that fat gives the tumor something to eat that is slightly less important than the rest of you.

One more reason I give the poor bastards ice cream, beyond the cardiovascular benefits.

But it’s not just cancer patients. Peripheral vascular disease too.

As your study says:

Recent studies conducted in patients with chronic diseases have reported an inverse association between body mass index (BMI) and mortality.

So where doesn't it? A dozen specific explanations aren't satisfactory.

Like regular ice cream and alcohol consumption, overweight BMI is one of those things that annoy modern medicine by stubbornly correlating with lower mortality.

One more reason I give the poor bastards ice cream, beyond the cardiovascular benefits.

And the fun. But don’t forget the alcohol. My grandma’s universal cure showed a deeper understanding of the human body than all of modern medicine: If I even thought about looking pale, she would forcefeed me delicious desserts, baba au rum, black forest cake, rinced down with a warm grog.

https://www.bmj.com/content/353/bmj.i2156

Overweight and obesity is associated with increased risk of all cause mortality and the nadir of the curve was observed at BMI 23-24 among never smokers, 22-23 among healthy never smokers, and 20-22 with longer durations of follow-up. The increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. Lack of exclusion of ever smokers, people with prevalent and preclinical disease, and early follow-up could bias the results towards a more U shaped association.

https://www.bmj.com/content/370/bmj.m3324

Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.

https://europepmc.org/article/pmc/4855514

Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

TLDR: Being overweight and grade 1 obese are not that bad for you, and being slightly overweight can tentatively be considered beneficial. Confounders abound, beyond my ability to unconfound. But being fat fat? Bad idea.

My grandma’s universal cure showed a deeper understanding of the human body than all of modern medicine: If I even thought about looking pale, she would forcefeed me delicious desserts, baba au rum, black forest cake, rinced down with a warm grog.

My grandfather calls me anemic every time he sees me, and to be fair, last time I passed out and hit my head, the VBG showed I was 0.3 g% below the cutoff. Though his solution was iron tablets. And he's a doctor too.

https://www.bmj.com/content/353/bmj.i2156

Imo they're trying to get it as low as possible, just mining for the right combination of factors:

In the analysis of all participants the lowest mortality was observed in those with a BMI of around 25. In subgroup analyses, however, the lowest mortality was observed in the BMI range of 23-24 among never smokers, 22-23 among healthy never smokers, and 20-22 among studies of never smokers with longer durations of follow-up (≥20 and ≥25 years).

On the curves, the mortality at 30 BMI is roughly the same as 20, and 18 is way worse than 32, so I strongly suspect aesthetic (and perhaps ascetic) considerations tainted the definition of the seemingly ‘healthy range’ of 18-25.

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