Vast majority of U.S. adults do not meet fitness guidelines

Of course, the real question is, I guess, how would an increase or decrease in BMI affect each of us as individuals…or how has it done so from past experience.

I’ve never been fat…I’m about the heaviest I’ve been (by a couple of pounds) since late in my pregnancy when I topped the scales at a whopping 140 lbs. Given this fact and the late realisation that I have significant coronary artery disease thanks to a familial dyslipidemia, I’m willing to bet that the additional bodyfat I’d be carrying if I’d been hefting a BMI of 26 or 27+ around would have me in a much worse cardiovascular state…quite apart from other consequences of heaviness.

I’m pretty sure there are posters reading this right now who could claim the reverse…that past excess fatness was a cause of metabolic dysfunction or worse which has become managable/disappeared with loss of “weight”.

But that is not talking about anyone in particular. There is no reason to worry about that.

I am pushing back here a bit because I think this is a dangerous assumption to make. The Stanford Longevity Center makes the following reference to another study:

BMI is calculated by taking an individual’s weight (in kilograms) divided by height squared (in meters). As might be supposed, this measure does not always provide an accurate account of body composition. Weight, as a measure, lumps fat mass and lean mass into a single number, failing to distinguish between the two. Consequently, BMI may miscategorize patients. A recent study found that in 41% of patients, BMI mislabeled body fat status. Moreover, the study showed that although BMI was positively correlated with body fat, it had a higher correlation with lean body mass. These findings suggest that a high body mass index may often be the result of higher muscle density, which is actually beneficial to health. Beyond BMI: Assessing Weight Status as We Age - Stanford Center on Longevity

41% is a pretty significant error rate. The reason I used the term dangerous is the evidence that BMI might actually be a better measure of lean body mass than body fat. Lean body mass becomes an increasingly important health factor as one ages and muscle starts to disappear.

If BMI is actually measuring lean body mass then the obesity paradox makes a lot more sense. High BMI even in the “overweight” range has positive health benefits for older adults because it means more lean body mass. It also explains why in the elderly, BMIs <25 have negative health outcomes.

Aaagh…I’ve done it again and inadvertently deleted a post by sloppy scrolling. How to restore it again…please?

I seem to have fixed it

I started looking at this issue a few years ago because I weighed more than 180 pounds for about half a century and now, in my late 60’s, I am stretching to keep my weight above the 160 mark. I have guessed that my weight loss in later years is partly a function of declining bone density and muscle mass, not great cardiovascular health. So I am much more disciplined now with my thrice weekly dumbbell workouts and consistent protein consumption despite my largely vegetarian/pescatarian diet.

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Congratulations. I can’t outrun my 21 month-old granddaughter.



That’s a bit unusual as the trend is usually the other way. Are you more active now or recently turned vegetarian/pescatarian?

I also lost a lot of weight after 65, but that took and continues to take a fair amount of effort. I am probably not as disciplined an eater as you are though.

I wish people would back off playing doctor or nutritionist on the internet. Talk about misleading anyone you can find. And not knowing you are misleading people.

Now this is an interesting post in an odd sort of way as it seems to demonstrate a strong affection for this concept of an Obesity Paradox…in spite of posting links that refuted the idea al9ng with explanation of the fat distribution that might make it appear so.

TL:DR…cherry picked quotes from a cherry picked article.

Since I’m demonstrably interested in longevity/healthspan I keep my eye on current literature (in areas I’m interested) so contrarian viewpoints tend to pique my interest. So, I read the full article, checked the 4 papers cited as evidence, looked to see credentials of the article’s author…and ended up quite underwhelmed by the assertions.

Now, the 41% figure came from this study…

Which, per date of publication isn’t recent and pertains to a relatively small number of study subjects with congestive heart failure. The study authors didn’t appear to think BMI was as useless as the article implies.

The real problem with the article and the inference that might be drawn from reading it is that it misrepresents this study…

This is a really long read and a quite exhaustive meta analysis. Publication date 2014…so about the time of the study appearing to show a similar advantage to higher BMI…but with the same limitation which the authors do state in their discussion.

They looked at only mortality. Not morbidity or weight loss prior to death. Additionally, they used all cause mortality so there was no indication of whether the lower BMI at time of death was due, say to sudden and dramatic weight loss caused by the disease that actually killed them. My in laws, for instance…both “comfortably padded” sufficient for both of them to suffer from high BP for a good few years before their demise from esophageal cancer (dad) and brain stem glioma (ma) Both of them well below the “healthy” BMI range in the few weeks prior to death.

Long story short. I think it would be quite a mistake to fall for the notion that, say, either gaining weight (and therefore increasing BMI) by methods other than increasing muscle mass for those entering their 70s (not that easy for a late bloomer) is a good thingbbased on faulty conclusions drawn here. Likewise, someone with a high enough BMI to be considered fat and with accompanying downstream metabolic dysfunction shouldn’t enter their later years continuing an obesogenic lifestyle because of what is implied in the article

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Just FYI. In an upstream post I provided a figure from a recent paper. Here it is again.

