- High WHR
Intentional weight loss didn’t have any effect either way on risk of death, according to recent research out of Baltimore. Surprising, huh?
Obesity tends to shorten lifespan, mostly due to higher rates of cancer and cardiovascular disease like heart attacks and strokes. Doctors and dietitians all day long recommend loss of excess weight, figuring it will reduce the risk of obesity-related death and disease. Many of them are unaware that’s not necessarily the case. It’s called the “obesity paradox“: some types of overweight and obese patients actually seem to do better (e.g., live longer) if they’re above the so-called healthy body mass index of 18.5 to 24.9. For instance: those with heart failure, coronary artery disease, and advanced kidney disease.
It’s never really been clear whether the average obese person (body mass index over 30) improves his longevity by losing some excess weight. That’s what the study at hand is about.
Methodology
Baltimore-based investigators followed the health status of 585 overweight or obese older adults over the course of 12 years. Half of them were randomized to an intentional weight loss intervention. All of them had a high blood pressure diagnosis. Average age was 66. Average body mass index was 31. Details of the weight-loss intervention are unclear, but it was probably along the lines of “eat less, exercise more.”
What Did They Find?
The weight-loss group lost and maintained an average of 4.4 kg (9.7 lb) over the 12 years of the study. This is about 5% of initial body weight, the minimal amount thought to be helpful for improvement in weight-related medical and metabolic problems. Most of the weight loss was over the first three years.
The men assigned to the weight-loss program had about half the risk of dying over the course of the study, compared to the men not assigned to weight loss. The authors don’t seem to put much stock in it, however, stating that “…no significant difference overall was found in all-cause mortality between older overweight and obese adults who were randomly assigned to an intentional weight-loss intervention and those who were not.”
Comments
With regards to the men losing weight, we’re only talking about 100-150 test subjects, a relatively small number. So I understand why the researchers didn’t make a big deal of the lower mortality: it may not be reproducible.
This same research group did a similar study of 318 arthritis patients and intentional weight loss, finding a 50% lower death rate over eight years.
The authors reviewed many similar studies done by other teams, noting increased death rates from weight loss in some studies, and lesser death rates in others.
When the studies are all over the place like this, it usually means there’s no strong association either way. Nearly all the pertinent studies were done on relatively healthy, middle-aged and older folks. The most reliable thing you can say about the issue is that loss of excess fat weight doesn’t increase your odds of premature death.
Remember that patients with coronary heart disease, congestive heart failure, or advanced kidney disease tend to live longer if they’re overweight or at least mildly obese. It’s the obesity paradox. Will they live longer or die earlier if they go on a weight-loss program? We don’t know.
We do know that intentional weight loss helps:
- prevent type 2 diabetes
- maintain reasonable blood pressures (avoiding high blood pressure)
- improves lower limb functional ability
Maybe that’s enough.
Reference: Shea, M.K., et al. The effect of intentional weight loss on all-cause mortality in older adults: results of a randomized controlled weight-loss trial. American Journal of Clinical Nutrition, 94 (2011): 839-846.
Diabetic Mediterranean Diet 
When I lose weight, I feel much better right away. That’s all I need to know.
It’s hard to argue with that, Jim.
Many folks don’t think loss of 10 or 15 pounds (4.5 to 7 kg) is much to crow about, but I used to go for hikes with that much weight in rocks in my backpack. That’s a lot of weight to lug around for five miles!
-Steve
Excellent article and comment.
As one who nearly died from this dam T2 diabetes and now follows a form of
mediterranean diet, thank you for excellent web site and comment.
In my case, liver was the culprit who after 26 years and finally corraled and shut down on metformin strategically taken in time, 1200 calorie mediterranean diet and 2 miles walking key to keeping the monster tammed.
The issue is not weight per sae – although extremes of anything kills. The real key is the amount of glucose generation on a hunter gatherer gene/gut set. that rots pipes, makes eye hemorrages, rots kidneys etc,
Today BG now under control. As I indicated, my liver cannot be trusted to do its glucose liver add when BG drops low below 70 and my Doctor has recommended I not let BG drop below a 100.
I use CGMS to watch and catch this and add a few more carbs to diet so as not to force liver into action. My ac1 is now 6.4 and was as high as 13.3.
Excess insulin – glyburide, starlix and large doses of 75/25 insulin along with the major hydraulic jack of Actos all stopped.
I am far healthier.
I am fed up with the fanaticism over weight, and stupid diets and faling to recognize the excess calories overload that feed the type 2 disease.
