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Diabetes, Cholesterol, BP: Normal is no longer normal


On 10 June 2014 there were global headlines about a ‘condition’ called pre-diabetes. From the Mail telling us that “A third of adults have ‘borderline’ diabetes – but most don’t know: Rising tide of obesity means number who have ‘pre-diabetes‘ has trebled since 2006″ to the Huffington Post proclaiming “Most People In England Have Borderline Diabetes, New Study Reveals“.  One third was never most people when I did proportions, but anyway.

Here is the summary of the study and findings from a journal web site and here is the original (full) article.

A quick review of the article should have made the media far more challenging, instead of just taking the press release headlines:

1) The study used data already gathered for Health Survey England (HSE), which started in 1991. The number of adults involved in the HSE, from whom blood samples were taken, was 7,455 in 2003; 6,347 in 2006 and 1,951 in 2009. I can’t find the numbers for 2011, but they are likely to be small if the trajectory continues. There are over 40 million adults in England. Using 2009 as a guide, projections on this concept of ‘pre-diabetes’ have been made based on 0.0048% of the population. I can’t get my head around such numbers.

2) People were diagnosed with pre-diabetes if they had glycated haemoglobin (an indicator of blood sugar levels) between 5.7% and 6.4%. This is the US guideline for ‘pre-diabetes’. The UK guideline is 6.0-6.4%. This would have over-predicted the idea of having a pre-condition.

3) The introduction to the full article in the BMJ is worth a read. The introduction notes that England set up a scheme to offer people aged between 40 and 74 a health check to try to pick up blood glucose concerns (and other things). Then it admits that “the scheme is controversial since randomised trial evidence does not show that health checks reduce morbidity or mortality.” i.e. these health checks made no difference to health or death. The article then notes the concern about “the extent to which medicine is extending the boundaries of illness through new definitions of disorders, with a consequent risk of treating more people than necessary.” I couldn’t have put it better myself. That should have been the headline.

The issues with the headlines on pre-diabetes aren’t, however, the main focus of this post. This post is about the fact that normal is being redefined as abnormal to the point that normal is no more. The whole concept of pre-diabetes is just one example and it’s by no means the first distortion in the diabetes world…


Aside from this created condition of pre-diabetes, the definition of diabetes itself has been manipulated. There’s a useful diagram here (scroll about half way down), which has a clear illustration of the game being played.

The curve in this graph is known as a “normal distribution”. This means that, when we plot the population, people are normally (typically) distributed as this curve indicates – most people are in the middle and fewer people at both ends. The peak of the hump indicates the average (mean and mode in this case if you like stats). The average fasting blood glucose level is 100 mg/dL (this is the US measurement – UK would be 5.6 mmol/L). Don’t worry about the mgs and the mmols – we’ll just call them US and UK measures from now on. So 100 (US)/5.6 (UK) is the true average of the population. There are very few people with a fasting blood glucose level of 50 (US) and about the same number of few people with a fasting blood level of 150 (US) – most people fall within the 60-140 range (US) (3.3-7.7 UK).

Then see what has happened. Diagnosis of diabetes used to occur at a fasting blood glucose level of 140 (US) 7.8 (UK). This is a number on that normal distribution curve and so is an entirely normal reading for a section of the population. Normal was redefined as high. But then it got worse. Back in 1997, high was re-re-defined as 126 (US) and another large segment of entirely normal people became abnormal.

The UK uses the same benchmark to diagnose diabetes. This states that diabetes is diagnosed at a fasting blood glucose level above 6.9 UK (126 US). If you look at what the UK thinks is normal, it is arguably worse than the US graph. The UK has defined normal fasting blood glucose levels as 4.0-5.9 (72-106 US). The true centre of the norm from the graph is 100. The range which captures most people is thus 80-120 – not 72-106.