Note that figures C and D exclude data from subjects who died within two years of their follow up after their BMIs were recorded. This should eliminate any bias from those who had low BMI due to a mortal illness. The paper was published in 2023 and involved over 500,000 subjects

The conclusion of the paper:

In conclusion, our findings suggest that BMI in the overweight range is generally not associated with increased risk of all-cause mortality. Our study suggests that BMI may not necessarily increase mortality independently of other risk factors in those with BMI of 25.0–29.9 and in older adults with BMI of 25.0–34.9. Consequently, this highlights the potential limitations of BMI in capturing true adiposity and limitations of its clinical value independent of traditional metabolic syndrome criteria.

I don’t think anyone is suggesting folks should try to get fat. My suggestion is to ignore BMI altogether and replace it with the waist to height ratio (WHtR). Using WHtR as an obesity metric or recognizing that whatever BMI is measuring it is not correlated with health will not cause people to lead an obesogenic lifestyle. You are starting to make stuff up.


My cholesterol, lipid and glucose readings improved dramatically after I added a regimen of time restricted eating and fasted exercise to my regimen. That journey started after reading an article in NEJM dated 12/26/19 by mark mattson followed by his Ted talk, stem talk, and book and other stuff after that. And I also lost additional weight.

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This (30 seconds long) video

fits my experience exactly.

I think, basically, it is that simple.

What is the essence: community really matters, and places that devalue communal values and exaggerate individual whims are going to get sick – in all manner of ways.

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During the pandemic I could not get to a restaurant. My old habit was eating in restaurants. At age 17 I worked in a restaurant. I put in huge efforts and rewarded myself with somewhat addictive foods. I put on my first five pounds.

During the pandemic I took on only cooking my meals. I took on counting my calories. I lost at one point 55 pounds. I call it 50 pounds because that is where I was stable for a while. Right now it is 44 pounds.

I buy broccoli…surprise surprise!


Leap congrats!

My very hard to break individualist bad habit was constant adrenaline rush risk taking. The circumstances of breaking free of it echoed yours with food addictions and corona, only mine were adrenaline addictions curbed with help by moving to Europe for over a year, leaving my climbing rope, crampons and ice ax, surf board, skis, and (especially) motorcycle behind.

When we got back to Hollywood my husband and mother ganged up to push me hard to reform.

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Dayum - I have the exact same problem. Relatively fit, good body weight . . . . annnd I have coronary artery disease. I have a high Ca score >500 - but don’t know what my occlusions might be, if any. Need a CT angiogram for that. Haven’t done it yet.

Upped my statins, trying to get LDL <55 mg/Dl. Now at 65
EKG and stress test were fine.
Current BMI - 23.5
waist/Height ratio is 0.45
Hard to fight genetics.

Let the cardiologist inform you.

I have 163 Ca and perfectly well off.

I have t2d does not matter.

Currently down 44 pounds and still a bit obese don’t matter

I am in top 20% who exercise. My bloodworks are all excellent

On the topic of statins, this news crossed my radar screen a day or two ago…

The usual poor description of the lipidology of ASCVD, but I guess that would’ve been considered secondary to the main subject. Still, it shouldn’t have been too hard.

@Volucris … didn’t your physician (I assume PCP) suggest a referral to a cardiologist? My CAC scan score of over 700 came as a surprise to both me, my PCP and my husband who didn’t mess around with the tinkering that she would probably have been happy with (a reduction in LDL-C on introduction of a statin to about 90 mg/dL from about 135). He arranged an appointment with a colleague with expertise in intervention cardiology and the rest is history. CTangiogram, introduction of a PCSK9 inhibitor (Repatha) to the lipitor and a reduction to LDL-C levels that toggle around 40 and triglycerides about the same.

Even without any medication my lipid levels only raised a half hearted red flag by ASCVD risk assessment algorithms so, it certainly doesn’t do to ignore family history because you’re doing everything “right”. Genetics can be a bear.

In addition to the CTangiogram, I had Fractional Flow Reserve analysis using this technology…

It basically assesses the flow through the coronary arteries. Again, my score suggested quite severe flow restriction which, possibly in the hands of a super aggressive, private practice based intervention cardiologist (like my next door neighbour) would have me with stent placement rather than the route I’m taking. One genetic “plus” I seem to have inherited along with the FH, is the ability to build a strong collateral circulation to compensate for the restricted flow. Yet another reason for a commitment to exercise.

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Thanks for the info. I appreciate it a lot.
I am seeing a cardiologist - he does not seem to concerned.
I have no sign of ischemia under stress test or EKG.
Taking statin + Ezetimibe - blood tests in a month to see if that is working.
I may have the same genes. My dad built a bypass from a vein.

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