$36,000
$25,176

Excess Weight Increases Disease Risk and Shortens Life

No-one wants to hear that they are responsible for their own ill health, or that they are destroying the prospects for their own future. Thus, human nature being what it is in this era of cheap calories, there exists a thriving cottage industry based upon telling people that their excess weight is just fine and can be managed in such a way as to cause no harm. Unfortunately, that just isn't the case. Carrying excess visceral fat tissue does cause considerable personal harm: it reduces life expectancy, significantly increases risk of disease, and for all intents and purposes essentially accelerates the downward spiral of degenerative aging. You won't just be less healthy, you'll also spend more on medical services despite living a shorter life. The amount and quality of evidence that exists to support these conclusions is very hard to argue with. Nonetheless, people try, Canute against the tide.

The visceral fat tissue packed around internal organs is metabolically active, and by this point I think most people are at least passingly familiar with the idea that too much fat tissue distorts the operation of metabolism in ways that lead to metabolic syndrome and type 2 diabetes. These conditions are harmful enough over the long term that scientists have long used diabetes as a stand-in for aging in laboratory animals, a way to induce most of the consequences and conditions of aging more rapidly and thus more cheaply. In our species, type 2 diabetes is a self-inflicted condition for the vast majority of those who suffer it, caused by being overweight. It can even be turned back simply through the exercise of will power, through losing weight via a low calorie diet. It is amazing that this isn't the first thing done by every patient, rather than suffering through years of disability and medications with significant side-effects.

An excessive amount of fat tissue causes many other issues, however. It spurs chronic inflammation through its interactions with the immune system, and inflammation drives all of the common age-related diseases, especially those related to the decline in function and structure of the cardiovascular system. Excess weight also contributes to the development of hypertension, increased blood pressure, which puts further stress on blood vessels and heart tissue. Raised blood pressure is an important determinant of age-related mortality. Fat tissue also clearly drives the corrosion of the mind, as conditions such as Alzheimer's disease are strongly correlated with weight. Some of these links are mediated through the increased levels of cellular senescence produced by the presence of visceral fat tissue - recall that senescent cells are one of the root causes of aging, and more of them is a bad thing. Along the same lines, fat tissue and its activities can be linked to dysfunction of the immune system. It is just a really bad idea to get fat or stay fat: you are damaging yourself in so many ways.

'Fat but fit is a big fat myth'

The idea that people can be fat but medically fit is a myth. Early work, as yet unpublished, involved looking at the GP records of 3.5 million people in the UK. The researchers say people who were obese but who had no initial signs of heart disease, diabetes or high cholesterol were not protected from ill health in later life, contradicting previous research. A summary of their study was discussed at the European Congress on Obesity.

The term "fat but fit" refers to the alluring theory that if people are obese but all their other metabolic factors such as blood pressure and blood sugar are within recommended limits then the extra weight will not be harmful. In this study, researchers analysed data of millions of British patients between 1995 and 2015 to see if this claim held true. They tracked people who were obese at the start of the study, defined as people with a body mass index (BMI) of 30 or more, who had no evidence of heart disease, high blood pressure, high cholesterol or diabetes at this point. They found these people who were obese but "metabolically healthy" were at higher risk of developing heart disease, strokes and heart failure than people of normal weight.

No such thing as 'fat but fit', major study finds

Several studies in the past have suggested that the idea of "metabolically healthy" obese individuals is an illusion, but they have been smaller than this one. The new study involved 3.5 million people, approximately 61,000 of whom developed coronary heart disease. The scientists examined electronic health records from 1995 to 2015 in the Health Improvement Network - a large UK general practice database. They found records for 3.5 million people who were free of coronary heart disease at the starting point of the study and divided them into groups according to their BMI and whether they had diabetes, high blood pressure (hypertension), and abnormal blood fats (hyperlipidemia), which are all classed as metabolic abnormalities. Anyone who had none of those was classed as "metabolically healthy obese".

The study found that those obese individuals who appeared healthy in fact had a 50% higher risk of coronary heart disease than people who were of normal weight. They had a 7% increased risk of cerebrovascular disease - problems affecting the blood supply to the brain - which can cause a stroke, and double the risk of heart failure. While BMI results for particular individuals could be misleading, the study showed that on a population level, the idea that large numbers of people can be obese and yet metabolically healthy and at no risk of heart disease was wrong. "So-called metabolically healthy obesity is not a harmless condition and perhaps it is better not to use this term to describe an obese person, regardless of how many metabolic complications they have."

Comments

Gosh. I am thin myself and consider myself fortunate. But it is not because of my behavior or will. It is largely genetic. If I were overweight, I would be insulted by your tone, Reason. Treating obesity is an unmet medical need.

Posted by: NY2LA at May 18th, 2017 3:17 AM

I was thin until I entered university. Then I first developed a fat belly and a round face. I practiced basketball before that, since I was 8 or so, but stopped in university. When I graduated I went to Japan for my PhD. There I entered a university's sports club and became thin again, even dangerously thin (I had an anorexic look, nevertheless being stronger than I'm now). Then, after obtaining my PhD, I returned to Spain, began an office job and grew the fat belly again. I have a 24.4 BMI but nevertheless have a big belly.

Posted by: Antonio at May 18th, 2017 4:22 AM

Thanks NY2LA. As one of the "fit but fat" people (who in my 40s can still outsprint many 20-year-olds), it gets annoying to see Reason bang this drum about "personal responsibility" or "willpower" every few months. Certainly I'd like to be trim. 2/3 of the U.S. (and 1/3 of the world) is currently overweight; has everyone become irresponsible in the last 20 years?