Normal is not normal. The medical world has overruled the human population and decreed that normal is not normal. Normal is now high and people shall be treated accordingly. Now that we have pre-diabetes on top, joy of joys, we can start medicating people even sooner than our re-re-defined norm would otherwise let us drug them. (Or we can give them ‘base your meals on starchy foods’ dietary advice and speed up their pathway to type 2 diabetes.)


This doesn’t just happen in the world of diabetes. Cholesterol is perhaps the most successful and horrific redefining of normal that the medical world has ever got away with. Look at figure 2, on page 3 of 5, here. It’s a graph of the normal distribution for cholesterol in the UK. There are two lines – one from the Health Survey for England and the other for The Health Improvement Network. The high point of the chart (the average) is 5.6 mmol/l (216 mg/dl) for the Health Survey for England and 6.3 mmol/l (243 mg/dl) for The Health Improvement Network. Both the red and blue lines follow a normal distribution (slightly skewed) with readings between 2 and 10. Can you imagine the reaction of your doctor if your cholesterol reading were 9-10 mmol/l (that’s 348-387 mg/dl)?! And yet it is absolutely normal that a section of the population will have this as their normal reading, just as a section will have a normal cholesterol level of 2-3 (77-116 mg/dl).

Just as happened with diabetes, normal is not allowed to remain normal. The medical profession has redefined cholesterol to be high at the absurdly low number of 5 mmol/l (193 mg/dl). You can see from the graph that only a small proportion of the population would have a cholesterol level below 5 in normal circumstances. Indeed, if you look at government data measuring people against this made-up target – the Health Survey for England for example (summary of key findings) – we have the crazy situation (page 22) where it is noted that 80% of men and women in many age groups have cholesterol levels above the government target of 5.0 mmol/L. That’s not because 80% of people have ‘high cholesterol’, but because normal has been redefined as high so people cannot be normal any more.

Look at what has happened in America. In 1960-62, normal (average) cholesterol levels for 60-74 year olds were 250 mg/dl (6.5 mmol/l). After decades of statinating people, ‘normal’ cholesterol levels have been reduced to approximately 215 mg/dl (5.6 mmol/l) for this age group, by 1999-2002.

You know why this happens. Normal people have no value whatsoever to the pharmaceutical industry. But redefine ‘normal’ as hi gh and suddenly healthy people can be medicated. This is how Lipitor was able to earn $125 billion for Pfizer during its patent. And who sets the targets?

In America, they are set by the National Cholesterol Education Programme (NCEP). The 2004 NCEP financial disclosure report reveals that ALL members of the 2004 guideline participants had received payments and/or grant funds from some, many or most of the following organisations: Abbott, Astra Zeneca, Bayer, BMS-Sanofi, Bristol-Myers Squibb, Esperion, Fournier, Glaxo SmithKline, Kos, Lipid Sciences, Merck, Novartis, Pfizer, Procter & Gamble, Reliant, Sankyo, Takeda, Tularik, Wyeth. (For full details of conflicts see point 3 on this post.)

In the UK they are set by the National Institute of Clinical Excellence (NICE). Here are their conflicts – 8 out of 12 of the NICE panel members have conflicts of interest with the statinators.

Blood pressure

Blood pressure is the same. Here is a journal article with a couple of very interesting graphs – open up figure 1 and figure 2. Figure 1 is the higher number when you have your blood pressure reading (the 140 in 140/90 kind of thing). This shows that the normal blood pressure range for the general population is anywhere from 90 to 240 as the top number, with 130 being the most common reading (mode) and the average (mean) being around 140.

Figure 2 is the lower number (the 90 in the 140/90) and this ranges from 50 to 130. The most common is around 85 and the average is around 90. So the true average blood pressure (BP) in the normal population is approximately 140/90. You may be aware that 140/90 is the definition of high BP. Yet again, normal has become high and now everyone who is deemed high shall be medicated, when they are in fact normal.

