Obesity Paradox Not a Paradox

waist-hipA diabetes study found that being overweight is linked to better survival, and being thin is the biggest risk (Costanzo et al 2015).

This finding—that the overweight are healthier—is a paradox that perplexes doctors and academics. For instance, look at the timid way the researchers from the aforementioned study phrase their conclusion:

Conclusion: In this cohort, patients with type 2 diabetes who were overweight or obese were more likely to be hospitalized for cardiovascular reasons. Being overweight was associated with a lower mortality risk, but being obese was not.

Essentially, the researchers are apologizing for their findings, emphasizing cardiovascular hospitalizations instead of mortality, then saving their last phrase “but being obese was not” as a trick to make it sound like obesity was found to be bad.

In response to the study, in this MedPage Today piece, dressed-up reasons are given for the paradox:

  • poor study design
  • BMI was only measured once
  • treatment of type 2 diabetes may influence body weight
  • patients with lower BMI may have already been ill for reasons unrelated to diabetes
  • the people in the overweight/obese group may have been ‘sicker’, and more likely to be put on meds which lowered their risk of death
  • “reverse causation”: not that being overweight confers a survival advantage, but that salient survival advantages related to overall health and social circumstance are associated with keeping on the extra weight that caused the type 2 diabetes in the first place

How salient is it, really, to say that this whole obesity paradox is from fat people having more friends? Then, the article caps off with this:

The results of the new study are “unsettling,” according to Keith Ayoob, EdD, RD, at Albert Einstein College of Medicine in New York City, because they run contrary to expectations. “The results end up producing more questions than they answer,” said Ayoob in an email to MedPage Today. “You’d expect to see a higher risk of cardiovascular problems as degree of obesity increases.”

And this:

“These types of studies — observational with a lot of important factors missing — need to be very carefully interpreted and their results not exaggerated,” said Kitchin. “I don’t think we should be making any clinical decisions based off of this study.”

Wow, tell the truth and your peers will hammer you in an ode to pedantry and status quo. Telling the truth is just so unsettling.

Well, buck up, Pierluigi Costanzo and Hull York Medical School. You did great with this study, and thanks for telling the truth.

The obesity paradox comes from heavier people having a greater stockpile of benelles. Overweight people have more benelles than normal and underweight people.

Benelles are the foundation of health. Indeed, they are so powerful that even if a portion remain healthy, they will pull immense weight, evidenced in the study by the fact that overweight people had more hospitalizations for cardiac events, but lower mortality. The corpulent can live in a reasonably healthy state with hearts in a state of partial failure because surplus heart benelles will pick up load, plus benelles in supporting organs like lungs and kidneys will chip-in more.

More corpus means more benelles. And mote benelles means more soldiers working together in an intelligent system. As your heart sickens, surplus lung cells pull more oxygen, and extra kidney benelles will allow continued good filtering, even with less blood flow. As morbidity increases and benelles die, a greater number of benelles (i.e. more corpus) in the bank yields a longer draw-down period (i.e. longer life).

The “secret medicine” of current healthcare is benelle draw-down. Most of our healthcare is based on drawing down benelles in surrounding healthy organs to provide temporary relief of a sick organ. This is illustrated by mainstream treatment for peptic ulcer, which reduces risk of ulcer by 5.9% but increases your risk of serious adverse health events and death.

To me, an increased chance of death or adverse event is not worth a 5.9% reduced risk of ulcer. However, this trade-off is what our government, doctors, and educated class consider the healthy and scientific path. In reality, it’s a way to use chemicals to slightly halt ulcers by “plucking” benelles from around your body such that you tend to die more quickly overall. Plucking is felt as side effects.

The obesity paradox will be shown again and again in honest studies. Yes, the hearts of the overweight may be sicker at face value, but they will be healthier overall. This is because benelles are organic medicine, and heavier people have more of this medicine. If we think of healthcare as a predator of benelles, those with more to start with will, in general, stay healthy longer.

Citations: 
Costanzo P, et al “The obesity paradox in type 2 diabetes mellitus: Relationship of body mass index to prognosis” Ann Intern Med 2015; 162: 610-618. doi:10.7326/M14-1551