Obesity is a societal failure. Not a personal one.

[batman1425]

Originally Posted by nmrt

I have been following the microbiome research for more than fifteen years now. I have tried very hard to see if there is any "take-home" message here. Despite the plethora of excellent studies, some from faculty from my university, there is so much we do not understand about the microbiome, that all I can take away from all of this is that it all all very interesting.

That the gut microbiome is diverse in childeren or in people in agrarian societies, and that the diversity of these microbiomes can decrease when switched to a western diet is interesting. But then, having a different microbiome does not neccesarily mean having a different funtional core. In fact, many functional gene profiles are similar despite variance in microbiome diversity.

Importantly, in the western world, we don't just have different microbes, we have fewer kinds. A landmark study out of Stanford several years back showed that if you take a mouse with diverse microbial community and feed it a western diet or mediterranean diet (high fiber, low fat), for several generations, the mice fed the med. diet keep their diversity. The mice fed a western diet experience microbial extinction events - the number of different kinds of microbes drops, rapidly. The microbes that can survive expand to fill the space, but functions of those missing microbes are now lost. This underlies all kinds of problems that we are now uncovering from obesity, ASD, cancer, the list goes on.

You've also hit the key limitation that slowed progress in the early days of advanced microbiome research the compositional fallacy. It largely doesn't matter what specific microbes we have, so long as the combination that we contain satisfies the functional needs of a diverse community. Not all forests have to look the same as long as all the niches are full. Early studies focused on composition because it was the easiest thing to measure and was the easiest thing to try and fix if we could find a compositional problem. After chasing that rabbit for a few decades, we now know composition is somewhat irrelevant. Everyone has different compositional diversity to start with. Even identical twins. Further, two people may have the same microbe, but that microbe is doing different things in person A vs. B because their overall landscapes are different. It becomes very difficult very quickly to assign functions and roles to specific microbes because it is unique for everyone. This is largely why things like mass market probiotics and prebiotics are, to put it bluntly, not very useful. A 1 treatment rule is never going to work for microbiome especially after the community is established. The tools to pick apart this billion variable equation are getting better, but we're not there yet. We can see it matters, but the circuitry is too dense to make sense of with current tools.

There are some clear connections that we are starting to unwind. There is a very clear mechanistic link between diet, specific microbes in the gut, and colon cancer for example. High fat/protein/sugar (western) diet causes us to secrete more bile to solubilize those fats and proteins for digestion. The increased bile acid content changes microbial diversity in the colon - bile acids are toxic to many microbes. The ones that survive are quite good at consuming those bile acids and converting them into carcinogenic compounds in the distal colon. This mechanism is predicted to be one of the reasons that colon cancer is no longer a disease of the elderly and more and more young people are getting the disease.

What does it all mean for take home messages? Thats a hard one because we are still a long way to go. As a microbiome scientist, I think about eating things that support diversity - those also tend to be things that are "good" for you. I think about limiting exposure to antimicrobials as much as reasonably possible. I work really hard to make sure my offspring get access to high quality, antibiotic free foods that support microbial diversity, especially in the critical microbiome development years and try to make sure they get chances to interact with a diversity of microbes (quit bathing them in purel all the time).

What I see happening in the next couple decades is that once we get a better handle on the function/diversity question, microbiome analysis will become a routine part of prenatal and early childhood care. We will monitor what microbes mom has and supplement to assist with transfer at delivery. We will do the same for kiddo throughout early childhood and you'll see pediatricians prescribe specific microbes at key developmental stages to ensure the microbiome develops correctly. We have a much better chance of making changes if we start early. Fixing dysbiosis for a middle aged person that has already had microbes pumping out carcinogens into their distal colon for 20 years is too little too late in many respects.

[benb]

You made it personal in your very first post in the thread when you listed your body dimensions and then complained about BMI. Which is how you start every one of these threads.

Quoting again for the second time to show you how ridiculous you're being:

Originally Posted by XXtwindad

1) The BMI standard needs to be completely dismantled. At six feet and 195, I qualify as "overweight" (with all due modesty...hardly). Many athletes have more muscle than the average population, which isn't reflected in the chart. The chart was developed by insurance actuaries in the 1940s. It's antiquated junk and should be ditched immediately.

Either you're worried about it or you're not. Why are you so defensive about it? Why even start these threads? BMI is not about you and only you!

But if you're not trying to make it personal you need to realize someone else could have the same height and weight as you and most of the time they WILL be overweight as they won't be carrying the same amount of muscle versus fat.

Given you're a trainer you have to have seen this. Two people can be the same height and weight. One will be twice as strong as the other with half the fat. Most people in society are not that "twice as strong, half the fat" person.

Also open your eyes and get out the gym. Above about 21 "athletes' are a tiny percentage of the population as a whole. You could debate who gets to call themselves an "athlete" but most people won't fit the definition regardless of what you come up with.

[prototoast]

Originally Posted by XXtwindad

I don't often post pictures of myself. I'm not on Facebook or Instagram. So, here is a recent pic I sent to a couple of Paceline buddies when I was trying to convince them that "brown" is the new "pink."* I'm six feet and 195, and most certainly not overweight.

