Not Just “Obese” Was Redefined…

As Fillyjonk reminded me, this chart shows how the diagnosis criteria for diabetes, hypertension, and high cholesterol were also changed in 1997 and 1998.   In the case of high cholesterol, this nearly doubled (86% increase) the number of people who officially have “high cholesterol”.

I don’t know the science behind these changes.  I’d like to think they made a lot more sense than lowering the overweight and obese BMI thresholds.  But it does make one look at statements that “So many more people have high blood pressure now!” in a different light.

24 thoughts on “Not Just “Obese” Was Redefined…

  1. If the standards for diagnosing diabetes, hypertension, and high cholesterol aren’t lowered, the drug companies have no excuse to come up with newer and more drugs to treat those diseases. I’ve said all along it’s not about health, it’s about money. The more people that can be diagnosed as “ill”, the more drugs that can be sold and the more money those pharmaceutical companies can make. It’s all about the greed.

  2. Yeah. I’d LIKE to think that, too, but I can’t. My experiences with the medical world–primarily due to my fat body–have really opened my eyes. When someone lies to me, repeatedly and thoroughly, about one thing, I have a really hard time believing the protestations of “But I really MEAN it this time!”

    There is a huge, and I mean HUGE, amount of money to be made in convincing people they need high blood pressure and high cholesterol medication.

    What research I have done does lead me to believe these, like the “obesity epidemic,” are invented panics, but even without that research I would be seriously damn suspicious.

  3. If you have read JunkfoodScience, you know it is all about money, about selling more drugs, convincing more people that they need to more medications, more doctor’s visits, etc. It has nothing to do with “health”. I have seen the papers with cholesterol meds (which I would flatly refuse…no one is pumping statins into me) in which it is admitted that lowering cholesterol has not been shown to reduce risk of heart attack or stroke. In actual fact, the only people who have cholesterol “problems” are the 5% or less who have inherited familial hypercholesterolimia, I believe is the word. Cholesterol is actually irrelevant for most of us, statins are full of harmful side effects, & are totally useless to women & do nothing positive for all but maybe 10% of men. And, yes, apparently, BP & blood sugar both also need to be much higher than they want us to believe before we actually have real medical problems. Why else do you think that they created these lovely terms such as “pre-diabetic” & “pre-hypertensive”? I have news for the pharmaceutical industry…I am predead, we all are, & most of us will live longer & better the farther away we stay from them & their products.

    People are not less healthy than they used to be…on the contrary, we are, on average, living longer & being overall healthier than ever. And “obesity” is not some killer disease, but something someone made up as a club with which to beat us. What many people are these days is over-panicked & over-medicalized & too often convinced that they are incapable of running their own lives & that they don’t have the right to own their own bodies.

  4. Patsy, “pre-hypertensive” and “pre-diabetic” make me and my husband laugh. If we continue to live longer and longer, then there’s a good chance that most of us will be diabetic and hypertensive at some point, if we live long enough, especially if they keep lowering diagnostic criteria.

    I’d like to think that the medical community has the beset interest of people in mind, and that our increasing life expectancy is due to being more proactive about dealing with these sorts of conditions. But, if that were the case, I would think they’d frame the issue more honestly and rather than pretending that they are finding new pathologies, they are taking preventative measures in an attempt to extend life expectancy. I would certainly not expect them to be silent as the media pretends that Americans have skyrocketing blood sugar, blood pressure, and cholesterol, when the truth is that it’s the diagnostic criteria that has changed, not people’s vitals.

    I’m not willing to say, given that we have seen increases in life expectancy continually, that there might not be some health benefits to these sorts of proactive health measures for levels that are not actually dangerous. Maybe putting somebody on blood pressure medication at 140/90 rather than 160/100, or putting them on Metformin when their blood sugar level is 126 rather than 140, will extend their life by a couple of years. Maybe for some people, those few extra years are worth the cost and side effects of medication. I don’t know. I saw one of my grandmothers (the thin one, actually) die of a stroke at 78 with all of her mental faculties intact, and my other three grandparents make it to their late 80s but spent their last years suffering from dementia. Right now, given the choice, I’d rather go like my grandmother who died at 78. But that might change as I get older, and at 60 I might welcome intervention that might help me eke an extra few years out of life.