The obesogenic environment has changed drastically; it'll be interesting when the root cause is fully understood in, say, another 20 years.

We all have our good and bad genetics. I have nearly perfect (including wisdom) teeth, and I can put on muscle at the drop of a hat. Aubrey de Grey: "I'm one of those lucky people who are built well for health and youth: I can eat and drink what I like and nothing happens." It's nice he says lucky; but is this truly likely?

BTW -- even a casual reading of the article indicates that it's talking about visceral fat, not subcutaneous fat. Big difference. And plenty of "skinny fat" people have the first one. So if you think you're thin, don't be too smug about it... and even if you are, it may not last.

Posted by: John at May 18th, 2017 10:44 PM

(to clarify, by "you", I didn't mean NY2LA at all, but rather the royal "You")

Posted by: John at May 18th, 2017 11:04 PM

"Certainly I'd like to be trim. 2/3 of the U.S. (and 1/3 of the world) is currently overweight; has everyone become irresponsible in the last 20 years?"

That's much more probable that everyone mutating for obesity in the last 20 years.

Posted by: Antonio at May 19th, 2017 4:11 PM

I don't think it's terribly plausible that the obesity pandemic has been caused by a sudden rise in irresponsibility starting in the late 1970s; I agree that it's even less plausible that it's due to the sudden takeover of the global human genome by a novel obesogenic mutation, but that's far from exhausting the universe of possible explanations. The most likely culprit is changes in the price, processing, and availability of food over that time period, but there are lots of additional, plausible, and non-exclusive possibilities (one of which does actually involve genetic changes in the population).
As summarized in this press release, for example:

Less sleep can cause increased body weight;

Endocrine disruptors, including DDT and PCBs can increase body fat;

Keeping ones home or office at one temperature year around promotes body fat;

Smoking cessation increases weight because nicotine has both thermogenic and appetite suppressant effects;

Certain pharmaceuticals, including antipsychotics, antidepressants, contraceptives and antihistamines increase weight;

Some age and ethnic groups that have a higher prevalence of obesity than others have increased as a proportion of the population;

Greater maternal age may increases risk of offspring obesity;

Obesity may perpetuate its own increase through a fetally-driven positive feedback loop;

Obesity has a genetic component and individuals with genetic predisposition toward obesity may be reproducing at a higher rate; and

The probability that two individuals will mate is related to how similar their body types in adiposity and this can increase the number of offspring with high levels of adiposity.

... and all of these things have increased over the last several decades in the United States and other countries that are now struggling with the obesity epidemic.

The above press release was based on this free, full-text paper; the same authors then followed up with this paper three years later, with more causes and with the evidence supporting the above hypotheses in most cases having strengthened in the intervening time period.

OK: back to radical anti-aging biomedical research ;) .

Posted by: Michael at May 19th, 2017 5:39 PM

Before we move back to "radical anti-aging biomedical research", lets not forget about the role that epigenetics probably plays in the rise of obesity as well.

Genetics and epigenetics of obesity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213306/

Epigenetics of Obesity
http://www.the-scientist.com/?articles.view/articleNo/45199/title/Epigenetics-of-Obesity/

Epigenetic switch for obesity
https://www.sciencedaily.com/releases/2016/01/160128133352.htm

Recent developments on the role of epigenetics in obesity and metabolic disease
https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-015-0101-5

My key point is, the majority of the possibilities (though not all of them) listed in the press release cited by Michael in his comment above require that a person be born first. (For example, one has to be born in order to get less sleep.) Along with genetic factors, epigenetics accounts for possible inherited gene expression. Hence, we have to take into account the obese person possibly have been born with a disadvantage, at the very least.

Posted by: NY2LA at May 19th, 2017 8:16 PM

The ability to store fat would have been essential for our survival, I suspect that senescent cells are also a stored food source. Storing food is no longer required, so editing our genome seems the best way forward.

Posted by: Tj Green at May 19th, 2017 8:21 PM

Yet another confounding factor: adenoviruses. (Brought up as one possibility for why lab animals are mysteriously gaining weight too!)
http://www.nature.com/news/2010/101124/full/news.2010.628.html
https://www.wired.com/2016/12/mysterious-virus-cause-obesity/

As Michael and NY2LA mention, there are lots of potential causes. Some are bad luck (genetically predetermined or environmental), and some are under conscious control. So Reason -- please tone down the moralizing; I assume you're not struggling with this issue daily.

Advance medical intervention (genomic or epigenomic editing, biomedical devices) would go a long way towards resolving this, and would help billions of people live longer. Which sounds like "radical anti-aging biomedical research" to me.

Per Tj: perhaps a lot of this will just be resolved with senescent cell clearance. Or maybe mitochondrial clearance. Hope so, for my sake and others.

Posted by: John at May 19th, 2017 11:13 PM

Increasing food softness is leading to increased obesity. There is very little evidence that people are eating more calories, it is just that softer food takes less energy to digest:

http://www.economist.com/node/13139619

Basically fast and microwave food as well as soft snacks is killing people.

Posted by: Jim at May 20th, 2017 5:40 AM

Post a comment; thoughtful, considered opinions are valued. Comments incorporating ad hominem attacks, advertising, and other forms of inappropriate behavior are likely to be deleted.

Note that there is a comment feed for those who like to keep up with conversations.