An article on BBC.com stirred up controversy this week, publishing the finding that:
…those who were overweight had an 18% reduction in dementia – and the figure was 24% for the obese.
“Yes, it is a surprise,” said lead researcher Dr Nawab Qizilbash.
He told the BBC News website: “The controversial side is the observation that overweight and obese people have a lower risk of dementia than people with a normal, healthy body mass index.
“That’s contrary to most if not all studies that have been done, but if you collect them all together our study overwhelms them in terms of size and precision.”
As you might imagine I’ve received a number of requests for comment (we’re way over The 100 Rule) and I’m glad that people are asking because there is a lot of questionable stuff here. According to the study’s authors, they undertook the study because “Obesity in middle age has been proposed to lead to dementia in old age. We investigated the association between BMI and risk of dementia.” I’m aware of this belief because it is often quoted at me as if 1. it were truth and 2. the natural conclusion is that fat people should lose weight to reduce dementia risk, but we’ll get back to that in a minute. The authors concluded that:
Being underweight in middle age and old age carries an increased risk of dementia over two decades. Our results contradict the hypothesis that obesity in middle age could increase the risk of dementia in old age. The reasons for and public health consequences of these findings need further investigation.
This study has all the same limitations of any study that produces results based on correlation. Basically, it’s just finding how often that things happen at the same time, not what, if anything, causes them to happen at the same time. Hence the researchers correctly explaining that these findings need further investigation.
What I do think is interesting is the way that the media is treating this study – that shows health benefits correlated with being fat – as opposed to how it treats studies that show health benefits correlated with being thin. To demonstrate, I thought that we might compare and contrast this article with one the BBC.com published in 2013 about some studies that showed that obesity might increase the risk of dementia.
Let’s start with the titles:
2015: Being overweight ‘reduces dementia risk’ which I’ll call RDR for short
vs
2013: Rise in obesity poses ‘dementia time bomb’ which I’ll call DTB for short (trigger warning, obviously.)
Hmmm… “reduces demetia risk” vs “poses demtia time bomb” I would call that, at least, an interesting difference in word choice. Moving on…
Mentions of the purported cost to society of people who are at a higher risk of contracting dementia based on their size:
DTB: 3 mentions, including a large font section header
RDR: 0 mentions. Also, no mentions that they may have been wrong when they blamed fat people for costing the world 1.4 billion dollars
Mentions of the lack of a causal relationship/limitations of the studies
DTB: None. Instead: “This study highlights the impact obesity will have on the numbers of people with the condition in the future.” (emphasis mine)
RDR: One: “Any explanation for the protective effect is distinctly lacking” (also see below re: “Analysis” section
Mentions of other health issues correlated with being the size that has a higher correlation to contracting dementia:
DTB: 6 mentions
RDR: 0 mentions (though they do mention 5 times that being in the lower risk group for dementia is correlated to higher risk for other diseases)
Mentions of changing body size as a way to reduce dementia risk
DTB: “maintaining a health weight [is] hugely important in reducing your risk”
RDR: “not an excuse to pile on the pounds” (points for alliteration if not for content)
RDR also contains an additional component – an “Analysis” section wherein the BBC Health Editor discusses, including quotes from other scientists, the limitation of the study and also says “These results do not seem to be an excuse to eye up an evening on the couch with an extra slice of cake.” I guess I must have missed the class that explained that “analysis” means “conflate body size with behaviors in the most unscientific way possible.” Although the exact same limitations (and some additional limitations because of size and scope) exist for the studies discussed in DTB, absolutely no analysis is given to clarify that.
When you read a lot of articles like this it becomes very difficult not to notice that any report that suggests that there are correlations between being healthy and being fat contain admonishments that it’s not a good reason to stay or become fat, but any reports that suggest that there are correlations between being healthy and being thin insist that it’s an excellent reason to stay or try to become thin.
The thing about correlations is that one thing might cause the other, or it could simply be coincidence, or they could be caused by a third unknown factor. When we look at correlations between larger body size and health issues it’s important to realize that negative health issues could be caused by a third factor – whether that’s the psychological stress of constant stigma and oppression (the kind that reporting like DTB contributes to), the physical realities of living in a world (including a healthcare system) this is not built to accommodate you, the physical stress of going on repeated diets and spending a good part of your life feeding your body less food than it needs to survive in the hopes that it will consume itself and become smaller, or something else. Especially in the case of dementia, where nutritional deficiencies are one of the possible causes being investigated, it is does not exactly smack of rigorous science to not consider and study the affects of intentional weight loss attempts, or purposeful under-eating to maintain a body with a certain height/weight ratio.
Another dangerous incidence of poor reporting is the constant conflation of body size with habits:
There is no cure or treatment, and the mainstay of advice has been to reduce risk by maintaining a healthy lifestyle. Yet it might be misguided.