And there you go again, just completely undermining your own credibility.

[OtayBW]

Originally Posted by XXtwindad

Interesting take from Bicycling Magazine recently:
https://www.bicycling.com/health-nut...ty-researcher/

This follows on the heels of a similar article I read last week:

https://www.nytimes.com/2022/11/21/o...ity-cause.html

I agree with the Bicycling article on a number of counts:

1) The BMI standard needs to be completely dismantled.

Maybe get to work on (HRM = 220 - Age) while you're at it!

[XXtwindad]

Originally Posted by benb

You made it personal in your very first post in the thread when you listed your body dimensions and then complained about BMI. Which is how you start every one of these threads.

Quoting again for the second time to show you how ridiculous you're being:



Either you're worried about it or you're not. Why are you so defensive about it? Why even start these threads? BMI is not about you and only you!

But if you're not trying to make it personal you need to realize someone else could have the same height and weight as you and most of the time they WILL be overweight as they won't be carrying the same amount of muscle versus fat.

Given you're a trainer you have to have seen this. Two people can be the same height and weight. One will be twice as strong as the other with half the fat. Most people in society are not that "twice as strong, half the fat" person.

Also open your eyes and get out the gym. Above about 21 "athletes' are a tiny percentage of the population as a whole. You could debate who gets to call themselves an "athlete" but most people won't fit the definition regardless of what you come up with.

From: Earth
To: Ben

Hello Ben,

The BMI is about xxtwindad. And benb. And all of us. It's the metric by which most Western medical practitioners gauge fitness. It's symptomatic of our shallow, harried cookie cutter approach to health. It's an antiquated standard that needs to be recalibrated.

[XXtwindad]

Originally Posted by prototoast

And there you go again, just completely undermining your own credibility.

That is certainly the majority opinion.

[batman1425]

Originally Posted by mstateglfr

- is a c-section or traditional birth the 'best'?
- are established shots 'better' than unvaccinated?
- is formula or breast milk 'best' and how is that even measured in a controlled study?
- are any packaged beginner foods healthy or is it all worse than home prepped first foods for babies/toddlers?


Do these changed microbes just sit there and not do what they are supposed to do?...or what is the fundamental difference between them and what we would ideally have?

The vaginal microbiome reprograms in the days/weeks preceding birth. The microbes that increase in abundance are ones that help baby digest breast milk more effectively and also assist with immune system development and training. When you look at big data sets - kids born C-section have increased risks of a variety of autoimmune and allergic conditions. That said - "best" is getting baby and mom through delivery safely, C-sections save lives and should always be used when needed. In that instance, there are ways of supplementing exposure with C-section and more hospitals are offering that care.

Vaccines are a different question than microbiome, but as a pathogenic microbiologist and microbiome scientist, yes. Get vaccinated.

In addition to the immunological benefits, breast milk contains polysaccharides called HMOs (human milk oligosaccharides). These are carbohydrates that cannot be digested by baby but feed the microbes in their colon. HMOs are a large fraction of the content of breast milk. Evolutionarily speaking, they wouldn't be there if they weren't important and the fact that baby can't digest them means they have a different important role. We've found they support the growth of many beneficial microbes in baby's gut. Traditionally mass market formulas lacked these compounds because they are very difficult to manuf. at scale. Recently (last 5-10 years) companies have figured it out and HMO supplemented formulas are now available.

In my opinion, quality is what matters. There are quality, fresh prepared packaged options out there, but they are not cheap. Home prep gives you more control of the process at a more affordable price, but you need to start with good stuff - pesticide, hormone, abx free ingredients.

[benb]

To be fair XX Twin Dad is a trainer so he is probably seeing a skewed group of people in day to day life.

I'm not really sure how many people work in my office park. 5000?

When I go to the gym in the park I see the same group of less than 100 people at the gym and it's been that way for years and years. There's a full time trainer on staff there. It would be 100% normal for her to assume far more of the people in the park are fit just because she's only seeing the people who walk into the gym. Easily 90%+ of the people you would see in the gym would either fit into "normal" BMI or "overweight BMI but low body fat and high lean mass".

But walk through any one of the actual offices and you'll see 50%+ are obese and the high muscle mass, low % BF, "overweight" BMI category is probably only about one in 500 or even one in 1000 people.

And you'd see 25+ people smoking outside the large bank office on the other side of the park at any point in the day who all look super unhealthy.. enough to make a trainer cry.

[batman1425]

Originally Posted by XXtwindad

I'd appreciate more information. Maybe in layperson's terms. There was a recent book by Dr. Jason Fung ("The Obesity Code") that referred to a body's "set point": which (according to Dr. Fung) the body isn't capable of maintaining. I thought this was a bit too fatalistic, but there's lots of speculation on the impact of the industrial food complex, particularly as it relates to ghrelin: https://www.healthline.com/nutrition/ghrelin

I usually point folks toward:

"The Good Gut" - written by the Sonnenburgs - microbiome science legends and Faculty members at Stanford. It's about how diet shapes microbiome and how to eat to feed your microbes.