Height and foot size

In the Western Journal of Medicine, (May 2002) Thomas Samaras and Harold Elrick posed the question “Height, body size and longevity – is smaller better for the human body?” The study took 100,000 males from 6 different ethnic populations – in the same city (California) to try to normalise other factors. The table had the following height orders (tallest first): African Americans; White Americans; Hispanics; Asian Indians; Chinese and Japanese (the first two groups were recorded as of equal average height – 70 inches).

The death rates for all causes and coronary heart disease (CHD) were presented in the study. A clear pattern was immediately obvious. I calculated the correlation coefficients as 0.85 for height and CHD and 0.9 for height and all causes of death (1 is a perfect relationship – scores of 0.85 and 0.9 are very strong relationships).

What if we concluded that height were a cause of CHD (and all causes of death) and that we should therefore redefine the average height to declare the actual average of 69.7 inches (for all American men) to be abnormal? What if we made up a new target 10% lower than the actual average and decreed that normal height should be 63 inches? We could then administer drugs to stop growth hormones from doing their job. I trust that this analogy disturbs you and yet…

The Chinese practice of foot binding – an artificial intervention in the normal development of the human body, to achieve an artificial ‘norm’ – was thankfully outlawed in the early twentieth century, but trying to reduce many other genuine human norms – from diabetes to BP – has now become common practice and big business.

38 thoughts on “Diabetes, Cholesterol, BP: Normal is no longer normal

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  • Hi… I’m 41 years old. I weigh 115, female and have been eating keto for over 10 months now. I have never smoked, don’t consume alcoholic or caffeine.

    My doctors are concerned with my recent lipid profile. I told them about all of the research and how my numbers are normal for me and my lifestyle and they seem to disagree.
    I need more research…
    Total: 319
    Trig: 55
    HDL: 118
    LDL: 190

  • Hi Zoe, what about the argument that normal is only normal with respect to the god awful westernized diet that the majority of people are consuming. I am not so sure about this with regard to cholesterol as like you I am something of a cholesterol sceptic but with blood sugar this would have more relevance

    • I thought the same thing, Mark. Should “normal” be distinguished from “common”. Has the difference between common and normal varied over time in westernized cultures? I suspect that would be anticipated because of all the cultural changes which have occurred in the last 150 years.

  • It’s surprising that pharma has missed the opportunity to create a disease out of “abnormal” height and find a drug or two to market.

  • I am not medical so please excuse any ignorance! I take your point about ‘normal’ Cholestrol, BP and Diabetes now being re-classified as high, but is it not possible that it has now been found that those levels are not healthy levels? Because more people are obese now surely doesn’t mean that the ‘average’/normal’ weight is healthy ? Please explain what I am missing.

  • Hi Zoe,

    I actually do have high cholesterol. In fact my TC is 9.9mmol/l, trig 0.7, HDL 2.4; and even my HFLC doctor is concerned. I’ve been HCLF for 4 years, A1c of 4.8. Do you think intermittent fasting could raise TC?

    • Hi Kay
      So sorry for the delay in approving this – a month’s worth of comments have just appeared – I wondered why it had gone quiet!

      I don’t see how intermittent fasting could raise TC. You’re also at the top end of normal on the graph in this post – someone has to be at the top end (and bottom end) of normal on any normal distribution – that’s what the normal distribution is!

      This may help with some other thoughts/things to read:

      Best wishes – Zoe

  • I know a lot of obesity researchers think that fruit is bad. I could be wrong, but I think it’s supersized fruit that is bad. For example, when we grew our own fruit, the pears were tiny. Now the pears at the store are huge. I try to buy the smaller fruit. or just eat less of it. So the grapes we grew were tiny, but the ones in the store are huge, so just eat 1/2. Instead of noticing these things and going back to natural fruit not genetically made huge fruit. INstead of ditching the low fat diet, the health officials invented a new disease, prediabetes.

