Thread by @asymmetricinfo

A bunch of things well established in the literature, and ferociously disputed by many in the public health community:

1) Obesity kills but not as many as you've heard
2) "Overweight" = lower mortality than "normal" weight
3) No one knows how to make people permanently thinner.

https://twitter.com/CharlesCMann/status/1407349909574107139

The wrath-of-a-thousand-suns reaction to point two, in particular, seems completely bizarre; the only way I can explain it is a kind of puritanism that wants being plump to be bad for you because it's fun getting that way.

To be sure, it may be confounding--lots of illnesses make you lose weight, though researchers do try to control for it. But no one has correctly identified the confounder yet, as far as I am aware.

As for point 3, there is no one so earnestly convinced, on so little evidence, as a public health expert averring that their environmental redesign/school lunch overhaul/public health ads/ doctor interventions/nutrition labeling/bad food tax will make America Skinny Again

That's not an argument against healthy lunches or better environments, to be clear: exercise is good for you! Sugar isn't. Just don't expect a miracle.

The two actually effective possibilities are bariatric surgery--which does work, though not for everyone--and this new drug: healio.com/news/endocrino…

I'm really interested to see how the drug performs in wider use. And how off-label prescribing evolves.

Somehow I forgot to attach this tweet to this thread: the fact that "overweight" looks healthier than "normal" may well be confounding--people who have long-term terminal illnesses that haven't caused overt symptoms yet. But that's a matter for discussion not "kill the messenger"