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.

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.