Let me preface this by saying unequivocally: all obesity is unhealthy and should be changed. That isn’t questioned by me at all, not by any sane person.

However, is all obesity the same?l I don’t mean the guy who is 35lbw overweight vs the guy who is 135lb overweight.

To put it another way… Is obesity itself, the act of carrying around the extra fat, the direct problem? Or is it the common issues that come along with obesity like high blood pressure, diabetes, breathing difficulty, cholesterol, and so forth?

Let’s take two different people.

Person A is me, literally. I am well into morbid obesity by weight and BMI. I weigh over 400lbs but am actively losing weight. I’m relatively tall, though, to look at me, while it is patently clear I’m fat, I don’t appear to be a beach ball. My fat is carried much more evenly across my body. I’ve had recent blood work done and I had a completely clean return. Blood pressure is always fine, if a properly sized cuff is used. No trace of diabetes. Cholesterol levels aren’t just ok, they’re fantastic. I get winded faster than a smaller guy, when I’m working out, but that seems to be expected. My heart rate day to day is well within typical ranges. My Apple Watch reports good heart rate response to exercise and, what I think is decent recovery after exercise. Sleeping heart rate is good and has a solid dip most nights…for what it is worth, my Watch tells my my sleeping HR Dip is always well into the GOOD range and often tips out the chart on the good side. I work out 5-8 times a week… a combination of weight lifting and intensive cardiovascular stimulating circuit training. Weight lifting will give me an average HR in the 128-133 ballpark for 60-80 minutes. The circuit training is more like 150 for 45 minutes.

Person B is a relative who recently passed of covid. He is substantially shorter to me and had that beach ball, waddling penguin look. He likely was lighter than I was, but he had the full list of “fat people problems”. He had extremely limited mobility, couldn’t breathe well before covid, diabetes, hypertension, the works. He was the warning poster you see at the doctors office.

Yes, there was a HUGE disparity of age and I know that is a vitally important factor as well, but let’s assume it wasn’t there. Let’s assume A and B are both in the 35-40 range. They exist for sure.

These people, though both morbidly obese, couldn’t be more different. Right? While both need to lose the weight to increase their health I don’t think it is accurate to say the my risks when contracting COVID are the same as his.

Am I right or am I off base?

Watching this. IM 6'0 and 375. But I have a big chest, so I "carry it well". But yes, anyone looking would say, that there is a BIG boy. I don't exercise but BP is ok, no diabetes and cholesterol is a bit high but not whacko, Dr. recommends against statins as I am 45.
Who knows. One of my best friends, 5'5" 140 lbs wet, peloton junkie, keto eating pansie boy just got nailed for a quad bypass at 55. On paper I should be dead compared to him.

quote:

Originally posted by Timdogg6:
Watching this. IM 6'0 and 375. But I have a big chest, so I "carry it well". But yes, anyone looking would say, that there is a BIG boy. I don't exercise but BP is ok, no diabetes and cholesterol is a bit high but not whacko, Dr. recommends against statins as I am 45.
Who knows. One of my best friends, 5'5" 140 lbs wet, peloton junkie, keto eating pansie boy just got nailed for a quad bypass at 55. On paper I should be dead compared to him.

Another example of my thought process. Thanks for helping add context. Genetics must play a huge role in all this.

Looking forward to the discussion.

Oh, and I’m on no meds, to answer the question that may come up.

I’ve heard something about hip to waist ratio being a valid indicator. Any thoughts on that, anybody?

And then, there are the "side effects" of many prescription and OTC medications.

Such as "Flu like symptoms".

quote:

However, is all obesity the same?l I don’t mean the guy who is 35lbw overweight vs the guy who is 135lb overweight.

^^^^^^^^^^^^^^^
No. There are multiple causes and comorbidites not caused by obesity. People overeat for many different reasons. Many of them are psychological.

quote:

Person B is a relative who recently passed of covid.

I don’t think it is accurate to say the my risks when contracting COVID are the same as his.

Am I right or am I off base?

When you say "passed" - like dead?

Not obese by any means. But reading this thread.

5'9" 160 lbs, small statued..
Age 52 I weighed 200 lbs, all at my waist , wore size 38 waist pants . After going through cancer. Lost down to 100 lbs.
Honest.
Years afterwards gained back up to 180, but have lost down to 160. Size 34 waist pants. But I still have a slight tummy. Muscle tone perhaps.

If a persons weight does not affect their health over a span of years. Is it really a problem?

quote:

Originally posted by smschulz:

quote:

Person B is a relative who recently passed of covid.

I don’t think it is accurate to say the my risks when contracting COVID are the same as his.

Am I right or am I off base?

When you say "passed" - like dead?

Yes. He passed away a few days ago. He was elderly and not healthy by any metric. Nobody was surprised at the outcome, I’m afraid. For the record, he was vaccinated several months back.

I'm a little overweight but with a family history of heart trouble, high blood pressure ,etc.
I've room for much improvement in lifestyle and need to get back to exercising more. Covid made the wellness center gym close.

Being overweight doesn't mean as much in a younger person but catches up to you in time. I remember a doctor asking me, "Do you ever see an old fat person?" No, not really.

quote:

Originally posted by Sunset_Va:

If a persons weight does not affect their health over a span of years. Is it really a problem?

Interesting way to look at it. My first thoughts I’d this: it does effect me, but maybe not my health, directly, at this time. I’m referring to quality of life. I can’t do all the things I’d like to. I love roller coasters and would like to ride them with my kids. Maybe some day, but I don’t fit in them now. Last time I tried was the log flume ride at Santa Cruz Boardwalk. The log got hung up at the edge of the drop and we had to disembark and walk down. That wasn’t fun.

