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Why being 'overweight' means you live longer: The way scientists twist the facts.
             by Dr. Malcolm Kendrick, M.D.

I have been studying medical research for many years, and the single most outstanding thing I have learned is that many medical "facts" are simply not true. Let's take as an example the health risks of drinking alcohol. If you are a man, it has virtually become gospel that drinking more than 21 units of alcohol a week is damaging to your health. But where did the evidence to support this well-known "fact" come from?

The answer may surprise you. According to Richard Smith, a former editor of the British Medical Journal, the level for safe drinking was "plucked out of the air". He was on a Royal College of Physicians team that helped produce the guidelines in 1987. He told The Times newspaper that the committee's epidemiologist had conceded that there was no data about safe limits available and that "it's impossible to say what's safe and what isn't". Smith said the drinking limits were "not based on any firm evidence at all", but were an "intelligent guess".

In time, the intelligent guess becomes an undisputed fact. On much the same lines, we have the inarguable "fact" that being overweight is bad for your health. I should say that, by definition, being "overweight" must be bad for your health – or we wouldn't call it overweight. But we do not define overweight as being the weight above which you are damaging your health; it has an exact definition.

To be overweight means having a BMI of between 25 and 30. Not as bad for you as obesity, but still damaging. Why else would all hospitals and doctors surgeries have BMI charts plastered on the wall with little green squares, orange squares and red squares? Green is normal weight, orange is overweight and red is obese. Even Wikipedia confirms this: "The generally accepted view is that being overweight causes similar health problems to obesity, but to a lesser degree. Adams et al estimated that the risk of death increases by 20 to 40 per cent among overweight people, and the Framingham heart study found that being overweight at age 40 reduced life expectancy by three years."

You can also find papers in prestigious medical journals such as the Journal of the American Medical Association (Jama) with the following headline: "Excess deaths associated with underweight, overweight and obesity." That certainly suggests that overweight is bad for you. However, if you look more closely at the paper in Jama, we can find these words: "Overweight was not associated with excess mortality." (My italics). Perhaps more extraordinarily, what the researchers actually found was that those who were overweight lived the longest; they lived longer than those of "normal" weight.
 
You may be surprised to find that you can have a paper in one of the world's leading medical journals entitled "Excess deaths associated with underweight, overweight and obesity", which found that overweight people lived the longest. After studying medical research for as long as I have, I am far from surprised. I regularly find that the title of a paper, the abstract, and even the conclusions often bear very little relationship to what the study actually found.

Perhaps you think I am being selective and only choosing one misleading paper. Well, here are the conclusions of another study done in Canada in 2010: "Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ (BMI > 35) are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality." I love the way they couldn't bring themselves to say "normal" BMI. They had to call it "the acceptable BMI category". This, I suppose, helps to fend off the inevitable question. If people of normal weight have shorter lifespans than those who are overweight, why do we call them normal? Surely we should call them "mildly underweight", at which point we would have to call people who are now considered overweight "normal".

You can see a further example of the weird strangulation of the language occurring a year earlier. In 2009, a German group did a painstaking meta-analysis of all studies on overweight and obesity that they could find. As with most other researchers, they found that being overweight was good for you. Of course, they didn't phrase it in this way. They said: "The prevailing notion that overweight increases morbidity and mortality, as compared to so-called normal weight, is in need of further specification."

In need of further specification? An interesting phrase, but one that hints at the terrible problems researchers have when their findings fail to match prevailing dogma; if the prevailing consensus is "if your BMI is between 25 and 29, it is damaging your health and you should lose weight", then you challenge this at your peril. The end result of this is that the titles of scientific papers can end up twisted through 180 degrees, while in others, the prose becomes ever more tortured.

Despite the fact that study after study has demonstrated quite clearly that "overweight" people live the longest, no one can bring themselves to say: "Sorry, we were wrong. A BMI between 25 and 29 is the healthiest weight of all. For those of you between 20 and 25, I say, eat more, become healthier." Who would dare say such a thing? Not anyone with tenure at a leading university, that's for sure.

In truth, this discussion should not quite stop here. For even when we get into those with a BMI greater than 30, those who truly are defined as "obese", the health dangers are greatly overestimated, mainly because of the widespread use of what I call the statistical "clumping game". Obesity researchers are world-leading experts at the clumping game. In most studies, the entire population is divided ("clumped") into four groups: underweight, normal weight, overweight and obese – obese being defined as a BMI of 30 and above. That means those with a BMI of 31 are clumped together as part of a group which includes those with a BMI of 50 – and above. What does this tell us about the health problems of having a BMI of 31? Well, absolutely nothing.