    Of course, that raises the issue of whether or not spending so much money and using so many medical resources to try to extend the life of healthy people a bit rather than treating sick people is an appropriate use of medicine. And, it’s assuming that these interventions actually do extend life a bit, which they very well may not. But even if both of those things were the case, then I still think the medical community has failed epically in allowing the media to paint the situation as an explosion of pathology, rather than a redefinition of it.

  5. This is one of my “I don’t know what to think” areas too.

    See, I’ve got hypothyroid. And it took years to get diagnosed and treated. I’m finally on the meds and feel FUCKING AWESOME compared to the last, oh, 9 years of my life. 9 years feeling like shit before I got the meds. Yeah, I’m not bitter. Whatever.

    But part of why I’m finally diagnosed is because they lowered the threshold for what is considered hypothyroid. Because even though I had so many of the symptoms, by the standards of a few years ago, I don’t have it. And even by today’s standards, I just barely squeak by. My doc even said I’m probably “sub clinical” but he agreed I needed it.

    But me on armour vs me not on it? Like light and day. Seriously. I have my freaking life back.

    So I’m not going to across the board say that changing lines is wrong. But I’m also not going to say it’s right every time.

    I’m a total waffle on this one. I really just don’t know enough to say. Except for hypothyroid. And you know, I truly believe the reason they don’t treat more people for it is because the meds (natural or not) for hypothyroid are just too inexpensive. No one is buying a yacht on selling me this stuff. It apparently makes more sense to prescribe meds to cover all the symptoms of hypothyroid rather than give people one inexpensive med to treat the thyroid itself.

    Yeah, I’m cynical.

    Lori – just watched my Great Aunt die of alzheimer’s at 95 and am currently watching my 90 year old Grandmother also deal with the disease.I’m joking a lot lately that Maude (of Harold and . . .) might have had a good idea ;-)

    • I really just don’t know enough to say.

      Yeah, me too. One thing I have seen, from talking with people who are hypothyroid, is that some people (like you) feel totally sick with test results that are “okay” under the old standards, and others feel totally fine with test results that are “treat this person now” under the new standards. To my mind, this means that it’s not just the one test result. It has to do with the individual and everything else going on with their body, you know?

      And I think the same thing can apply to cholesterol and blood pressure and so on. One thing I remember from Big Fat Lies is that blood pressure tends to be higher in fat people overall, but it also seems to be less destructive to fat people than in thin people. I think there’s a lot we don’t know about healthy fat people and how their bodies operate.

      • That is true! My sister had thyroid cancer, which is way more serious than what I have, and her only symptom was a lump in her throat. Meanwhile, I’m “sub clinical” and had the fatigue, aches and pains, depression, all that happy stuff. No lump though.

        I think there’s a lot we don’t know about PEOPLE and how their bodies operate, LOL! A lot of medicine seems to be just guess work. And yes, there are plenty of good, well meaning doctors out there, but still, they don’t know nearly as much as they seem to think they do.

    • I’m hypothyroid too. They haven’t changed the lab ranges for TSH here in Australia yet, so I had to find a doctor who pays attention to world medical news. :P

      I think there’s a difference between the TSH and other measurements such as BP, glucose, etc. The healthy population is not spread evenly across the range, it’s heavily clustered around a TSH of about 1.3. There are doctors who believe that a TSH of 2.0 is too high if you are having hypothyroid symptoms. (That’s not even taking into account people who have hypopituitary problems, so their TSH says “perfect” at 1.2 but their FT3 and FT4 are all over the place.)

      Much of the other range lowering is done on extremely flimsy evidence. I think doctors need to take individuals and their symptoms far more into account when diagnosing and treating in addition to lab numbers. Some people seem to have naturally higher blood glucose, some people run low. And so it is with most health measurements.

