Monday, March 30, 2009

If You Like Gina Kolata! or Fat is Phat.

Just finished Rethinking Thin: The New Science of Weight Loss---and the Myths and Realities of Dieting by Gina Kolata. Much food for thought.

Most diets succeed only for a short time and then people gain back the weight. Overweight people appear to have a lower death rate than thin and normal size people (and the really obese). According to studies by Dr. Katherine Flegal and her team, the best BMI to have is between 25 and 30. As Kolata wrote both in the NYT and Rethinking Thin, challenging the belief that being overweight makes you unhealthy treads on political questions as much as scientific ones. Kolata reports and others concur that the Harvard School of Public Health using data from the Harvard Nurses Study went after Flegal's research with untold and unprecedented vigor. I am intrigued by the methodology issues here but I am not sure I can solve them since I am hardly a statistician of the sort Flegal is. It is interesting to have your core values challenged. Everyone thinks being fat is bad. But being a little bit fat is not so bad according to Flegal and an anthropology study also published in 2005.
Kolata also reported about the effects of bariatric surgery, a procedure of particular interest to us this week. Bariatric surgery does help eliminate diabetes, lower cholesterol and lower blood pressure but the latter two are only affected in the short term. After a few years, BP and cholesterol go back up. Thankfully the diabetes remains treated by the surgery which is as good a reason as any to get it. Also, most people do lose weight that they are more likely to keep off after bariatric surgery than any other weight loss method. Kolata only touches on this issue since the phenomenon has been growing in recent years as surgeons get better and more people elect lap-band than gastric bypass surgery. Lap-band surgery is heavily promoted here in LA. Billboards and television commercials scream at you to Get the Lap-Band! This particular center will take anyone with a BMI of 27 or more which is different from most practitioners who look for someone who is 50 pounds or more overweight. It also takes PPO insurance and promises you the procedure is 100% reversible without telling you that insurance won't pay if you change your mind.
I am happy to be pleasantly plump and within the magic BMI range. Think I will have another Weight Watcher's ice cream bar!

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