The article specifically points out that the link between weight and health on its own is in question:
> Some researchers also worry that by offering a weight solution in societies that prize thinness, these drugs could also inadvertently reinforce the disputed link between excess weight and health. One study found that nearly 30% of people who are considered obese are metabolically healthy.
The abstract from that article also points out that a significant share of non-obese people are metabolically unhealthy:
> Nearly half of overweight individuals, 29% of obese individuals and even 16% of obesity type 2/3 individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy.
Further, the way that study measures (cardio)-metabolic health is itself multi-dimensional:
> Using the blood pressure, triglyceride, cholesterol, glucose, insulin resistance and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI.
I think we may need to admit that weight is a low cost and highly visible variable which is a poor proxy for actual health and as in business, optimizing for the wrong metric will eventually lead to dysfunction.
Sure, I'll grant that BMI is not the end all be all metric of health, but its a hell of a strong indicator, and pretending that its okay for your health to be obese is farcical.
Maybe that paper just shows that BMI isn’t the best metric. For example, would the results look different if the participants were stratified by bodyfat%?
An earlier study looked at BF% vs BMI-based obesity definitions, when you adjust for fitness (as measured with a treadmill test). They compare the all-cause-mortality risk for normal weight + metabolically healthy vs obese (for each definition) metabolically healthy. When adjusting for fitness, the risks / hazard ratios are not significantly different.
I.e. if you do someone's bloodwork and a treadmill test, and they look metabolically normal, knowing whether their BF% is high (or if their BMI is high) doesn't seem to tell you more about whether they're going to die. If they're fat but fit, trying to lower their BMI or BF% doesn't seem to be about making them healthier.
If we're talking about interventions which might involve putting someone on medication with side effects for the rest of their lives, just do the extra tests! There's no reason to reduce the decision input variables to just "are they obese?" when better indicators are known.
> Some researchers also worry that by offering a weight solution in societies that prize thinness, these drugs could also inadvertently reinforce the disputed link between excess weight and health. One study found that nearly 30% of people who are considered obese are metabolically healthy.
The abstract from that article also points out that a significant share of non-obese people are metabolically unhealthy:
> Nearly half of overweight individuals, 29% of obese individuals and even 16% of obesity type 2/3 individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy.
Further, the way that study measures (cardio)-metabolic health is itself multi-dimensional:
> Using the blood pressure, triglyceride, cholesterol, glucose, insulin resistance and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI.
https://www.nature.com/articles/ijo201617
I think we may need to admit that weight is a low cost and highly visible variable which is a poor proxy for actual health and as in business, optimizing for the wrong metric will eventually lead to dysfunction.