      FatFu has two excellent posts on the trouble with “normal” in weight and medicine.
      http://fatfu.wordpress.com/2007/06/17/the-trouble-with-normal-weight/
      http://fatfu.wordpress.com/2007/06/19/the-trouble-with-normal-weight-part-2/

  6. Those charts were great! Thing is, I’ve even seen arguments that maybe the thresholds are TOO high. WTF. People don’t seem to understand that there will ALWAYS be people with no warning signs, whether fat or thin, who drop dead of “preventable” diseases. There will always be people who have high cholesterol / blood sugar / body weight who live until they’re 102. Because death and disease, while forming some pattern in the aggregate, are at heart as random as all other kinds of human suffering. We can treat acute conditions. We can lead healthier lives (I would argue that medicating up or maintaining a body weight below one’s equilibrium are decidedly not healthy). We will still die, maybe in an accident, maybe when really old, maybe of a preventable disease our numbers said we shouldn’t get. There’s only so much you can do, no matter what the advertisements say and no matter how much doctors feel they need to do everything they can.

  7. This kind of re-establishing of the guidelines is the kind of thing that makes you throw your hands up in the air admitting defeat. I have reached a place where I no longer strive to play the game, so to speak, because someone keeps changing the rules. I can never win at this game.

    Before there were proper medical labels for everything, people just dealt with the symtoms. Runny nose-steam and hot fluids. Aching joints-rub eucalyptus on them. I wholeheartedly believe that the main reason people live longer is that we have more sanitary living conditions. This prevents a whole host of diseases and infectious conditions. Science has been great about identifying various viruses and bacteria that cause illness. What it’s done even better is scare us into thinking there’s a pill for that. 20 years ago antibiotics were overprescribed by doctors, which now has created a whole different, evolved set of bacteria to deal with-then they blamed us for taking the antibiotics in the first place!

    As I said before…you can’t win.

    • I wholeheartedly believe that the main reason people live longer is that we have more sanitary living conditions.

      It’s certainly a biggie. There’s also the “herd effect” of vaccinations – huge numbers of adults never had measles or mumps, and were never exposed to polio. That’s made a huge effect on health and lifespan too.

  8. Yes, more sanitary living conditions & immunization help a lot. So does having enough money to keep a decent roof over one’s head & have enough food not to go hungry. Stress, which will all live with, &, which, in the current economy is skyrocketing, is not beneficial to health. But most of what diseases we get & when we get them & how long we live is genetics & most of what they beat us to death is tied to aging (& I say this as a person who will be 60 in September & who is not taking any prescriptions & who avoids the medical profession as much as possible.) It is indeed NORMAL for most people to gain weight with age, until our early 60’s or so at least, for weight distribution to change, for us to lose some strength & muscle tone, & not to always be 25. And it is normal for human beings to eventually die & along the way perhaps to have some health ‘problems’, more the older we get. My generation, the Baby Boomers, is the single largest generation in the history of this country, & we are aging, but we are being told constantly that we are not supposed to be aging, we should be more ‘proactive’ (a word I think I hate unless you are talking about acne treatments) & stay young forever. We are being sold the idea of total personal responsibility, of choice, that it is all our ‘fault’ if we ever get sick &/or don’t live to be at least 100…you know, just like it is our ‘choice’ that we are fat?

    As for medications, they have their place & their uses & they do have a lot of people, but we are all, medical personnel included, pushing the idea that no matter what happens, what ache or pain we have, there is a pill for that, we are being overmedicated. My mother lived to be 85, 40 of those years with one kidney, & for several years of her life, she was on at least nine different medications. Who Knows? Maybe if they had not pumped so much crap into her, especially the damn Prednisone, she woul have lived even longer? Her mother was a hypochondriac who self-medicated a lot & she lived to be 90. Both of them, btw, were fat for almost their entire lives & basically only lost weight if they were sick.

