Some conditions like COPD (emphysema/chronic bronchitis), cause to use a LOT of energy and calories just to breathe. Patients with such conditions need to consume more calories to maintain their weight and when they’re ill (like many other folks), they lose muscle first and have a very show and hard road to regain it.
Many of our patients who have died got quite thin as they got closer to death and would lose a significant amount of muscle mass every time they got a serious infection. I suspect similar situations occur for folks with other health conditions.
I’ve been at a pretty stable weight for most of my life, as have most of my close relatives and H. Our family tends to live long anyway, so I’m not sure how this or other studies apply. Most my relatives are close to their “ideal BMI.” The one sib I have who is higher BMI is the youngest and unhealthiest of all of us. My folks are 86 and 90 and have been pretty stable & close to ideal BMI all their lives.
I would love to be able to just toss cares to the wind and allow the weight to roll on. Unfortunately, even when I am 10-15 pounds over my normal/ideal weight, I become full on Type 2 diabetic. Ugh. I truly have had patients who weigh double my weight who have had better Hgb A1c (a three month blood glucose average) than I do when I am just 10 lbs overweight. More interesting to me would be what protective factor those patients seem to have that keeps them from developing all the stuff we think will happen!
The BMI-overweight weights that are in the low risk part of the curve are probably up to around 20-30 pounds over the top end of the BMI-normal weight range, not 100 pounds over.
I grew up with the MetLife ideal weight tables that had 3 classes of frames, S, M & L. The humor is even bigger than with BMI. I found the 1999 tables - I assume others are online but I don’t know - and according to it, unless I’m magically a large framed person, which is clearly untrue, I should weigh at least 15 lbs less than I do. I once hit that weight as an adult … when I was a vegan … and I could barely maintain that weight and was hungry all the time (in fact, until I stopped being a vegan). Since my frame is somewhat “smaller” I really should, it seems, weigh slightly more than my bones, organs and a glass of water.
In terms of science, when you begin with crap like BMI, you get crappy analysis.
I think the MetLife tables were the ones that said in the small print that the height figures assumed two inch shoes. As a six-foot tall woman, I wasn’t covered by those tables since they assumed that women didn’t come in heights above 5’10". This may have been the version of the tables published earlier than the nineties but I remember thinking that they were veey funny.
I believe there is some truth to this to some extent.
That’s probably a reason why in many Chinese/Chinese-American families I’ve been a part of/known, there’s a preference to being slightly heavier than too thin…especially among older generations. Granted, a part of that was the older generation(old enough to have lived through/remember the Second Sino-Japanese War(1937-1945) remembered growing up with serious food insecurity during this period due to the war and having to flee the Japanese army.
I’ve wondered whether the BMI and weight/height scales took body frames/bone structure into account. For instance, according to most weight/height scales in doctors’ offices, I should be fine weighing between 131-182 pounds. However, I felt the worst when I weighed at the higher end of that scale in the upper 150s/lower 160s(Spending 70-90 hr workweeks in office working overtime/weekends) and best when weighing somewhere below 135.
Heck, I feel great atm even though my current weight places me at 17.6 BMI which means I’m technically underweight. And I do exercise frequently and my work does require me to lift heavy items on occasion(up to 50 pounds).
Let’s see…
Check on the walking part. I average around 1-2 hours every day/every other day.
No check on drinking 4-7 servings of alcohol a week. I have done that one evening back in my early 20s…but can go months without touching a drop of alcohol and not care one way or another.
Check on staying active in engaged work of some kind
No check on 10-20 pounds over ideal weight. In fact, I’m a few pounds under my lowest part of my ideal weight range atm…but feel great. Incidentally, 10-20 pounds over my ideal weight on BMI/most doctor’s weight/height scales I’ve seen would place me at around 200 pounds. NO THANK YOU.
Presumably, at higher weights, you gained mostly fat rather than muscle, correct? If that is the case, then, at higher weights, you were probably in the state of “normal weight obesity” or “skinny fat”, so it is no surprise that you would feel worse then.
It was a mix of both as I was also doing more heavy lifting of computer servers and large heavy boxes of documents from one part of the floor/building to another along with others in my workgroup.
Ironically, everyone who has seen what I looked like then compared with now felt I looked “healthier” back when I was at the upper-end of my “normal” weight range than now. Now I’m “too thin/skinny”.
Interesting read. I think I’ll adjust my target weight accordingly. Having taken off 30+ lbs definitely helped blood sugar levels, but it seems there might be no need to drop the additional 20 to get “within range.”
I don’t become diabetic with 10-15 extra pounds, but I head that direction, going into metabolic syndrome with high blood pressure, weight concentrated in the abdominal area, and high fasting insulin levels, and pre-diabetic A1c.
My stepmother has been morbidly obese for decades and has never even come close to being diabetic. I don’t get it. Of course, she has tons of other obesity related illnesses, so it’s no picnic for her.
I’ve read over and over in studies that the strongest predictor for longevity and good quality of life in old age is FITNESS, not weight. I think it is possible to be very fit and overweight. It’s not so likely to be fit and obese or morbidly obese.
I’ve observed the healthiest geriatric patients I have are those who are fit and active, and always have been. They have FAR fewer issues with arthritis and mobility problems, are on far far fewer medications, and have a good attitude about life. Those who have been sedentary most of their lives, whether they are thin or heavy, are on pages of medications, have constant aches and pains, can hardly walk, much less exercise, and in general are neither well nor particularly happy.
I am with you, Nrdsb. An overweight person can be both overweight and fit, but I don’t think it is possible to find an obese fit person (a bodybuilder with next to zero body fat is not necessarily a fit person either).
I am reading a very interesting book on weight and athletic performance, Racing Weight. It is aimed at an average age grouper who either wants to begin athletic activity such as running or improve performance. Good, down to earth advice that would be helpful to anyone. The book does not advocate dropping as much weight as one can, but rather gives guidelines on how to balance muscle/fat ratio and find the optimal weight.
Knew a CA patient who was obese and then couldn’t eat. Literally. It was said that if he had NOT had the extra weight on him that he most likely would have died. He beat his CA–70 lbs. lighter.
Can’t argue that maybe he wouldn’t have had CA if he’d been healthier etc. but the extra weight was a blessing at the time.
Wow, that book sounds exactly like what I’m looking for - thank you @BunsenBurner.
Just signed up for my 4th half-marathon; at 45 I want to train smarter and not longer/more miles. I also know that running - alone - does not help me drop much weight.
I’ve always been somewhat overweight, but in the last two years, despite no changes in eating or exercise, I’ve gained about 20 pounds, pushing me into the obese territory–which is terrifying. OTOH, I am not sure you’d call me “fit” but my blood pressure, sugar, cholesterol, and any other marker would say i am. So, whatever. Almost all my excess weight is below the waist, so that’s one possible reason.
I am 52 and skinny. I don’t starve myself, but my family is genetically predisposed to thinness. I work out by swimming, cycling, and lifting weights to cut my risk of osteoporosis. I may die early, but it won’t be my fault!
@Massmomm, if you are FIT, that decreases your risks of dying early compared to people who are thin but not fit or thin but smoke or thin but have risk factors for other conditions.