There is no doubt that becoming heavier and heavier must, at some point, damage your health and reduce your life expectancy. Where is this point? Well, it is certainly not anywhere between 25 and 30, and it could be even higher. Indeed, I have seen research on Italian women showing that a BMI of 33 was associated with the longest life expectancy. In other studies, where obesity was actually further sub-divided, those with a BMI between 30 and 35 lived longer than those of so-called "normal" weight.

So, while I cannot tell you when "obesity" becomes a major health problem, I can definitely tell you that being "overweight" is the healthiest and most "normal" weight of all.



Malcolm Kendrick is a Scottish medical doctor, author of Doctoring Data (2015), and The Great Cholesterol Con (2008).

Here's a copy of the most recent article in Dr. Jason Fung's series on Fasting.

Fasting and Hunger – Fasting 17
      by Dr. Jason Fung
           Intensive Dietary Management .com

Does fasting increase your hunger to unimaginable and uncontrollable dimensions? This is often how fasting is portrayed, but is it really true? From a purely practical standpoint, it is not. From my personal experience with hundreds of patients, one of the most consistent, yet surprising things reported is the reduction, not an augmentation of hunger. They often say things like, “I thought I would be consumed by hunger, but now I only eat 1/3 of what I used to, because I am full!” That’s great, because now you are working with your body’s hunger signalling to lose weight instead of constantly fighting it.

The number 1, most common misperception of fasting is it will leave us overwhelmed with hunger and therefore prone to severe overeating. Thus you get pronouncements from ‘experts’ like “Don’t even think about fasting, otherwise you will be so hungry that you will stuff your face full of Krispy Kreme donuts”. Funny enough, these ‘experts’ often have zero experience with fasting either personally or with clients. So why does it seem so reasonable?

Approximately 4-8 hours after we eat a meal, we start to feel hunger pangs and may become slightly cranky. Occasionally they are quite strong. So we imagine that fasting for a full 24 hours creates hunger sensations 5 times stronger – and that will be intolerable. But this is exactly what does NOT happen. Why?

Hunger is, in fact, a highly suggestible state. That is, we may not be hungry one second, but after smelling a steak and hearing the sizzle, we may become quite ravenous.  Hunger is also a learned phenomenon, asdemonstrated by the classic experiments of Pavlov’s dogs – known in psychology as Pavlovian, or classical conditioning.

In the 1890s, Ivan Pavlov was studying salivation in dogs. Dogs will salivate when they see food and expect to eat (unconditioned stimulus – UCS) – that is, this reaction occurs naturally and without teaching. In his experiments, lab assistants would go in to feed the dogs and the dogs soon began to associate lab coats (conditioned stimulus -CS) with eating. There is nothing intrinsically appetizing about a man in a lab coat (yummy!), but the consistent association between the lab coat and food paired these two in the dog’s mind.

Very soon, the dogs began to salivate at the sight of the lab coats alone (having now been conditioned) even if food was not available. Ivan Pavlov, genius that he was, noticed this association and started to work with bells instead and before you know it, he was packing his bags to Stockholm to get his Nobel Prize and taste some of those oh-so-delicious Swedish meatballs. By pairing bells and food, the dogs began to anticipate food (salivate) at hearing bells alone without the food. This was the Conditioned Response.

The applicability of this Psychology 101 lesson to hunger is obvious. That is, we can become hungry for many reasons – some of which are natural (smell and sizzle of steak) and others which have become conditioned into us. These conditioned responses can be very powerful and cause great hunger. If we consistently eat breakfast every single morning at 7:00, lunch at 12:00 and dinner at 6:00pm, then the time of day itself becomes a conditioned stimulus for eating. Even if we ate a huge meal at dinner the night before, and would not otherwise be hungry in the morning, we may become ‘hungry’ because it is 7:00. The Conditioned Stimulus (time of 7:00) causes the Conditioned Response (hunger).

Similarly, if we start to pair the act of watching a movie with delicious popcorn and sugary drinks, then the mere thought of a movie may make us hungry even though we have already eaten dinner and would normally not be hungry. The movie is the conditioned stimulus. Food companies, of course, spend billions of dollars trying to increase the number of CS that will make us hungry. The Conditioned Response is hunger – for popcorn, chips, hot dogs, sodas, etc.

Food at the ballgame! Food with movies! Food with TV! Food in between halves of kids soccer! Food while listening to a lecture! Food at the concerts! You can eat with a goat. You can eat on a boat. You can eat in a house. You can eat with a mouse. Conditioned responses, every one.

