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> not generalizable

But there's already a general advise on this: eat more fiber.

https://med.stanford.edu/news/all-news/2017/08/hunter-gather...

We're a great ape, our body evolved to process a lot of fiber from fruits and starches. It's the modern fiber-deficient diet that's really weird.

90g/day of fiber is similar to the Hadza tribe diet, where they can consume 100-150g of fiber per day.

Also, the authors claim the starch "inhibited lipid absorption." They do not argue why they used surrogate blood biomarkers instead of residual energy output in fecal samples (which is a better measurement).

sample size is 37, number of authors 29

> highly effective

Purely behavioral lifestyle interventions have the lowest long term success rates of all available treatments for obesity. It's especially unreliable if you have weight loss targets higher than 15%.

They are of course still widely recommended due to numerous benefits other than weight loss, but "highly effective" is just wrong in the context of obesity treatments.

Why not, though? Eating is fun and pleasurable. If we can figure out a way to eat the things that we want, in the quantities that we want, while maintaining our health, why shouldn't we try?

I've lost weight through forcing myself into a calorie deficit, and it works really well, but it's not particularly fun.

You can induce a calorie deficit by eating foods that fill you up but don’t have many calories. Also avoiding the sugar-spike carbs cause leaving you even hungrier shortly after works also.

A good dietician is worth a few consults if you don’t have the will power to just fast. And as a bonus you don’t lose muscle mass as well because they’ll focus on keeping protein up.

The vast majority of people who lose weight by calorie restriction gain it back, so I wouldn't call it highly effective. Short term yes, but long term, definitely not.

Yeah, that’s why there were no obese people in concentration camp. No matter the “metabolism” excuses

> which is highly effective

How are you defining highly effective? In the sense that a body will definitely lose weight when starved? Or in the sense that counting calories is broadly effective as a weight loss strategy?

The former is painfully obvious and entirely unhelpful, and the latter is provably false.

"you people"

> The study was conducted in Shanghai, China from 3 July 2013 to 14 October 2016

Figuring out and understanding the physiology of different gut bacteria is not just for people trying to shortcut weight loss while still eating unhealthy food or to be sedentary all day.

Eh, the "real food" of Jamie Oliver and Michael Pollan (shop the peripheries) and such isn't very health promoting. So I'll pass and keep eating a mix of fresh food and cheap food that keeps for a long time like legumes. Kthxbai.

Having a CAC done is fairly cheap, ~$100 in the US. Insurance typically doesn’t cover it, but if anyone is concerned, it’s worth calling to set one up.

My dad’s doctor said he should get one, Medicare denied it, but he paid out of pocket to get one anyway. He found out he was 95% blocked pretty much everywhere and had a quadruple bypass. It likely added many years to his life and avoided a heart attack.

If you’re under a certain age (I want to say somewhere in your 50s), there isn’t any guidance for what normal is. If you’re in your 20s or 30s, I wouldn’t run out and get one. But if you’re in your 40s with a family history, or up into your 50s and beyond, it’s worth thinking about. I’ve also heard you’re only supposed to get them every 2-3 years, it’s not a yearly thing, due to the radiation.

(I am not a doctor)

>For non-invasive heart disease risk prediction nothing beat ECG, period.

Emphasis on non-invasive diagnostic screening as invasive testing like angiogram need to be operated by specialist and can take months to be arranged, and only done after incidents e.g heart attack.

ECG is excellent for generic top level CVD anomaly conditions for examples arrhythmia and ischemia.

You don't even necessarily need insurance. Some of those tests you listed are pretty cheap so most people reading this can afford to pay out of pocket even if they're not covered by insurance.

> ECG, EKG

Those are the same thing, did you mean to type something else?

>How many ECGs can you sell vs how many other snake-oil products?

A lot, probably. You could sell people on the idea that it should be a part of your yearly health screening.

"And if you really care about your health you should do them every 3 months to catch problems early!"

or some such.

You can still sell snake oil that's purported to improve ECGs.

Poe's law in a full swing.

At a population level, it's great. For individuals, it can fail in all kinds of ways. For me: it is not very good because my body has very strange proportions. I'm 6'2", but my waist is barely higher than my 5'1" wife, and my torso is nearly the same length as my 6'7" brother.

In other words, for my height, I have a very long torso and very short legs. I think it should be relatively obvious that an inch of leg weighs significantly less than an inch of torso, so at a given level of body fat percentage, I'm going to weigh quite a bit more than someone my same height with more typical proportions, and thus my BMI reads me as more overweight than it otherwise would.

My point is not that BMI is bad or useless or anything else. My point is that it was designed as a population statistic and that it can be fraught when one tries to apply it to any individual with no nuance. A high BMI should cause one to consider and examine your health and weight. But it should not over-ride specific details about your physiology that point in the other direction.

> screening tool

People tend to think in absolutes. Even perfectly rational people fall logically foul to not considering outliers.

> I’ve been in the “overweight” BMI range with low body fat before. It’s not too hard to get there

Did you do that as a natural lifter? It’s hard for me to imagine most guys being able to get into the “overweight” range at < 15% body fat without some assistance.

The farther from average height you are the worse it is. If you are from some part of the world where the average height distribution is near the point BMI based itself you will perceive it to be so much better.

I am only 6' and only an intermediate lifter. I'm overweight, but BMI makes me look obese. It really only takes a normal person a year or so to get to three plates on squat with no supplements other than chicken broccoli and rice if they don't skip workouts. Assuming no injuries. That level of strength easily distorts bmi wildly if you are even a little taller than average.