The “simply add more insulin” of the fanatics peddling type 1 solutions to type 2 diabetics is a disgrace and unhelpful.
Its all your fault – life style is shere useless crap and fails to recognize the huge jump in grain, corn, rice and sugar production coupled with extreme drops in exercise from all the couch potatoe tools,, entertainment, lap tops, cars, video games, automation.. Energy balance in past was achieved by scarce, poor quality food and shortages of winter times. Today we have 24/7 of high quality carbs and diet. We should all be working on the pharoh’s tombs and eddifices moving 2 ton stone blocks by hand.
The biggest favour the ADA and other misled promoters, FDA, goverment, is shut the hell up for a while and get this mess under control.
As always, best wishes, and your efforts demonstrate that most good Doctor’s are honestly trying to help their patients.
Jim Snell 805-383-7759 1435 Calle lozano, Camarillo, Ca 93012
At Jim Snell….THANKS for a succinct statement that a LOT of us feel! My doctor keeps treating me like a kook when I talk low carb diet and keeps telling me “whole grains are healthy”….That’s NOT what my glucometer tells me…yet he was stunned when I lost 30 pounds and lowered my A1c from 7.5 to 5.8 on it. His solution always seems to be that horrible T2 complications are inevitable so just keep throwing meds at it till they AND I fail….
At Dr. Parker….I wonder if the reason overweight heart patients live longer is that they are probably far less mobile and not exercising much. Maybe that prevents just that little extra stress on their cardiovascular system that might otherwise push them into heart failure….Just wondrin’…IF that thought was correct, then perhaps they would live even longer if they low carb dieted and lost that weight.
“The men assigned to the weight-loss program had about half the risk of dying over the course of the study, compared to the men not assigned to weight loss. The authors don’t seem to put much stock in it, however, stating that “…no significant difference overall was found…”
———————
This illustrates how misleading the misleading language used in reporting results. Biomedical researchers use “significant” in a way that conflicts with the standard English-language meaning.
For example, a factor-of-two improvement shown in a small study with considerable scatter in the results will be “not significant”, while a 2% improvement in a large study with little scatter in the results will be “significant”. This all has to do with the widely misunderstood “r” statistic, and the convention of calling only results with r ≤ 0.05 “significant”.
A recommended translation:
“Not significant” = “not strongly evidential“ (by the standard but arbitrary r-value criterion), yet perhaps indicating a large and important effect.
“Significant” = “strongly evidential” (by the same criterion), yet perhaps indicating, with great confidence, that the effect is of insignificant magnitude.
Worse, many authors equate “no significant difference” with “no difference”, even when the numbers presented that same paper are, in fact, substantially different.
I think there are several things going on here.
1 – Timing. When you lose weight in your 60s, there doesn’t seem to be much of a protective effect. This is becoming more well known. When you lose it in your 30s-40s, I’d bet there would be, though. But that’s a heckuva large and long study to follow weight prospectively out from a patient population in their 30s. Not sure if it’s been done.
2 – Treating numbers, rather than a disease. Weight, in and of itself, is not a disease. It’s a surrogate predictor of disease, and a secondary or tertiary one at that. Increased weight correlates with increased diabetes which correlates with increased coronary artery disease which correlates with death. That’s more than a few steps removed. What happened to their LDL, HbA1c, blood pressure, etc? Ah, but even those are also surrogate markers for what we’re really worried about, which is microvascular and macrovascular disease, which is what kills the patient. So the question we should REALLY be looking at is what happened to the disease itself. If we’re not attacking the underlying pathological changes, it’s meaningless. Treating weight specifically is appearing to be of little clinical benefit with respect to hard endpoints, at least in patients older than 60.
3 – This may not be enough weight loss. There are have been studies looking at the long term outcomes of gastric surgeries (bypass, NOT lap band), and they see a substantial drop in all cause mortality. Predictable decreasese in heart disease and diabetes, but even bigger decreases in cancer. Of course, these patients lost massive amounts of weight and saw concommittant improvements in all the other markers noted above. And compliance is good because it’s so radical.
4 – Following that logic, there are programs out there trying to do this. I know Ornish is trying. I haven’t exhaustively reviewed his stuff but I do know Medicare will now reimburse his program so it probably has some data to back it up. The problem with his program is compliance. It demands a much more strict regimen than a roughly 10 pound weight loss. But it does seem to be working, at least in the highly motivated patients, which is another variable bugaboo.
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Jim – Congratulations on your medical success. I bet you had to figure out a lot of it on your own.
