Wei et al. and Ragen’s Deadly Health Advice

Happy Easter to all our readers! Today’s post will be a bit technical because we need to discuss the science behind the terrible health advice Ragen gives to her readers.

One of Ragen’s very favourite “healthy obese” studies is a 1999 JAMA paper, Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men. According to Ragen, this study “proves” obesity has no causal influence on mortality. She even includes a handy self-created graphic demonstrating that fitness level, rather than weight, is the most significant predictor of all-cause mortality.

Source: Dances With Fat

If you look at the second half of the data tables, you can see where these numbers came from.

At first glance, it seems like Ragen’s expert college dropout trained researcher assessment is pretty accurate. Obese men with normal fitness levels are about as likely to die as healthy weight men during the follow-up period, which was around 10 years, but could be as little as one year.

What Ragen doesn’t mention is that pre-existing cardiovascular disease (CVD) is actually the overall best predictor of all-cause mortality, and it was present in 16.5% of obese men vs. only 9.1% for normal weight men. Obese men are three times as likely to have type 2 diabetes and 2.5 times as likely to have hypertension, both of which are major risk factors for CVD. A full 51% of obese men had low cardiorespiratory fitness vs. only 9.3% of normal weight men.

Most importantly, the mean BMI of the obese group was 33.2, or only about 60 lbs overweight for an average man. This is considered “moderately obese”. Ragen’s BMI is estimated to be around 55, which is equivalent to an average man being 210 lbs overweight, or super obese. Many of her followers have similar BMIs. Current research indicates this level of obesity represents a three-fold increase in overall average mortality (see Kitahara et al., Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies). Wei does not study any subjects remotely close to Ragen’s size, and the results emphatically cannot be extrapolated to morbidly obese people. This is a frequent theme in Ragen’s “research” where she misrepresents studies of mildly obese subjects to give health advice to morbidly obese people.

It’s obvious from the data that obese men as a whole have greatly reduced fitness levels and suffer from significantly higher rates of CVD and associated risks. From this we could conclude that either fat people are simply too lazy to exercise, or alternatively that there is a negative relationship between obesity and fitness. Perhaps it’s much harder to remain fit while carrying 50-60 pounds of excess weight and dealing with other health effects, let alone 200 pounds or more like many of the people who take medical advice from Ragen? There are certainly other factors at play, but the relationship is incredibly strong. Ragen would no doubt put the extreme difference in fitness level down to “weight stigma”.

The most damning evidence against Ragen’s “healthy obese” claims is that the latest available research following subjects for up to 20 years shows almost all obese people eventually become “unhealthy obese”, no matter how many “healthy habits” they practice. The metabolic effects of obesity are inescapable in the long run.

If Ragen truly believes obesity has no causal relationship with mortality and uses this study to prove it, then we must conclude she either thinks fat people are all incredibly lazy, or that “weight stigma” is the foremost public health issue of our time. It makes the fact that she constantly discourages her readers from exercising by telling them it isn’t an “obligation” and complaining about how miserable it makes her all the more despicable.

Here’s an example of what happens if you rely on Ragen for important medical advice.

14 thoughts on “Wei et al. and Ragen’s Deadly Health Advice

  1. We need more stuff like this. It is good to have some hard facts before these idiots. Not saying that there aren’t facts out there already, but it is is good they are digested into concise conclusions.

  2. One thing that has been bothering me about the whole “calories in calories out” thing is the lack of adjustment in calculation. I’m taking a feeds class for my agriculture degree, and we were formulating rations for cattle based on nutritional requirements and weight of the cattle. They required somewhere around 15 pounds of feed a day to gain a pound and a half a day on average. In order to maintain that level of gain, we had to recalculate their requirements every 25 days. As the cattle gained weight, they required more feed to put on the same amount of weight. This can be attributed to their rising energy of maintenance requirements.
    This has been a bit long but here’s where it relates:
    As you lose weight, your body needs fewer calories to maintain the same level of energy. So unless you increase your activity level proportionately along with your weight loss, simply eating 1,500 calories will only help you lose a few pounds quickly before you plateau.
    Perhaps the reason most diets fail is because people forget to take this into account.

  3. Studies also show that the average obese man gets less than four hours of exercise per year and the average obese woman gets just one hour per year. “Obese and fit” is a very rare combination.

  4. […] Yeah, like I said…no comment. But as I mentioned in the title, I want to offer a genuine thank you to Ragen herself. I have had long dreams to race long course triathlon. Simply because I wanted to prove you wrong when you said how difficult it was to register for the Tempe 70.3, I found myself in a position where I am racing not only in October but I have my volunteer spot for the full IMAZ in November which hopefully translates into a race position in 2016. I really do owe that to you Ragen. Since then I’ve run hundreds of miles, swam 10s of thousands of meters and biked…well like I mentioned the other day, I haven’t biked enough. My diet is better, I’ve certainly lost weight and I feel as good at 41 as I did when I when I was in college. My kids have stopped calling me “fat dad” and that feels pretty good (see Ragen, in the world that doesn’t consist of odd and arbitrary absolutes, fat can be a relative term). I have to admit, all of this is because of you and how easy it is to prove you wrong. In addition to all this also maintain online friendships with the other two authors of this blog who as you can tell by their entries, they are genuinely smart, dedicated and good people. The trouble is Ragen isn’t going anywhere, she’s found her niche, she has her supporters who don’t care if she succeeds or fails (and addressing Ragen personally, don’t you see that if they don’t care if you succeed or fail…they really don’t care about you…that if you were to fall off the face of the earth today, there would be some pithy mourning but then they would be on to the next charlatan? That’s what you have to show for your existence?). Her followers don’t care if she’s right or wrong. They, like she, are simply looking for validation of what they must know is wrong. But I think Ragen has willfully deluded herself into buying and believing her own snake oil for far too long (don’t believe me, read through this blog and find the dozen+ examples of the times she misinterprets research that actually proves her dead wrong, yet willfully (gleefully even) posts it as her smoking gun proof. Wei, et. Al comes to mind immediately https://truthaboutragen.wordpress.com/2015/04/04/wei-et-al-and-ragens-deadly-health-advice/). […]

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