Yeah, people don't want to understand that your body structure messing with BMI is quite real but only a few points. It's unquestionably "wrong" in scoring me higher than my wife despite the fact that she's the one with a few extra pounds. But it scores us both as normal, the difference doesn't matter.

Anything to pretend they aren't too heavy.

>Getting all the way to the obese BMI range while having healthy body fat is only happening for people with an extreme dedication to body building and diet

And sumo wrestlers.

The line seems to be drawn at (effortful) activity level more than anything else. And BMI doesn't say anything about that.

I think the vexation comes from the focus on an attribute that is not directly mutable, per one's agency, because that's easier to sell things related to. Versus action that you have a lot more direct control over (social or physical circumstances notwithstanding).

> Many active gym people have pretty high BMIs but fairly low fat

I think this is greatly exhaggerated.

Yeah you can put on as much muscle as Arnold and have a FFMI of about 27 then maybe have a BMI of 34 if you have 20% body fat.

But a very gifted natty might cap out at maybe 24 with a BMI of 30 at 20% bodyfat. But let's be realistic. This is not "many active gym people". This is the guy winning the local strongman meet.

Yes a couple of years training for most people can add a couple of points to BMI but I think people exaggerate how much this is. Go look at a 20lb brisket at costco - you don't see people with that much extra muscle all that often.

> Many active gym people have pretty high BMIs but fairly low fat (because muscle is dense),

I’ve been in the overweight BMI category with low body fat by being active at the gym and focusing on diet. It takes some work to get there.

If I check the calculators for the obese BMI range, there was no way I could get there without either gaining a lot of fat on top of the muscle. The amount of muscle required to have an obese BMI with healthy amount of fat is absurd.

I believe evidence points towards absolute level of fat being more important than % for overall health.

E.g. 20% bodyfat at 250lbs is still a lot of fat.

Of course it's difficult to ever get very high on absolute fat if at 15% or below.

It’s a tool not the tool. If you have obese BMI you can… look in the mirror and see how accurate it is. If you aren’t sure take one of the dozens of other tests. People focus too much on it being a one stop shop - it’s not. It’s the start of a dialogue with your pcp and self on assessing your health that’s highly correlated with poor health outcomes.

If bmi says you're obese, you very likely (~95%) are. The problem is that bmi only catches about half of people who are obese.

https://www.nature.com/articles/s41598-020-69498-7

It's not really intended to be applied to individuals at all, but if you're in the "healthy" BMI range then you are probably fine just not thinking any further about your weight and doing something like measuring your body fat percentage would just be a waste of time and a source of stress for some people. If you're outside that range, then it is worth doing some of the more involved things to judge if your weight is healthy.

It isn't accurate. It is a statistical tool meant for easily measuring populations of people. It does not apply in any meaningful way to individuals.

Which for the majority of the population isn't relevant.

The people most obsessed with "BMI isn't accurate" are overweight people making excuses for themselves.

A muscular person can be "overweight" by BMI standards but not overfat at all. This is the case for many types of athletes, specially in strength disciplines but not only. It is the case in the fitness world that people ignore BMI and are intesterested in body-fat-percentage instead. This is hard to measure accurately so not so useful metric for the general population.

Not necessarily, a bodybuilder or very athletic person might be overweight in the sense of above average for their height but not overfat.

The dominant discrepancies are "expected" fat (boobs, etc), and "unexpected" muscle (cyclists, body builders, hard labour careers, etc). I'm currently around 10-15lb overfat and 40-50lb overweight [0]. Only the former statistic matters.

[0] And that, at least somewhat, tracks visual perceptions. Nobody looks at me with a shirt on and believes I need to lose weight, because 10-15lb isn't _that_ much extra on a tall frame. If I were 40-50lb overfat then that would be painfully obvious regardless.

I've been considered borderline or obese by the standard BMI index for 20 years at least, but for a lot of that had very little to no visible extra weight. A lot of that was just plain having more muscle than the average the standards are built around, but I also suspect BMI gets to be really inaccurate for tall people. I would look anorexic if I had to drop enough weight to be considered not overweight.

"Overfat" just refers to having too much fat.

"Overweight" can mean the same thing for weight, but it also refers to those with a BMI specifically between 25 and 30, and those with BMIs greater than 30 are classified as "obese".

This is not true.

It is what is called “skinny fat“.

It's not a remotely good proxy

and because it is comparative ratio (cm / cm), it works in any length metric. CMIIW

> And by adulthood, height doesn't change significantly and you probably know it ...

But height does change in adulthood [0]. On average people living past 40 gradually lose height. At age 80, it's likely height loss will be >=2 inches. This loss is reflected in higher BMI even when body fat content hasn't changed. Average BMI increase isn't large, but think about a person losing 4 or 5 inches of height while maintaining body fat unchanged.

Self-reported height is generally greater than measured height. Adding 1/2 to 1 inch is common (per experience measuring height). "Height inflation" has modest effect on BMI but problematic in research and workup for medical procedures. In the latter cases, measuring height is necessary.

[0] https://www.uhhospitals.org/blog/articles/2024/10/why-do-peo...

I think the recent stance (not really recent in terms of assumptive idea, but now there is evidence) is that not all forms of sugar intake are equal. For instance, habitually drinking beverages with sugar in them (what are called sugar-sweetened-beverages in literature) is associated with a risk of developing T2D, where getting sugar from normal foods isn't really.

https://link.springer.com/article/10.1007/s13668-026-00740-w

$50? Are you talking about US Healthcare where $50 just gets you a call to the receptionist?

It only fails to classify people with excess body fat who are in the healthy weight range.

It's really good at catching people who are obese who are overweight.

It's like 25% of the men in my family. I am but a mere 6'1". What do?