Frank – Regarding sedentariness and longevity in heart patients: folks with coronary artery disease improve their longevity if the start and maintain a regular exercise. Timing and intensity have to be worked out with the cardiologist. E.g., a 10-K jog done four days after a heart attack is a bad idea.
Dr. Steve Parker:
Thank you most kindly for your comments.
In fact a team of good Doctors helped out from my main line of defense my family Doctor, my kidney Doctor, optometrist – strabimus issues and others.
To them, I pass the most generous part of your comments.
Type 2 Diabetes is such a nasty business that eludes the excellent battle field resources of our excellent medical system.
For your patients, one needs good patient Doctors who while they do not have the instant answer, have the patience, medical discipline and open mindedness to stay “steady on target”.
For me, the patient, my role was to run to all the one shot lab tests, learn about carbs control and diets and implement, get hearty exercise ( 1 to 2 miles walking a day).
I ended up doing eatensive data gathering using my fingerstick machine up to 30 sticks a day that provided the extensive data my doctors could paw thru and draw useful conclusions.
AFter 30 years doing it wrong ( hey I held the shovel in my hands), it took 4 years to get this mess under control.
When the medical condition overrides the gut/intestine system – the liver stuffs extra glucose, the carbs control and exercise are critical to minimize the damage until the medical condition is snagged and controlled. This buys critical time for the medical team to work.
Once liver corraled, carbs control-diet and hearty exercise are crucial to keep the monster down. Energy balance – energy burned match up to energy eaten ensure monster stays in cage. Excess glucose in body rots veins, eyes, kidney’s and other parts of body. Body is truly amazing and fights horrendous odds, it is patient’s responsibility to alleviate the pressure on the body so it has best chance of healing and stopping rot.
My kidney Doctor was the one who wanted me off the actos. At the time before hearty exercise, actos was only thing getting BG down from 238 in morning to 180.
I remembered that heavy exercise would get my BG down so I started walking and finding 2 miles regularly flushed out the dawn effect load.
At these time my IR was max and 26 units of 75/25 in early am was like inserting a dead wood post – NO EFFECT!
After a year walking 2 miles every am, I by accident discovered that talking my metformin late a night one night , pulled back my morning BG to 180. From that my Doctor and I found that 500 mg dose taken at 10:00 pm and 12:00am would shut down liver from midnight to 5:30 am so that morning BG was same as at midnight. A1c dropped from 13.3 to 6.9 after 2 months doing this.
Further checking medical reserach data by Salk, John Hopkins et all revealed the horsepower of metformin up to strength in the blood system and shutting down liver. That work has been out for a couple of years.
Today, my weight is down from 330 lbs at max and now sub 250 lbs.
Eyes healed, kidney’s stabalized and feeling way better – off actos, off starlix, glyburide et all and remain on metformin as the key drug with a small boost of insulin from 3 to 4 units of humalog lispro at each meal.
I am most thankful to all my Doctors’ help in seeing this mess shutdown.
There is unfortunately too much evangelisim over this condition -disease by those reminicent of the Women’s Christian Temperance Union tryting to stop alcohol drinking and making matters worse. i.e. the explosion in diabetes world wide and rates 200 and 300 per cent higher.
At same time we have had since world war 2 , the biggest improvement and productivity of grains – corn, rice etc along with a dramatic reduction in exercise from cars, computers, lap tops, couch potato games and entertainment.
The hunter gatherer gene – gut digestion system optimized years ago for scarce food, poor quality, scrawny rabbits and some nuts and native fruits is being hammered by this 24-7 hour high quality grains and sugars
that is rotting out body. This body grabs all calories in any food eaten and relies on external events to prevent overloading the body and over filling all the glucose storage sites of liver, fat cells and skeletal muscles.
We all need to be working on the pharohs tomb’s and edifices moving 2 ton stone blocks by hand.
Thank you most kindly for your serviice, the excellent mediterranean diet and medical web site helping us all.
Best wishes.
Journal reader – Yes, the scientific community does has a much more specific defnition of “significant” than dose the general public. Sometimes the scientist flip back and forth between the two, confusing things even more. (I’m guilty of that myself.) I haven’t read it, but here’s the Wikipedia entry for “statistical significance”: http://en.wikipedia.org/wiki/Statistically_significant
Isaac- I agree with all you say, although I have a little less faith in the government’s (Medicare’s) rationality.
-Steve
Many thanks for the exposition, Jim. You sound like a real character (and I mean that as a high compliment!).
-Steve