    We all live in our own bodies & make our own choices. I like to think that the choices I make now, approaching 60 (& it really isn’t as old or as far away as some of you may think & believe me it sneaks up on you when you aren’t looking), to avoid medications & any unnecessary medical interventions in my life will perhaps extend my life…or at least help me to enjoy it more & to avoid using up money which I could better spend elsewhere on expensive drugs with sometimes catastrophic side effects. That is one thing which stiffens my anti-drug resolve…watching the drug commercials & hearing side effects listed which are worse than the condition the drug is supposed to treat.

  9. One thing I have seen, from talking with people who are hypothyroid, is that some people (like you) feel totally sick with test results that are “okay” under the old standards, and others feel totally fine with test results that are “treat this person now” under the new standards. To my mind, this means that it’s not just the one test result. It has to do with the individual and everything else going on with their body, you know?

    Wow. That is totally the problem about this that bothers me, and you put it so well.

    Yeah, I’ve known way too many people who have been suffering for years with a variety of symptoms that seem to point to a condition, but won’t/can’t be treated because they just don’t meet some set of diagnostic criteria. And, I’ve known a lot of people who have been aggressively treated for a condition solely based on one set of numbers, even though they feel totally fine and even when the medication seems to impede their quality of life. Something is wrong there.

    It’s hard for me to jump on the anti-drug bandwagon, because Zoloft has literally changed my life. I have panic disorder and my life on Zoloft and off of it is night and day. The funny thing is, it took me forever to be diagnosed with panic disorder, and then to be put on Zoloft rather than told “Just try to calm down,” whereas I have friends who have been offered an SSRI prescription by their general practitioner because the doctor though they seemed kind of down at their check-up. So I feel like it’s one thing to say that anti-depressants are over-prescribed, which they probably are if people who just seem kind of sad at a regular check-up are being prescribed them, and another to assume that there’s some vast conspiracy behind the use of these drugs, which do help a lot of people live fuller, happier, healthier lives.

    It’s almost as if the problem is that doctors aren’t treating their patients like human beings. I try to see nurse practitioners now, because I’ve found that they’ll generally spend 2-3 times as long with me as a doctor will, will ask me questions about my life, and will talk to me about things rather than just telling me what to do. As an example, I had my gyno exam a couple of weeks ago, and I wanted to talk to the NP about whether or not she’d recommend staying on Zoloft since we wanted to start trying for another baby, and instead of just giving me a “Yeah, stay on” or “No, go off,” she looked up some studies on it, read through them with me, and then talked with me a bit about my experiences on and off of the medication, and asked me about what I felt would be right for me. And then she left the decision up to me. I’ve had similar experiences with NPs in the past: they’ve nearly always taken the time to get to know me as a person, to discussion medication and testing options with me, and to provide me with information then ultimately leave the choices up to me. It’s such a different experience than what I’ve had going to many doctors, where they’ve checked me out for 5-10 minutes then gave me instructions on how to proceed.

  10. It’s the same as with BMI. The levels for that were changed, and suddenly, overnight millions of people had gone from being ‘normal’ to ‘overweight’ without even gaining an ounce. Crazy.

    My mum, at 60, has recently been diagnosed with high blood pressure and put on medication. She has been very upset about this. The doctor told her she could lose a bit of weight. My mum is 5’5.5″ (she makes me put that extra half in!) and wears a size 14-16 (UK). She is the slimmest she has been since before she was pregnant with me, 30 years ago. So this doctor has now convinced my mother that this is all to do with her weight. Never mind the fact that her (15 year younger) sister and her mother both have high blood pressure and are on meds for it. She won;t believe this is all genetics and says it must be her weight. A 60 year old fit and otherwise healthy woman on a diet. It makes me sad. So I took her to the pharmacy for a BP check – guess what? 160/85. The pharmacist said she was fine. She’s going to go back to the doctors now because I told her it could be nerves about going. She had only been on the meds a few days so I doubt it was that. She was only a little over before anyway. Way under by the old standards. It makes me so angry.