How to combat this? Well, intermittent fasting offers a unique solution. By randomly skipping meals and varying the intervals that we eat, we can break our current habit of feeding 3 times a day, come hell or high water. We no longer have a conditioned response of hunger every 3-5 hours. We would no longer become hungry simply because the time is 12:00. Instead, we would still get the unconditioned response of hunger, but not the conditioned one. That is, ‘you get hungry because you are hungry’, rather than ‘you get hungry because it’s noon’.

Similarly, by not eating throughout the entire day, we can break any associations between food and anything else – TV, movies, car rides, ball game etc. Here’s the solution. Eat only at the table. No eating at your computer station. No eating in the car. No eating on the couch. No eating in bed. No eating in the lecture hall. No eating at the ball game. No eating on the toilet. (OK, that last one is gross, but I’ve seen it!).

Our current Western food environment, of course, strives to do the opposite. There is a coffee shop or fast food restaurant on every corner. There are vending machines in every nook and cranny of every building in North America. In every conference, even at the Canadian Obesity Network, each break time is greeted by fattening muffins and cookies. Ironic and funny if not so heartbreaking. (Yes, we are doctors that treat obesity. Oh look, muffin! I’ll just eat it in the lecture hall even though I’m not really hungry!)

One key advantage of fasting is the ability to break all these conditioned responses. If you are not accustomed to eating every 4 hours, then you will not start salivating like Pavlov’s dog every 4 hours. If we are conditioned this way, no wonder we find it increasingly difficult to resist all the Mcdonald’s and Tim Horton’s stores while walking around. We are bombarded daily with images of food, references to food, and food stores themselves. The combination of their convenience and our ingrained Pavlovian response is deadly and fattening.

In breaking habits, you must understand that going cold turkey is not often successful. Instead, it is far better to replace one habit with another, less harmful habit. For example, suppose you have a habit to munch while watching TV – chips or popcorn or nuts. Simply quitting will make you feel that something is ‘missing’. Instead, replace that habit of snacking with a habit of drinking a cup of herbal or green tea. Yes, you will find this weird at first, but you will feel a lot less like something is ‘missing’. So, during fasting, you may, instead of completely skipping lunch, drink a large cup of coffee. Same at breakfast. Or perhaps replace dinner with a bowl of homemade bone broth. It will be easier in the long run. This is, of course, the same reason that people who want to quit smoking often chew gum.

Social influence can also play a large role in eating. When we get together with friends, it is often over a meal, over coffee, or some such dietary event. This is normal, natural and part of human culture worldwide. Trying to fight it is clearly not a winning strategy. Avoiding social situations is not healthy either.

So what to do? Simple. Don’t try to fight it. Fit the fasting into your schedule. If you know you are going to eat a large dinner, then skip breakfast and lunch. One of the easiest ways to fit fasting into your life is to skip breakfast, since that meal is very uncommonly taken with others and, during working days is easy to skip without anybody noticing. This will quite easily allow you to fast for 16 hours (16:8 protocol). Also, unless you go out to lunch every day with the same crowd, lunch is also quite easy to miss without anybody noticing during the work day. This allows you to ‘slip in’ a 24 hour fast without any special effort.

So, in essence, there are two major components to hunger. The unconditioned biological stimuli – that is, the part that will normally stimulate hunger naturally (smells, sights, and tastes of food) and the conditioned stimuli (learned – movie, lecture, ball game). These CS do not naturally stimulate hunger, but through consistent association, have become almost as powerful. That is, the movie, the TV, the sight of McDonalds, the sound of a jingle etc. They have become hopelessly intertwined but they are by no means irreversibly so. Simply change out the response (drink green tea instead of eat popcorn). Fasting helps to break all the conditioned stimuli, and thus helps to reduce, not enhance hunger. Hunger is not so simple as your stomach being ’empty’.

So – here’s the real question – does fasting lead to over-eating? This was answered in a study published in 2002. 24 healthy subjects underwent a 36 hour fast and then caloric intake was measured. At baseline, subjects ate 2,436 calories per day. After a 36 hour fast, there was an increase in caloric intake to 2914 calories. So there was a degree of over-eating – almost 20%. However, over the 2 day period, there was still a net deficit of 1,958 calories over 2 days. So the amount ‘over’ eaten did not nearly compensate for the period of time fasting. They conclude the “a 36 hr fast..did not induce a powerful, unconditioned stimulus to compensate on the subsequent day.”

Here’s the ‘spare me the details’ bottom line – NO, fasting does not lead to overeating. No, You will NOT be overwhelmed with hunger.

For more about Dr. Fung's fasting series and direct links to those articles, see: Helpful Fasting Information.  DietHobby also has a direct link to his website in Blogs of Interest which can be found here under RESOURCES, Links.

Also, for easy Access to further articles and information about Fasting here at DietHobby, look on the right hand side of this page for Fasting under the section entitled: BLOG CATEGORIES.