Weight loss apart it’s the best health kick I’ve come across after a lifetime of addiction to food generally, bread, jam and cheese in particular, fish and chips and chocolate, all the usual deprived childhood habits, frantically interspersed with all the usual diet fads. These all worked for a while but then bad habits either crept in by stealth or crashed back in with crazy cravings.

When I discovered that a medically supervised fast could rapidly relieve me of arthritis and depression at the same as rejuvenate me I set about reading the recommended literature and have never been on a diet since. Once I’d stopped eating and discovered how it felt to occupy a chemical and additive free body I began to explore organic foods and ultimately have come to a balanced diet.

I’m in better health than ever. Great feeling at my age. I bless that GP, unusual and alternative that he was, and extraordinarily difficult to get an appointment with!

I’m still an addict by the way! Just can’t kick the chocolate and the coffee! Well, food generally, with every meal enjoyed – organically produced cheeses, fish and some meat, but always accompanied by home grown vegetables and salads. I love wine too, though addiction can’t take hold here since I fall asleep after two glasses.

And water! Plenty of it, from waking till late afternoon. Not too late though – as FXH says we all have some problem or other. Still, an aging bladder is manageable, and occasionally ‘wetting myself’ seems a small price to pay for a good meal out with friends and plenty of laughter.

If I’d been rung up and asked those questions by some survey-taking call centre person I would have quibbled about the wording of every single one.

In whch case, PC, you would have achieved your aim. You’d be put on their internal “Do not call: difficult arsehole” register.

The only thing this proves is the lack of communication skills on the part of the scientists.

Word, desipis. If I’d been rung up and asked those questions by some survey-taking call centre person I would have quibbled about the wording of every single one.

both the originator Quetelet and the reviver Keys (1972) specifically stated that the BMI was designed for population studies and was inappropriate for individual assessment. But it’s easy, so it gets misused.

this is what i was referring to in my second paragraph. Doctors shouldn’t use BMI to assess obesity in the consultation, but as a screening tool its validity is assessed by different standards.

Your talk of ectomorphs and endomorphs makes me think of Traveller:2300 …

8x cups of black coffee 8kcals
mother energy drink 208kcals
Celery 6x stalks 62cals
Apples large raw 116cals
tuna in lite oil x2 466kcals
corn, raw, small 62kcals
spinach raw 2x cups 14kcals
corn wraps x6 389kcals

Total consumption 1325kcals

Base metabolic rate -2521kcals
Activity level desk job -504kcals
Exercise -429kcals

Net kilocalories -2129kcals
Weight/gained lost -304g

There are plenty of active obese people who feel fit and well, so where do they lie on the “health problem” chart?

There are plenty of people with cancer that feel fit and well. Feeling fit and well doesn’t necessarily mean you are.

BMI is a useful tool as is the waist measurement one thats increasing used as a rule of thumb. They are probably best called indicators or proxies than measurements of obesity.

Dr S – I’m no inclined to the “absence of disease” view. I think it leads to an idealalised state of being that doesn’t exist in many people and it leads to thinking of anyone who is sick or disabled as different or the other.

I see health as the successful management of whatever diseases or disabilities one has so that they don’t have more impact than is unavoidable.

Most people actually have some ill health, many need to wear glasses, people have deteriorating hearing, some have a back back, people have genetic predisposition to certain illnesses , some high cholesterol isn’t due to diet, many “bad hearts” aren’t due to lifestyle, not all diabeties can be prevented, bowel cancer can’t be prevented, cataracts can’t be prevented, and so on, it is rare to see a person who doesn’t have some less than perfect health.

The successful management of whatever degree of less than perfect health we all have is influenced mainly by access to services, educational level and financial security.

If the argument is that health includes the absence of meaningful risks and the sense of feeling well, as it must if hypertension and smoking become health problems, to exclude obesity from the category of health problems is not rational, it is definitional and political.

I can see your point on the absence of meaningful risks, but “the sense of feeling well” seems to suffer from a term definition problem too, surely? There are plenty of active obese people who feel fit and well, so where do they lie on the “health problem” chart?

The bottom line is that obesity, defined in a way that captures those who are more than a little overweight, is an independent risk factor for diabetes, osteoarthritis and sleep apnoea. There is a clearly increased rate of the cardiovascular risk factors among those with increasing body fat but, I agree, disentangling chicken from egg in that situation is difficult. What is clear is that obesity is, in a significant group, a necessary cause for their diabetes. In this group weight loss is curative.

Now, I personally take a very restrictive view of health and disease. I look at hypertension, hypercholesterolaemia and smoking as risks to one’s health rather than health problems in themselves. I view health as the absence of disease, it ends up being much less pejorative and messy way to look at it. From this standpoint the statement that “obese people can be healthy” is self-evidently true. If the argument is that health includes the absence of meaningful risks and the sense of feeling well, as it must if hypertension and smoking become health problems, to exclude obesity from the category of health problems is not rational, it is definitional and political.

Disease is not inevitable in obesity but it is certainly more likely. If that is sufficient to define ill health, as many modern authors on this subject feel it to be, then the answers are reasonable. Term definition problem, as previously noted.

Everyone knows that bmi is a good measure of obesity in those who don’t have special lifestyle considerations, i.e. your average sedentary office-worker

Everyone does, really? BMI can give an endomorph a “good” reading even if they are carrying a lot of abdominal fat, BMI can give a mesomorph a “bad” overweight reading even if their body fat is low. Ectomorphs can be given a “bad” underweight BMI reading despite being well-nourished. This has been known for a long time. Elite athletes are an extreme case, but it’s just the same for sedentary office workers.

BMI is a very broad brush – both the originator Quetelet and the reviver Keys (1972) specifically stated that the BMI was designed for population studies and was inappropriate for individual assessment. But it’s easy, so it gets misused.

But more generally, discussion of bmi is also about discussing the sensitivity and specificity of a screening test, i.e. how many people will be misdiagnosed by bmi if it is used as a rough and ready measure of obesity to encourage GPs to target weight loss on a population level. Discussion of these types of issues needs to be better than sound-bite level and it’s likely that when GPs answer a question like this they are considering the role of measurement in their daily practice, and answering accordingly.

An obese person can be fit and well depends on how you define well. If you mean they are without risk factors for serious illness of a significant nature then no, in the same way that someone with hypertension cannot be. Hence, yes and know, what do you mean?

It also depends on how you define obese, which is the point of the BMI question. Most professional male basketballers and football players are clinically obese as measured by the BMI because it does not accurately reflect the body composition of the very tall or the very muscular. Many people who are BMI-obese are only carrying small rolls of fat, and some people who are carrying more fat are nonetheless very active anyway.

What assumptions underlie your equating obesity with risk factors such as hypertension? The large subset of obese people whose blood pressure, lung capacity and cholesterol (and other blood) readings are all within normal limits (and sometimes spectacularly good): exactly what other risk factors besides a figure on a scale can you point to? Is obesity the cause of certain illnesses, or is it a side-effect of some illnesses/conditions rather than a sign that inevitably illnesses are just waiting to happen?

Weight Management: Facts and Fallacies