  • Hi Zoë,I have been on an LCHF diet for the past six months. Had my fasting cholesterol test done today. Results: Total: 6.2; HDL: 1.7; Trigs: 1.15; LDL: 3.99
    I was told these are all safe outcomes, but read on the internet LDL is too high. Your take on this?
    BTW (my blood pressure on non-fasting was 135/92 and glucose 5.6. I’m 52 years old)
    Best regards

  • How can I lower my blood pressure naturally. On meds but want to come off them. Doing low carb. Can I just stop taking them

    • Hi Carol
      You’ve got to discuss meds – starting/stopping – everything to do with them – with your doctor. You’ve read the right post – which is to understand if you really have high BP or if you fall into the redefinition of BP. If you have weight to lose, real food/low carb will help but you may find weight still adversely affecting BP. Low carb helps with BP at any weight because you avoid the carb/glycogen water retention. If you’re low carb/normal weight and genuinely high BP – you should be trying to work with your doc to understand why your BP is high.
      All of this is firm doctor territory – hope it can be discussed with her/him soon
      Best wishes – Zoe

  • I’m going to write some trap/dubstep/gabber songs that speak out against the pharmaceutical industry and warn the public to be aware of this and to not let their children become a victim. Basically, we’re just guinea pigs they like to torture with their experiments…out of pure entertainment and profit!

  • If there is a correlation between height and CHD, then perhaps there is an argument for compulsory amputations below the knee in order to bring ‘at risk’ groups back into the ‘normal’ range.

  • *checks pharmaceutical patents*

    Nope, no patented drugs exist for lowering body temp yet (whilst subject remains alive), guess it’s still ok to be 37 deg C.

  • So if the normal range for fasting blood glucose is higher that currently espoused by the disease management industry, does that also mean that the “hard” number of 140 (US) or 7.8(UK) at which organ damage begins, is also inaccurate?

    Because it would seem to me that if normal biochemistry can vary that much, then the body’s organs should be similarly flexible. Rather than there being a hard line at which organ damage occurs, perhaps it’s n% higher than fasting.

    Similarly, just having the occasional peak where post-prandial blood glucose exceeds this “magic” number is unlikely to cause lasting damage. Lasting organ damage comes after substantial and prolonged abuse. But just how substantial or prolonged, is going to vary from individual to individual.

    Modern medicine doesn’t like squishy numbers. Especially the bean-counter driven American healthcare system. They’re all about hard numbers and “pay for performance”. It’s a very mechanistic model, which is fine if you’re talking cars or vacuum cleaners, but doesn’t work nearly so well with people.

      • Both of you should read Jenny Ruhl’s links.

        It is well known that turning from traditional food to industrial one wrecks havoc with our glucose tolerance and health. Just read late Barry Groves’ Trick and Treat or even Lindeberg, Cordain and Eaton’s Biological and Clinical Potential of a Palaeolithic Diet. Our western normal is clearly not healthy.

        Personal information through postprandial measurement is the way to go if we are interested in knowing if this occasional peak exceeds this “magic” number either just barely and not often or instead sharply and often. Why? Because it is quite clear that the deleterious effect is dose-dependent: read Petro’s take on the matter.

        It is highly irresponsible to suggest people their fasting blood glucose of 140 (7.8) or even 120mg/dl (6.7mmol/l) is OK.

