I drank skim milk for years bc it saved calories and I believed the lies that dietary fat was the enemy. Then the store was out one day and I bought 1% and hubby said it really helped with his heartburn. And since I’m learning Intuitive Eating now I don’t have rules about what I eat so we have been buying 1% or 2%, depending on what is available. (I’m assuming whole milk will taste funny after drinking skim for 25+ years.
*Tangent: But now I have a question about IE that I need to see if meep has ever researched. Someone I follow said that people in the higher BMI categories have lower mortality rates. But is that bc once they get sick they lose weight? Like, what else was considered when they came to this conclusion. The studies are supposedly referenced in a book and I haven’t looked up the book yet or the studies.
Probably some other factors involved that led to that conclusion. Or, depending on what “higher BMI categories” means, yeah, people with extremely low BMIs might have higher mortality. So, would need to see what the vague definitions really mean.
Also, whole milk tastes great. And you don’t have to drink it as a substitute for water. It is nutritious, not for hydrating. I’ve even started to buy chocolate whole milk, because, chocolate.
What I’ve seen is that both very high and very low BMIs are associated with poor outcomes, but in the range from the bottom of “normal” to the top of “overweight” the best outcomes are close to that normal/overweight cut-off, suggesting that “overweight” was selected more based on esthetic measures than on actual health data.
So, I decided to look again re: all-cause mortality and obesity, and there are some interesting results out there, but the main result is that the “normal” range for BMI has the lowest mortality risk, underweight has increased mortality risk, and overweight into obese has increased mortality risk.
This one was a longitudinal study, looking at what was the highest BMI, and whether they lost weight:
Their discussion:
Weight loss is consistently associated with elevated mortality risks in the observational literature.23-25 The elevated risks are likely explained by several factors, including illness-induced weight loss (reverse causality)9,26 and age-related changes in body composition, often referred to as sarcopenia, which lead to reduced skeletal muscle mass and bone mineral density.27,28 Although some weight loss is clearly voluntary, it is unlikely the major driver of the associations in the present study given compelling evidence that voluntary weight loss is associated with improved outcomes across a variety of end points,29,30 combined with the fact that voluntary weight loss is rare at the population level.31 A sensitivity analysis in our study revealed that individuals experiencing rapid weight loss had higher mortality risks than individuals experiencing slower weight loss, possibly indicative of the severity of an underlying disease. Regardless of the underlying mechanisms of weight loss in the present study, the fact that those who lost weight exhibited higher mortality risks in the present study reinforces the need to treat them separately from those who maintained normal weight across time, accomplished only by incorporating weight history.
Our analysis provides intriguing new evidence on the age pattern of the obesity-mortality association. Prior literature generally suggests that the mortality risks of obesity decline with age6,32; however, this result may simply reflect increasing reverse causal biases at older ages. Consistent with this hypothesis, we found a reversal in the age pattern of the BMI-mortality association (from a negative to a positive association) in models using maximum BMI vs baseline as the exposure variable. Potential explanations for the stronger association between obesity and mortality at older ages include the possibility of increased cumulative exposure to obesity with age, which has been demonstrated as an independent risk factor for all-cause mortality,33 and the onset of conditions with long latency periods, such as cancer.
In short, someone who once was obese, and now normal weight… well, that is often due to illness (esp cancer), especially if you look at the population level, given these are large statistical studies. The depressing truth is that few people lose a considerable amount of weight and keep it off to make a difference.
Ok so if voluntary weight loss doesn’t help why do doctors always hit you over the head with diets? That is a discussion for another thread. I like that the first study talked about reasons why other studies might have different results. Now I can go look at the study in the book that was referenced and see what they considered.
Suppose that there exists a condition where you have an 8% chance of dying within 5 years if you are obese and only a 2% chance of dying if you are not obese.
People without this condition have a 1% chance of dying if they are obese and a 0.5% chance of dying if not obese.
And everyone knows which of the 4 categories they are in and what the mortality statistics are and they’re numerate enough to understand them. And the population is evenly divided between the 4 groups.
The obese people with the condition say “holy crap… 8%?!?!?! I’m too young to die, I better do something!!!” So 90% of them lose weight to improve their odds.
The obese people without the condition say “meh… 1% is pretty low, and I’m still way healthier than those poor souls with the condition” and only 10% of them lose weight.
Now if you look at the mortality of the folks who lost the weight it’s going to be .9 * .02 + .1 * .005 = 1.85%
The mortality of the folks who stayed obese is .1 * .08 + .9 * .01 = 1.7%
Every individual person who lost weight improved their mortality. But as a group they started out much sicker, because it was mostly the sick folks who were motivated enough to do the hard work of losing weight.
I nearly died last fall. (Thankfully there was space in ICU for me in this area at that time.)
Medical professionals read me the riot act, essentially telling me “lose weight or die”.
Because of the health condition that nearly killed me, I have a higher risk of mortality than most folks who have maintained my current BMI for an extended period of time, and a higher risk than many people who have held steady at my prior BMI.
Because doctors are not necessarily that smart. (or, rather, they do not necessarily give useful, actionable advice)
I have my own doc who gets on me about weight loss, but she is also clearly overweight (now, not obese like me, I’ll give her that), and she is always trying a new diet. I mean, seriously?
I’ve lost weight before, and I’m slowly losing weight now, but I do not need a doctor telling me I’m obese. I’m over 200 pounds. I know.
I used to have a plump doctor. She never mentioned my weight. She retired, and now i have a slim doctor. He brings it up from time to time, but usually when it’s actually relevant. If he was after me all the time about it, i might find a new doctor.
I’m on the cusp of obesity by the BMI charts. (Oddly, i lost weight during pandemic and now I’m just “very overweight”, but i was “slightly obese”.) Yeah, i know I’m overweight. I don’t need to be regularly reminded of that.
Except that less than 5% of people who go on a diet to lose weight actually keep the weight off. (I can find a source for that but I was at the ER all night with a family member so it will have to be later.)
My current doctor doesn’t bug me too much about weight. But she did mention that I had “gained”
5 lbs after being in the hospital with Covid. I was severely dehydrated when I went in the hospital with Covid!
I also have an adult daughter who appears to have some sort of autoimmune disease. Undiagnosed as of yet, or fibromyalgia (catch all). She is obese and might feel better if she lost weight but it is hard to cook proper meals and exercise when you are in pain all the time. But I swear every doctor who looks at her has to comment on the weight first, and it often feels that they don’t even try to figure out what is wrong.
I did have a doctor tell me to do the Keto diet. That’s when I switched to my current dr. Since then a coworker who lost a lot of weight with Keto almost died from pancreatitis.
Honestly I’m ok with my weight if it only costs me a few years. More concerned about quality of life, looking at my parents. I feel like exercise would make the biggest difference there but I’ve had a real problem with motivation this year. I keep waiting for cooler weather so I can hike and it keeps not coming. It’s cooler this week but the weekend is supposed to be 99 again.
