A significant increased risk of mortality over the 12 years of follow-up was observed for underweight (BMI 18.5-35; RR = 1.36, P l.t. 0.05) and obesity class II+ (BMI to 35; RR = 1.36, P l.t. 0.05). Overweight (BMI 25 to 30) was associated with a significantly decreased risk of death (RR = 0.83, P l.t. 0.05). The RR was close to one for obesity class I (BMI 30-35; RR = 0.95, P l.t. 0.05). Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality."Overweight appears to be protective against mortality." Then why is it called "overweight?"
"Public health," like "public education," was imported to America from Prussia. The Prussian state was founded by a military order of armed monks, who imposed on the people they conquered an order of Christian discipline similar to their own. Their ideal subject was a man optimally suited for military service. Their ideal soldier was a dragoon, that is, a mounted infantryman: Dragons could be used either as highly mobile infantry or as light cavalry. This meant that the ideal soldier, and therefore the ideal Prussian subject, had to be light enough to ride all day without exhausting the horse. The acceptable weight for conscripting a Prussian dragoon is still with us as the range of "acceptable weight" used in public health studies. Adapted to America's greater variation of human height by substituting height-adjusted BMI for weight, the old Prussian standard of "acceptable weight" remains in world-wide "public health" use to this day.
An objective science of human health would set ideal weight to the weight at which the likelihoods of disease and death from disease are minimized. The corresponding measurement is the relative risk of death: the ideal weight is the weight at which the long term (say 12 year) risk of death is at its local minimum. In other words, the real, objective ideal weight has nothing to do with the desiderata of the Prussian General Staff. It ought to be set by measuring the facts of reality. And, from the facts measured to date, it is clear that the objectively optimal weight is nothing like the "acceptable weight" found in "public health" directives. It is almost certainly somewhere in the range that "public health" professionals call "overweight:" BMI between 25.1 and 29.9.
From the perspective of objective scientific methodology there is much wrong with BMI as the independent variable in health research. Optimal weight should be measured by plotting long-term (e.g. 12-year) mortality versus actual weight in the context of sex/gender, age and height. Unfortunately, I do not have access to the raw data that I would need to set an objective target range for my own weight. In the absence of such data, I use a target of BMI 27.5, the midpoint of the BMI range with the lowest observed mortality risk in nearly all quantitative studies to date.
The continuing use of the Prussian "acceptable weight" ranges, objectively known to be sub-optimal for human life and health, should be an epistemic scandal. It is a public folly with political uses. It permits "public health" authoritarians to claim that individual choice must be restricted to save us from the supposed epidemic of fat. Because if one accepts the Prussian pseudo-standard, 68% of Americans are overweight or obese. And this Prussian pseudo-standard is seldom challenged, because Americans "educated" in Prussian-standard public schools are so concept-deprived that they will believe anything, as long as it comes with a number and a percent sign somewhere - and will submit to the authority of the hoax.
12 comments:
Since you so strongly emphasize the link to the collectivist/statist tradition from Prussia, what's your evidence linking BMI categories to Prussian military weight specifications?
William,
Every reference on the "public health movement" in the US documents that it was a copy of its Prussian precursor, with weight categories literally copied from Prussian standards explicitly citing fitness for military service as the primary criterion of health and fitness.
The initial adoption of BMI in the US set the overweight threshold at BMI 27.8, based on North American mortality data. However, in 1999 this was changed to 25, based on IHO guidelines reflecting an "international concensus" rather than data (see the Wikipedia article on BMI for references.) Since there was no data to support the IHO "concensus," its only possible origin is the old Prussian standard.
Maybe it is a mistake to think of any ideal weight range for all people or even gender/age groups. Maybe individual variances are so pronounced that this kind of analysis is useless to the individual. But we are so steeped in the collectivist "public health" mindset and guidelines that it's hard to imagine not having such standards, or what would replace them.
I don't know enough about health to answer that, but as you point out, the current guidelines seem so unconnected to the data that I throw them out. I wish I could find a doctor who would look at me as an individual, but since I can't find one, as long as there is no specific evidence that my weight is affecting my health (mortality), I'll base my decisions on things like ability to perform the physical tasks I want to perform, flexibility, endurance, strength, and appearance (a wider definition of health that I can assess firsthand).
Also, I like to eat and being hungry negatively impacts everything I do, and these may be more or less important than the other things. All of this has to be held in full context.
Aiming for a certain BMI seems like a big waste of time to me. In fact, I might stop aiming for a certain weight and start measuring, because size is really the issue for me.
Amy: Indirect measurements (weight, circumference etc.) are less useful than whole-body scans, but until the latter become cheap enough for daily use, daily indirect measurement is better than the alternative of no on-going monitoring at all.
As for physicians - maybe you should ask, on the mailing list, about physicians in your part of the country?
What mailing list do you mean?
I meant the OEvolve Google Group.
I'm not a member right now but I'll think about that. Thanks!
This is fascinating.
May I ask your opinion of mainstream Western society's beauty standards for female(=) bodies, and feminist critiques of the same?
(=) I know for a fact that these issues are not as gender-specific as either sexists or many feminists believe; body shame is quite prevalent among men, more intense than I would have imagined, and psychologically very similar to the respective prevalent feelings among women.
Please forgive me, but I have a lover who objectively merits torment now for this fiendish mockery.
Adam, thanks for this post and for recommending asking on the OEvolve list about finding a doctor. I am now in the process of finding a concierge physician and I have a feeling it is going to be a major value in my life!
Thought-provoking, thanks.
I am wary of medical studies. In this context, note that poor nutrition habits (especially common with scrawny people who try vegetarian diet without the knowledge of how to get full set of proteins) and excercise habits (especially common with obese people) must be controlled for.
(In general the challenge of excluding possible causes by candidate selection or filtering of data is great.)
Interesting point in medical advice regarding risks of driving with health problems.
Anorexia nervosa has high risk in driving.
OTOH, angina attacks low risk for car drivers but high for motorcyclists, because they often get chilled which increases probability/severity (I forget details).
(AMA and CMA have published guidance.
Of course the [%$#W@* censored] person who drove while recovering from an eye operation - complete with pain medicine and some marijuana intake for good measure, so hit a pedestrian while turning left in the rain, who should be locked up for a long time.)
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