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  12. My generation, the Baby Boomers, is the single largest generation in the history of this country, & we are aging, but we are being told constantly that we are not supposed to be aging, we should be more ‘proactive’ (a word I think I hate unless you are talking about acne treatments) & stay young forever. We are being sold the idea of total personal responsibility, of choice, that it is all our ‘fault’ if we ever get sick &/or don’t live to be at least 100…you know, just like it is our ‘choice’ that we are fat?

    I think what you’re describing is happening not just to baby boomers, but Generation X (of which I belong to), and more frightening, Generation Y, those who really shouldn’t even be caring at this point about wrinkles and whether that piece of cake will make them fat. The goal of the image-obsessed society is to keep us young-looking and thin at any cost without regard to our physical and mental health. Sure, you’ll feel like crap, but at least we can look at you without gagging.

    But I’m not anti-drug. I do feel we are being prescribed too many pills for too many ailments, some which can be relieved naturally, but there are just some things that can’t be eased or erased unless you’re taking the medicine. Ever since I started on BC, it has made a world of difference. I used to suffer from painful cramps and messy, clotty periods. Since the BC has been in my system, the cramps and clotting has ceased. I was reluctant to “tamper with nature,” but I had to, so I could feel better and not worry about embarassing moments.

  13. I am sorry if it sounded as if I thought no one should ever take medications. I know people do need meds for different things. I have been lucky not to have any kind of ongoing condition so far which required medication, only a short course of antiobiotics two or three times, which gave me terrible diarrhea every time, btw. I don’t like drugs personally, do not trust the medical profession, & am what they call a difficult or ‘non-compliant’ patient, I guess. They will have to give me a lot of proof that I really need medication & that I will be better off with it than without it.

    As for birth control pills, I don’t like the idea of them, or, for those of us who are older, HRT, but I guess some women do reasonably well on them & willing to deal with the risks. I took BC pills once in my mid-20’s for about three months, & had bloating, terrible headaches, elevated BP, & generally felt like crap, so they were not for me.

    I wish us all well finding our own ways to live the best lives possible for us as individuals & I wish us all the courage & spirit of independence to declare ownership of our own bodies & lives, regardless of what health problems we may have.

  14. In the mid-1980s my cholesterol was discoverd to be a bit over the limit of 240. I told them I would deal with it by diet and exercise. It’s been steady ever since (diet and exersice only help a little) and I’ve refused drugs consistently even though it’s now categorized as _really high_. It’s still my only indicator of a health problem.

    Lately I’ve been imagining all the damage I could have done if I had agreed to take the early cholesterol-lowering drugs, or even the more recent “improved” ones. Drugs with side effects COULDN”T have done anything but harm. Even if I keel over tomorrow, I think my quality of life in the last 25 years would have been worth it!

    So thanks for the little capsule version of what’s been happening.

  15. I disagree with the points when related to blood pressure. There is solid evidence that reducing even “borderline” high blood pressure (between 120 and 140 on the upper number) results in fewer strokes 20 years later. I once heard Paul Ernsberger speak to this question; I would trust his opinion. I will have to go look what Sandy Swarz has to say about blood pressure.

    The other 3 (cholesterol, blood sugar and weight) seem to have no basis in clinical practice or dependable studies. As a scientist (chemist), I am daily appalled at what is passed off as science these days.

  16. Thank you for this! I was wondering about that today, after seeing what this doctor had to say about apparently ‘unchanged in 20 years’ UK diabetes thresholds:
    http://www.dailymail.co.uk/health/article-1158670/Ask-doctor-My-wifes-big–diabetic.html
    …I’d like to find out what the truth is as regards the UK (I presume those are US figures on those charts), as his correspondent there with the diabetic wife isn’t the only person recently who’s been questioning whether our blood sugar levels have changed.

    Not to mention whether the ‘pre-diabetic’ category used to even exist…any guesses on how long before they start using the term ‘pre-obese’ instead of just plain ‘overweight’? We might as well say we’re all ‘pre-dead’ and be done with it.

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