        • While I agree with most of Zoe’s writings I STRONGLY disagree with this one on diabetes.
          I know enough diabetics who have tested friends and family and found the same as endocrinologist Richard Bernstein – who used to test meter salesmen – GENUINE nondiabetics have VERY tightly controlled BG at all times. Once this control starts going south you are On The Diabetic Progression, and the sooner you become aware of this the easier it is to stop the progression. To do this you need to reduce carbs rather than increase them and take more drugs. The mainstream advice leads to the inevitable decline in health requring increasing meds until you end up on insulin for life.
          EPIC-Norfolk and a very large New Zealand study show a correlation between A1c and cardiovascular risk, starting from truly normal values of below 5%. Further studies correlate A1c with microvascular complications and postprandial glucose peaks with macrovascular complications. By the time they are diagnosed, many Type 2s have significant “diabetic” complications.
          The forgotten factor is SYMPTOMS. I spent most of my life suffering from mostly minor but chronic and annoying symptoms which I now know were symptoms of diabetes, and symptoms of conditions “common in diabetics” but because my FBG was and still is normal they were all claimed to be psychiatric in origin, or just plain made up. They didn’t really progress until after I met a dietician. After 50 years of this a GP finally gave me a Glucose Tolerance Test which proved I was “not diabetic” because I “only” scored 10.8, not 11.1. Against direct advice I bought a glucometer and soon disacovered my BG was shooting up to 8 – 10 after eating, and subsequently dropping to 5 or less, and even under 4.
          By treating myself AS IF I WAS ALREADY DIABETIC, ie. reducing carbs until my BG came back into range, I reversed most of the symptoms that had plagued me all my life, including but not limited to skin, eye, sinus, gum and fungal infections, strange and unpredictable drops in energy and mood swings, and peripheral neuropathy to the extent of numb and tingling fingers and “feet going to sleep” after meals. In fact the rest of me would often go to sleep too. In addition I lost the 15 kg the dietician made me gain, and reverted to being able to sleep the night without a pissing trip or three.
          You only have to look in (almost) any diabetes forum to see even more spectacular success stories. Doctors and nurses generally write these off as “just anecdotes” without realising that most studies of “diabetics” exclude everyone with an A1c below 8 (sometimes only below 6.5) so there is no “evidence” that well controlled diabetics even exist let alone how they achieve this.
          Currently the low quality managers that infest the NHS have decided the best way to deal with the “diabetes epidemic” is to diagnose fewer diabetics later in the progression, hence the push to use ONLY A1c for diagnosis. Since ACCORD, doctors have been instructed not to use “intensive treatment” to reduce A1c below 6.5, which many doctors (PCTs?) have interpreted as stopping patients at all costs from attaining a normal A1c. The latest twist is that diabetics who reduce their A1c below 6 are now being told they are “no longer diabetic”, or were never diabetic, and are being deregistered. I even know several Type 1 (insulin dependent) diabetics who were deregistered and had their insulin prescription stopped, which should lead to a charge of attempted murder.
          The latest trendy young GP has now assured me I was not only never diabetic but never prediabetic because “the only thing that matters is A1c” and that it is “perfectly normal” for BG to go up to 10 or more after eating. NO! Just because it is COMMON does not make it normal. The same GP would not call obesity “normal” just because that too has become common. Disrupted glucose metabolism is behind the current “epidemics” of obesity and/or diabetes and ignoring this will inevitably (IMNSHO) lead to further “epidemics” of CVD and Alzheimers.
          OK, time for lunch: local lamb’s liver and bacon, with mushrooms and broccoli from not far away. I guarantee this will cause no symptoms and not shift my BG, and not leave me starving hungry again two hours later.

          • But the issue here is so called normal range NOT the symptoms. If you had 250 mg/dl and above blood sugar then there would be symptoms like polyuria (urination frequent). Reduction in blood sugar definitely reduces symptoms.

            So called organ damage studies are also flawed because of small sampling size and it is also not practical to follow a huge diabetic group for 50 yrs and note down every minor details of difference in food intake, exercise or activity they perform which can influence blood sugar levels. Everybody is unique based on height, weight, food consumed. I’ve known people without symptoms despite having high blood sugar of 200 mg/dl or above.

            So called non diabetic People who show all the time less than 85 mg/dl BS can also become diabetic one day, if they continue to consume high carb diet. So it is only a question of time for insulin resistance. It is all about glycemic load which takes into account how much carbs we are consuming per serving and glycemic index.

            This fear mongering by posting odd research studies with poor sampling size should stop. Internet is notorious for it.

    • I read an article that stated having BP levels at 110 or so over 70 or lower is not a good sign, yet we are being taught that it’s “healthy”.