WT actual F? You cannot substitute “maintain a healthy lifestyle” for a body size. You just can’t, at least not while calling yourself a scientist or a science writer. First of all, because what actually constitute a “healthy lifestyle” is widely debated, and even if it wasn’t there are thin and fat people who maintain the exact same behaviors around their health and have vastly different body sizes. NONE of the studies that are being talked about in these articles took lifestyle into account – they just look at body size which is not the same thing as behavior. It is completely ridiculous to suggest that if being fat reduces the risk of dementia, that means that advice to maintain a healthy lifestyle is misguided.
Or how about this gem:
But Dr Qizilbash said the findings were not an excuse to pile on the pounds or binge on Easter eggs. “You can’t walk away and think it’s OK to be overweight or obese. Even if there is a protective effect, you may not live long enough to get the benefits,” he added.
Let’s be clear about what’s happening here. Dr. Qizilbash, whose study just showed why we should be careful when we make assumptions based on correlational findings about body size and health, is now making declarations based on correlational findings about body size and health. Also fat is not the same as “binges on Easter eggs” (and “binge” has a real definition when it comes to eating disorders) so, while I understand that the media can be problematic when it comes to reporting science, can actual scientists please, for fuck’s sake, refrain from spouting bullshit stereotypes to science reporters or, you know, at all.
I think that a big part of the problem is that the media is either ignorant to the basic tenets of research, or they just don’t care as long as they get eyeballs, and so they report these things in ways that are massively misleading. That gives people misinformation about their own health and health risks, it also serves to fuel the fire of the anti-fat-people mob.
This type of reporting also contributes to healthism, ableism, and the misconception that health is completely understood, an obligation, barometer of worthiness and within our control, as well as the misconception that public health is about making the individual’s body the public’s business rather than about giving good information (including talking about the limitations of that information) and reducing barriers to accessing the food people want to eat, the activities in which they might want to participate, a world in which they do not face stigmatizing, bullying, or oppression, and appropriate evidence-based healthcare. At worst the so-called science and health reporting that we get is grossly misleading and at best it’s reader beware.
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Slow clap for Ragen Chastain. You left that piece dissected like a med school cadaver. Well done.
Excellent piece! It has always seemed to me that the emphasis on “thin” is purely a social construct, not a medical one. Obesity research is forever demonstrating that the insistence on being thin (let’s face it, primarily on women) has very little to do with health and more to do with social mores of Western culture. This finding about dementia, or the one about weight gain in middle age as a protection against heart attack and stroke is a challenge for media, health practitioners, family members et. al, Culture is a hard nut to crack.
Ah, you’re so good at explaining the logic – or lack thereof – of such studies, thanks a lot!
As for “You can’t walk away and think it’s OK to be overweight or obese. Even if there is a protective effect, you may not live long enough to get the benefits,” – even if this weren’t bullshit, of course I can! I could, for example, if all these correlations really were cause and effect, quite deliberately choose a lifestyle that protects me from dementia, because either I would die young or my fat would protect me in higher age. I could deliberately choose to live a little bit shorter, but with much more satisfaction and fun in the time I live. Things like that seem to be totally unimaginable to all those scientists.
Yeah, because who wants to be old and “healthy,” but too lost to be able to function? I sure don’t.
Short and full of life is better than a long and lonely life, trapped in a maze of my own memories.
That seems to be a trend among scientists that I have seen too. All these anti-aging “treatments”, creams, and lifestyles ignore what real people do and believe. There was one article I read that said retirees wished they hadn’t worked so long so they could’ve spent more time with the kids, and that they didn’t live so old. Scientists can’t grasp this, and are stunned when their patients/ordinary people want the exact opposite.
Michelle on Fat Nutritionist also had a post about this several years ago, that doctors seem to be afraid of death, and that fear drives questionable medical care. If they are afraid, they want everyone else to be too. “Oh noes, you got the diabeetees, yer gonna die!!!!” Among religious folk that I know, there is no fear of death, only the place you go after you die (heaven or hell) so they focus on their actions in this life so that they are set up right for death.
I don’t know if you meant dementia here right above the quote about easter eggs, instead of obesity but it did amuse me: “being fat reduces the risk of obesity”
And DTB turned into DTR part way through your post.
I did indeed mean dementia 🙂 Both issues are fixed, thanks so much for letting me know!
~Ragen
I think, for me, I’m too used to reading for content as opposed to tone. I agree with all you have said here, even if I believe that there is some truth to the actual research numbers. Mainly for this reason. Mylein sheaths. They are formed form fat. They are vitally necessary to the nervous system. So to an extent the fact that any research started to finally show a sign of common sense was also interesting to me. I don’t think language will change that quickly but we need all the voices to keep these things in mind and help remind people that it is denigrating to people.