"Missing Microbes" - written by Martin Blaser - physician scientist at NYU. Talks about how antibiotics are fueling modern plagues by reducing microbial diversity in the gut. Easy read and very accessible.

Also happy to answer specific questions as my training allows.

[sg8357]

Originally Posted by rallizes

lol who could possibly have predicted how this thread would go

When the Romans* put disc brakes on chariots,
they were doomed. Just look at us, making the same mistakes.


*The Byzantines stuck with spoon brakes,
and lasted another 700 years.

[witcombusa]

Originally Posted by batman1425

What if I told you that how you were born, what your parents fed you, how many ABX you were prescribed, and how "clean" of a lifestyle you had from birth till about age 3 or 4 will have one of the biggest impacts on your long term health, equal to if not greater than many "conscious" choices one makes about inputs, outputs, exercise, etc later in life.

I'm not saying we don't have a personal responsibility, but not everything is within our individual control.

We don't get to pick our parents! And yes they did many things that did affect me that I wish was not the case. I can't change that. But since about 16 they have been my choices and things are working out pretty damn well so far. I haven't been to a doctor in over 40 years and that is one of the reasons I'm doing so good! Western 'medicine' is a very serious problem indeed.

[HenryA]

Originally Posted by mstateglfr

For sure.
As an adult, I chose a couple of activity/sports though where at the competitive end I am not skinny- cycling and volleyball. Its funny how perception based on circumstance skews things. I am 2xl in Rapha(they dont make larger) and dont even own some of the boutique US brands since their 2xl results in an overstuffed sausage look. I fully accept this, but will comment that it cant help the confidence/perception for many people.

But yeah- unless almost all people have some particular competition performance goals in mind, we are almost all just fine at 5% over whatever weight we ideally want to be.
...but its then still there as a constant reminder of health and/or appearance(depending on person and circumstance).

Yep.
Being around competitive cyclists I’m fat as a pig. At the grocery store, not at all.

[CNY rider]

Originally Posted by benb

To be fair XX Twin Dad is a trainer so he is probably seeing a skewed group of people in day to day life.

I'm not really sure how many people work in my office park. 5000?

When I go to the gym in the park I see the same group of less than 100 people at the gym and it's been that way for years and years. There's a full time trainer on staff there. It would be 100% normal for her to assume far more of the people in the park are fit just because she's only seeing the people who walk into the gym. Easily 90%+ of the people you would see in the gym would either fit into "normal" BMI or "overweight BMI but low body fat and high lean mass".

But walk through any one of the actual offices and you'll see 50%+ are obese and the high muscle mass, low % BF, "overweight" BMI category is probably only about one in 500 or even one in 1000 people.

And you'd see 25+ people smoking outside the large bank office on the other side of the park at any point in the day who all look super unhealthy.. enough to make a trainer cry.

I notice this during my on call weeks, when I spend my time working in the 6 story hospital as opposed to the office.
If you judged the fitness level of our staff by who I pass in the stairwells you would be impressed.
Lots of lean and fit folks.
Skip the stairs, wait for the elevator and you would get a whole different impression.
I’m not saying which is the chicken and which is the egg but it is very noticeable.

[echappist]

Originally Posted by XXtwindad

The BMI is about xxtwindad. And benb. And all of us. It's the metric by which most Western medical practitioners gauge fitness. It's symptomatic of our shallow, harried cookie cutter approach to health. It's an antiquated standard that needs to be recalibrated.

Many of us here understands the intended usage of BMI. You are the only one here trying to paint a strawman usage of BMI and persisting with that perception. If your medical practitioner uses it in a prescriptive manner (as opposed to using it as one of many indicators), the suggestion would be to inform your practitioner the actual purpose of BMI and, failing that, switch practitioners.

It is not used to gauge fitness; rather, it's a metric used to see if any follow up is needed. Sometimes it generates false positives (in people with high proportions of muscle and low proportions of fat). Sometimes it generates false negatives (it cannot properly account for fat mass at the expense of reduced muscle mass). But on a population wide basis, it's not bad for a first-order estimate.

Certain parts of it could be remedied, e.g. by taking into account fat folds or waist measurements. Personally, I'd like to see BMI version 2 to take into account of such measurements, although the truth is that it isn't necessary for vast majority of the population.

Anything else to gauge fitness, whatever it may entail, is going to be more time consuming if not costly (e.g. dunk tests or DEXA scans)

It's perfectly fine to point out faults with BMI (as many here have acknowledged). Better question is that if it were to be "ditched immediately" as advocated by you, how do you plan to implement a better method that's not going to drastically increase time and cost?

And on a tangent, I always get told that my pulse is low (as compared to population-wide average). I tell my practitioner that I engage in aerobic endurance exercise, and the initial flag raised gets cleared. It should be no different in the case of a BMI reading (where a follow up explanation should clear the initial indication of "overweight BMI").

[batman1425]

Originally Posted by witcombusa

I haven't been to a doctor in over 40 years and that is one of the reasons I'm doing so good! Western 'medicine' is a very serious problem indeed.

Pretty broad brush there....