  • I will add the most relevant links to Jenny Ruhl’s work.

    In Misdiagnosis By Design – The Story Behind the ADA Diagnostic Criteria explains what Pam pointed out: “Therefore the “norms” were set at a high level.”

    In How Blood Sugar Control Works–And How It Stops Working explains what Judi pointed out: “According to Jenny Ruhl at Bloodsugar 101 by the time your fasting blood sugar is this high you are already most likely getting damaging post-prandial numbers of over 140.”

    In Research Connecting Organ Damage with Blood Sugar Level explains what those troubles are that Janknitz pointed out: “So they may be under 100 FBG and therefore “normal” on that curve, but they are already in trouble.”

    Under an unhealthy diet normal can be unhealthy. Everyone should check his/her postprandial blood glucose after most usual meals and act accordingly.

  • I agree with Lauren and Janknitz. Lowering norms for FBG is a good thing. From what I have read Doctors were loathe to diagnose diabetes too early b/c of the ramifications on getting health insurance costs/death sentence perception ages ago. Therefore the “norms” were set at a high level. But as others have said damage to blood vessels, capillaries, organs, pancreas etc occurs earlier than most people think according to Blood Sugar 101. And just as Lauren said, Fasting Blood Glucose is the last thing to go after years of sugar organ damage.

    This is what I have read. Jenny Rhul has diabetes and great difficulty regulating it with diet and medication. Zoe, I agree with you, we do not want to medicate more and more people. We need to change our diets. The Diabetes Diet needs to be changed to decrease the need for medication.

    But I don’t think we need to raise the FBG norms. But I could be wrong. Jenny Rhul could be wrong. Could you do more of your wonderful research on this issue and let us know what you find?

  • I get what you are saying, but I am wondering what the “normal” population has been doing. I mean, has the normal curve been going upward, or has it been staying in the same place? I would guess that, at least for blood sugar, it has been straying upward, since so many people eat so many carbohydrates. So, perhaps, docs have been moving it BACK down to where it should be, or to where it used to be?

  • I agree with Janknitz, a fasting glucose number over 100 is a call to action. According to Jenny Ruhl at Bloodsugar 101 by the time your fasting blood sugar is this high you are already most likely getting damaging post-prandial numbers of over 140. By the time I took matters into my own hands and changed my diet I was already suffering from neuropathy in my feet. I was not considered a diabetic – my doctor had told me my fasting was “high normal” at 102 and we would just keep our eye on it. Right.

    When I began testing after meals I discovered my sugar was going as high as 182. My doctor didn’t seem concerned by this, but I began a primal style diet and have never looked back. Metformin can be helpful, but it’s mostly about how much carbohydrate you’re eating and doing some sensible exercise.

  • I GET what you are saying, and I totally resent that my doctor is now telling me that my BP of 130/90 is now considered “pre-hypertension” when it used to be considered “normal”. They want to treat what was once considered normal. Ridiculous considering this is how high it goes with “white coat syndrome”. At home my BP typically runs in the 115/70 range–I’d be passing out all over the place if they tried to lower my “pre-hypertension” BP! Likewise for the changes in what is considered “normal” cholesterol, especially that no allowances are made for age, especially in women.

    OTOH, I do believe that there is a “diabetes spectrum” and that people who are considered “pre-diabetic” under the current standards are definitely on that spectrum (personally, I think HbA1C’s in the 5.7 range indicate they are already diabetic, but that is a personal opinion). Additionally, the so-called “normal” curve includes a lot of people who already have serious insulin resistance issues and do tend to be hyperglycemic, but maybe not when fasting–yet. So they may be under 100 FBG and therefore “normal” on that curve, but they are already in trouble. I have read that if you tested strictly a population of people who do NOT have insulin resistance, that the “normal” part of the FBG curve would range from about 70 to 85, not up to 100.

    I don’t think people need to be on diabetes drugs just because they are “on the spectrum”. But they certainly need to be paying attention to their diet and exercise AND be given the RIGHT diet advice, which doesn’t include eating low fat and lots of whole grains.

