General Discussion
In reply to the discussion: Is it a person's "fault" if they're fat? What does that question really mean? [View all]eridani
(51,907 posts)--and a great deal that indicates it is a marker for health problems without a direct causative role. (Unless you are maybe taking about people who weigh more than 400 lbs.) Women are fatter than men and live longer. Women are more likely to be obese than men, and still live longer. Type II diabetics who exercise more and limit intake of foods with a high glycemic index improve sugar control and blood pressure immediately, well before any weight loss occurs (which is minimal anyway). If weight loss occurs later, it can't possibly be the cause of health improvement. Further, there is zero correlation between health benefits and the amount of weight lost.
Genetic insulin resistance is one of the most common factors associated with obesity, and obesity is indeed a healthier condition for this population. And we are talking about 30% of Americans here.
If fat (rather than the underlying genetic trait of insulin resistance) is such a problem, why are fat type II diabetics less insulin-dependent, less likely to develop the complications of diabetes, and less likely to die from it than type II diabetics of average weight? {Turkington, R.W. and Weidling, H.K., JAMA Vol 240, p. 833-836 (1987)} Why do diabetic Pima Indian women (the human population with the largest known genetic concentration of insulin resistance) experience the lowest levels of mortality when they weigh twice the actuarial ideal? {Pettitt, D.J., et al Am. J. Epidemiol. Vol 115, p. 359-366 (1982)} (Pima men with the longest life spans weigh 45% more.)
Astrup et al {International Journal of Obesity Vol 11, p 51-66 (1987)} have demonstrated that it is fat people who eat the least who have abnormal insulin response. He compared two groups of fat people, one of which ate less than 1500 calories a day, and the other of which ate more than 3000. Every one of the former group had abnormal insulin response, and none of the latter group. The people who are most at risk genetically for developing type II diabetes are therefore those who are least likely to lose weight, and the most likely to benefit from more exercise and improvements in diet composition, making any emphasis on promoting weight loss as the first and most important consideration particularly perverse, stupid and harmful.
(Sorry for no links--I collected the references 15 years before I got online.)