I love your bat!
Ragen, this is one of your best. I hope you edit a bit and submit as an op ed to some main stream media.
I hope so too, it’s such a great study which could have helped dispel weight-health assumptions but instead was ruined by the conclusions and “disclaimers”. When the study came out I liked the science part but immediately noticed the major issues with the interpretation part, which all too often clouds the promising research usually labeled under the term “obesity paradox” which is flawed as well – health at every size shouldn’t ever have to be a paradox especially when it is scientifically proven to be fact, as these studies prove all the time 🙂 I have spent a while looking for an article that didn’t put down the results of the study or portray them as “shocking” or counter-intuitive which would be wrong. I did find a better article that’s still flawed (warning – unfortunately a face-less photo is used for the illustration) but it’s a little nicer on the results, it’s on Fox News haha 🙂 It sure beats the BBC one though. http://www.foxnews.com/health/2015/04/10/gaining-weight-in-midlife-may-decrease-dementia-risk-study-suggests/
Great comparison of the two articles!
Working on my PhD and doing research I have so many peeves about the way so many people talk about research. One thing too is that most folks who don’t work in research treat it as gospel without even understanding it- truth is, a lot of shitty research still gets published in peer review journals. And peer review is not perfect, it is important but it does not guarantee great research. Also there is a lot of shit people can do to get results or make results seem more important than they are (see p hacking for just one small example of that).
Another thing though is people treat limitations of studies as if they don’t exist if they like the results or like they completely invalidate the study if they don’t like the reults. Which makes me so frustrated because there is no perfect study! Every design has limitations!
So correlation studies aren’t bad, as long as we don’t pretend they prove cause. But here we have people acting like some correlation studies prove causation, but then this other correlation study they say “oh, but there are all these limitation so really it’s meaningless!”
“‘binge’ has a real definition when it comes to eating disorders”
YES!!!!! I hate when people talk about “binging” to just mean eating a lot of something considered indulgent or worse to just mean eating over a particular calorie limit. That is not a binge. Especially when people talk about enjoying it. There is nothing enjoyable about a binge! And it’s not really about how much is eaten, what separate a binge is the emotional aspect- it’s the feelings that drive and accompany the behavior- feeling out of control, feeling disgusted, et cetera. Just like other disordered eating behavior. If I go long periods without eating because I’m nauseous or a medication of mine has a side effect of causing me to not want to eat that is not the same as if I was not eating out of an extreme fear of weight gain and in order to feel a sense of control. Similarly eating a lot in one sitting because you just enjoy the food, or you are really hungry is NOT a binge (which is disordered eating behavior).
Yes, but I think that is just what the common use of the word “binging” wants us to believe – nowadays eating a lot in one sitting just HAS to come with feeling out of control and disgusted, because eating a lot is always bad. Eating a lot just because you enjoy the food? That seems to be the same as enjoying torturing animals nowadays – something that just shouldn’t happen. So the use of the word binging wants us to believe that if we don’t feel disgusted already, we sure should. And if we don’t already see eating a lot in one sitting as an eating diorder, we sure should – that’s the message I see in this.
In Europe cigarette packs have to have big warnings on them “smoking can kill you” “smoking can cause lung cancer”, things like that, don’t know how it is in the US. And they are always discussing labeling of food, too, if it is seen as too salty, too much fat, soo much sugar, whatever. So food seems to be a drug nowadays and someone who likes to eat a sort of addict?
Is there a large number of people who are purposely trying to become fat for some reason?
I’m thinking of this quote: “not an excuse to pile on the pounds”
I’ve seen a lot of this attitude in stories about fat, as though the majority of the population is secretly hoping to find an excuse to spend a week getting as fat as possible, as opposed to weight gain (or loss) being a part of life.
Yes. Totally agree. They seem oblivious to the fact that the current societal climate is against enjoying food, and pro-thin.
Like they have to remind us not be remiss about our “religion”.
A: “That’s contrary to most if not all studies that have been done, but if you collect them all together our study overwhelms them in terms of size and precision.”
B: “You can’t walk away and think it’s OK to be overweight or obese. Even if there is a protective effect, you may not live long enough to get the benefits,” he added.
So where’d he find that “overwhelming” sample of old fat people he got these resulst from, if no countable percentage of fat people are living that long?
*results. I need to not hit reply so fast.
Indeed, I am always pretty much amused by the way scientists put those things.
Headline: a study found some health benefits associated with obesity, results: benefits associated to higher BMI, conclusion: never ever try to be fat, or you’re gonna diiiieeeeee.
Like if you could literally read: I hoped for pretty much something different… And you know.. Worse. Sorry to tell ya’ll.
Blah..