Clothes are had to find. In my sizes there is no consistency and I have to order stuff online. As such, I have about 4 sets of identical tee shirts and shorts and except for my uniform, that’s almost all I wear.

Stuff like that. But as far as direct health issues… none, at this time.

I take that back: chronic knee pain that developed after my first round of intense weight loss. I exercised in ways that I shouldn’t have and damaged my knees over the course of 2 years and dropping 150, maybe 170 lbs.

I’ve gained back most of that by falling into my unhealthy eating habits. Interestingly, though, while weight was nearly the same as my previous heaviest, my body shape remained very different. I looked much thinner at 450 9 months ago then I did at 450 5 years ago.

Look at this way - when you put on weight, your organs do not grow along with you belly. Imagine a 4 cylinder Corolla engine in a Ford 250. How long is that engine going to last?

I have found that a "little" extra weight (10lbs for me) feels good and I perform better in the gym. When I cut and lean out (or at least when I used to ), I eventually feel tired and weak.

Carry a few extra lbs - and that's it. What is a few extra? Difficult to say based on your exercise habits, BMI, etc. However, you will know what that ideal range is based on how you feel when you arrive there.

The one thing physicians don't consider is a person's physique. I'm 5'9" and weigh 180. I watch what I eat and workout 2-4 times/wk.

By the PCP's standard, I should weigh 155.

Although I'm on a bit of medicine for genetical reasons, most people don't believe my age due to my physique. I don't look my age!

I can outdo many folks younger than me doing the same routine.

The BMI scale is a "standard" that fits most people.

Just remember, you are unique and probably don't fit a standard box number....

I have done around 25,000 anesthetics in my anesthesia career and feel that obesity is one of the greatest risk factors for poor outcome.

quote:

Originally posted by alreadydead:
I have done around 25,000 anesthetics in my anesthesia career and feel that obesity is one of the greatest risk factors for poor outcome.

Can you be elaborate? What specifically goes wrong? Is it the extra mass that can cause mechanical breathing difficulties when under? This is exactly the kind of info I was hoping to get. Thanks for your input!

quote:

Originally posted by alreadydead:
I have done around 25,000 anesthetics in my anesthesia career and feel that obesity is one of the greatest risk factors for poor outcome.

The only time I’ve had anesthesia was last year for a kidney stone shockwave surgery. I awoke to the nurse asking about what exercise I do, making the comment about my heart rate recovery.

I use the BMI to gauge my fatness, and I've figured out it is biased in favor of me not being over weight. As of today at the docs office I'm 153 lbs with shoes and clothes on, I'll estimate that at 150 lbs nekked. So at 5.8 that puts me at 22.8 BMI which is middle of the scale of normal weight. Yet, when I take my shirt off and look in the mirror I look fat. Surely wouldn't go shirtless at the pool.

But I can hide it pretty well with lose fitting shirts and no one says "here comes fatty". So I guess at my age, if the doc is okay with the weight, and no one makes fat jokes about me, I'll Take Bob Marely's advice and "don't worry, be happy"

There is a distinct difference between the beach ball shape and overall fatness. The terms escape me at the moment but yes different people put on weight differently and there is some evidence the so called beach ball shape carries more health risk then generalized fatness.
Having said that as an orthopedic medicine provider, I can tell you independent of other factors heavy people put more stress on and wear out joints faster than thinner people. ( there are always exceptions of course) and add to that most surgeons doing joint replacement won’t do one in a person with BMI over 40 ( risk of complications greatly increase with BMI over 40)
So even if it is just to prevent or delay needing hip or knee replacement losing weight even if all your labs are fine is still worthwhile

Not a Dr. Also carrying around too much weight. 5’8” and 185. BMI chart at the middle wants me at 140. I was never fat as a kid and quite athletic and I haven’t been 140 since I was in middle school. BMI seems wonky, always has.

As for being obese. I think it’s like diabetes. It’s killing you silently. Everything is working harder than it should. You feel fine now but as you age I doubt that continues. I don’t personally know a single obese old person that feels good. I’m sure they are out there. The odds aren’t in your favor though.

You want the medical reasons fat is bad. I can’t give that. I can say the risks for everything are much higher. That’s pretty statistically trackable. Covid has destroyed obese people. The % of that comorbidity I believe is in the 80 percentile. That’s not good odds.

To your initial question, yes I am pretty sure any Dr will say there is a world of difference between 35 and 135 lbs overweight. And then they would say drop the 35 as well.

Right now you have youth on your side so that’s the biggest benefactor of good numbers if you are not on any rx’s. The curve going downhill will be much sharper and more difficult to come back from once the downhill slide begins, and it will.

Just look around and you can see 70% of the people around you are obese. Then look at their ages and how many people over 50 do you see that are truly around 400lbs.

I’m 6’4” and weighed 275lbs from probably 40 to 55 and since it came on slowly It didn’t seem to bother me much. Then bam it started hitting me hard and the rx’s started piling up. I weigh 235lbs now and there’s a world of difference in how I feel and my numbers. You can just tell your body is way more efficient and not working so hard that you’re whipped by the end of the day, everyday.

quote:

Originally posted by alreadydead:
I have done around 25,000 anesthetics in my anesthesia career and feel that obesity is one of the greatest risk factors for poor outcome.

My wife is just starting her career in anesthesia and all I hear after clinical is the struggles of intubating the obese....

Then I help her study and it gets even worse and more complicated.

Tangential to the discussion, but I'd be curious to hear whether in your long experience you think obesity or habitual drug use is worse for the anesthesia provider.