Living Well Trumps Dying Late

By Susan B. Roberts, PhD

When I was young, an old friend with heart disease, cancer and impending kidney failure used to tell me “old age isn’t for sissies.” He may have just been quoting Bette Davis, but it’s profoundly true that middle aged and elderly folk with chronic health problems have a tough life – which is why many reports on the new study of obesity and lifespan miss the point.

The now widely-quoted meta analysis of 100 previous studies showed that people who are merely overweight (Body Mass Index, BMI, 25-30) as opposed to seriously obese don’t die sooner than non-overweight people. For somebody like me, who is 5’5” and 133 pounds, that means I could gain 80 pounds before I risk dying early. A man of 6 feet can be 260 pounds before life is shortened.

Of course, the study almost certainly underestimated the negative effects that being overweight confers on years of life. It included excessively thin people in the normal-weight group, who have health problems of their own and therefore made being obese look better than it actually is. But even if the results of this latest research were not skewed, the bigger issue with obesity has always been quality of life rather than length of life. Being obese might not kill us, but being hobbled by additional years of pain and disability is not an attractive prospect.But many obese people will not be rejoicing. They are too hobbled by heart disease, arthritis, diabetes, and other number of ills that are correlated with being overweight. And they will also likely come to wish that the article had never been published, after being subjected to negative push back from obese friends and family when they try to eat sensibly and look after their weight.

Well established links between health and BMI show that the fatter you are, the greater the risk of virtually all the common debilitating diseases including (but certainly not limited to) diabetes, heart disease, stroke, most cancers and arthritis. So maybe with excellent medical care we can avoid dying early if we gain weight, but that won’t stop the debilitating health problems caused by obesity in the meantime.

Getting down in the weeds of the effects of these health problems is shocking. To take just one example, the lifetime risk of diabetes is nearly double for somebody who is merely overweight compared to a non-obese person. And since diabetes amplifies the risk of other grave problems we don’t want, like stroke, blindness and even amputations (necessitated by gangrene, which is common in people with diabetes) – a diagnosis of diabetes leads us further down the path of disability. Indeed, even in this terrible economy, long-established businesses that make prosthetic limbs are booming, with profit increases of more than 50% in just the last few years — because the rising rates of diabetes are keeping them busy.

We can also factor a loss of brain power into the equation. A solid majority of studies show that, over time, obesity accelerates the cognitive decline that typically occurs as we get older.There is no need for complacency even in those who refuse to worry about diabetes or a heart attack. Men who are overweight are nearly twice as likely men with an ideal BMI to have erectile dysfunction and reduced sperm count. Overweight women have a 50% increased risk of urinary incontinence, and those of childbearing age are at increased risk of infertility and labor complications (if they do conceive) including caesarian section and physical injury of their baby during delivery.

Looking after our weight is not, to state the obvious, something that happens spontaneously in our toxic food environment. However, it clearly is possible. Even older research trials like the NIH-sponsored Diabetes Prevention Program, which achieved an average weight loss of only 15 pounds, found a dramatically reduced risk of diabetes.

It would be easy to distort the new study to write articles about how science has hoodwinked us and obesity doesn’t matter, but the reality is that weight control was never just about preventing premature death. What matters most to most of us is avoiding disabilities and leading our best life while we are alive.

Susan B. Roberts, PhD, is a professor of Nutrition, professor of Psychiatry and Scientific Staff Member in Pediatrics at Tufts University and Tufts Medical Center, author of Feeding Your Child for Lifelong Health (Bantam 1999) and The “I” Diet (Workman Publishing 2010), and co-founder of Instinct Health Science Inc.