  • Zoe, thank you for this, as usual an informed and sensible response.

    • What a coincidence: I’m currently reading a book called “The Patient Paradox” by Margaret McCartney. I’ve only just started it, but she writes about something similar- that the medical industry nowadays seems to be treating “numbers” rather than actual symptoms or sickness. (For instance, so-called “high cholesterol” is not an actual illness, and yet millions of people are being treated as if it were). Not only that, but one blood reading can vary drastically from day to day, or even hour to hour; it’s just a “blip” in the greater scheme of things. In addition, there does not seem to be any evidence that medically lowering blood cholesterol or blood pressure does anything at all, aside from causing possible side effects- (pre-diabetes could be a different case IF they were to advise people with high blood sugar to reduce carbohydrates, but of course they don’t).

      On a side note, I am now considered “underweight” because my BMI is below “normal”. But I feel perfectly healthy, and when I look at film footage of women from the 1950’s or 60’s, my body type looks average for that time period. So what is “abnormal” anyway?

      • Hi Lisa – sounds like a great book – I do like M McC – one for the holiday downloads – thank you!

        In terms of health, overweight (25-30) is ‘better’ (Lenz M, Richter T,Mühlhauser I, ‘The Morbidity and Mortality Associated With Overweight and Obesity in Adulthood A Systematic Review.’ Dtsch Arztebl Int. 2009 October; 106(40): 641–648. than underweight or normal. But anyone who is eating well and is finding a stable weight easy to maintain is probably at their natural weight. In some people this is low; in some it’s high. That’s why we have averages!

        Best wishes – Zoe

        • Hi Zoe,

          I had also read that being overweight is probably healthier than being underweight, particularly in muddle aged people. However, the only way I am able to “up” my weight is by eating sugar and refined carbohydrates, which I don’t want to do for obvious reasons! In fact, as soon as I stopped eating sugar and replaced it with healthy fats, I dropped down to this weight. (However, I feel much better eating this way!) One of the points I was trying to make though is that “averages” and what’s considered “healthy” might change over time, so there’s probably little point in stressing about it; for instance, my body type and weight looks like it was “average” for women of my age in the 1950’s and 60’s, if not now. To be honest, I was always a bit skeptical of BMI as a measuring tool (both for labeling “overweight” as well as “underweight”)- just as I am skeptical of other “numbers”.

        • Hi Zoe
          Within the conclusion of the quoted paper there is the statement that “However, an increased morbidity and mortality risk has been confirmed for being underweight.” I thought I had read a while back that this has been debunked. The study didn’t allow for the fact that some of the underweight folk had potentially serious health conditions which eventually killed them and also made them underweight, thus skewing the data?

          • Hi Philip
            I’m not sure which paper you’re referring to and you may well be right whatever it is – please share any debunks!
            Best wishes – Zoe
            p.s. this is the one that Dr Malcolm uses for the deaths and weight point Flegal KM, et al. “Excess deaths associated with underweight, overweight, and obesity.” JAMA. (2005).

          • Hi Zoe – I did some digging and came across a Wikipedia article (Obesity Paradox) which I hadn’t seen before – here are a few references from the “Criticisms” section:

            Confounding by smoking:

            Smoking again: “The obesity paradox is absent among never-smokers” two authors the same:

            I think this is the specific one I was remembering in my original post to you – it’s the J- shaped mortality versus BMI graph that I recall: “In an analysis of 1.46 million individuals, restriction to never-smoking participants greatly reduced the mortality estimates in the underweight group, as well as strengthening the estimates in the overweight and obese groups”:


            All the above post-date the 2005 paper

            Kind regards, Philip

          • Hi Philip
            It makes sense – not for the 2005 paper though as this adjusted for smoking and many other factors. I’ll look out for it if this come up again however.
            Many thanks!
            Best wishes – Zoe

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