> Conversely, metabolically healthy obese people have no increased risk of mortality.
I am not sure about this. *Outlive* says this info comes from a meta-analysis, it doesn't cite a source but I believe it's from Hui et al. (2010), "Metabolic syndrome and all-cause mortality: a meta-analysis of prospective cohort studies", based on the fact that the book says the meta-analysis had "a mean follow-up time of 11.5 years" and that was the only meta-analysis I found with that fit that criterion. But I looked over Hui et al. and it doesn't say anything about how obesity or BMI interacts with metabolic syndrome, so I don't see what Attia is basing this claim on.
> Metabolic syndrome is (to vastly oversimplify) when your body sends calories to places in your body where they aren’t needed or are even harmful.
Worth describing how [metabolic syndrome is defined](https://en.wikipedia.org/wiki/Metabolic_syndrome) because it's pretty simple. Someone is diagnosed with metabolic syndrome if they fit at least 3 out of 5 criteria: abdominal obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL.
EDIT: I looked a bit more and found a [different meta-analysis](https://www.jacc.org/doi/full/10.1016/j.jacc.2010.05.034) that reports on BMI and metabolic syndrome (MetS), but only one out of 87 studies actually looked at BMI, that study being [Song et al. 2007](https://sci-hub.hkvisa.net/https://www.ajconline.org/article/S0002-9149(07)01619-0/abstract), "Comparison of usefulness of body mass index versus metabolic risk factors in predicting 10-year risk of cardiovascular events in women". And that one study contradicts Attia's claim. Namely, it found that obese women without MetS had more CVD than normal-weight women without MetS. (It didn't look at all-cause mortality.) Although it's still true that if you control for MetS, most of the harm of obesity disappears.
Here's the table of CVD incidence by BMI for MetS and no-MetS, respectively:
Does it say anything about cognitive decline? I have a super strong family history of early onset Alzheimer’s, and if I can’t do anything to prevent that specifically I would rather not waste my time doing any longevity stuff.
Also the bit about exercise (and especially the ideal programme) makes me LITERALLY cry & want to develop a dignified and painless suicide plan for in about 10 years' time because all the other lifestyle advice pieces combined (including losing enough weight to stop being technically fat -- though I have no metabolic syndrome, so the only benefit would be mechanical, good for OA) seem like a doddle in comparison to that. But I've known this for a while so there's that. Some people drink themselves into early death, some smoke or eat or work themselves into same, and I'm clearly going to slob myself into it.
I do want to caveat that the ideal program is ideal. Most people don't have time for all that exercise! Exercise has a fairly linear dose-response curve-- any amount is better than no amount. (Of course, that doesn't help if any exercise makes you want to curl in a ball and cry, which isn't uncommon.)
Obviously exercise is worse than death, but some pleasant activities may actually secretly trick the body into thinking that you've exercised, even though you were having fun the whole time.
When I spend hours walking in the forest, I get sweaty, and occasionally out of breath if walking fast or uphill, and I may be sore afterwards. This is apparently a sign that I've found favour with the spirits of exercise, even though I wasn't performing ritual self-harm at all, just looking at some cool birds. I'm told swimming also counts.
The best exercise is the exercise you actually do. If the thought of getting on a treadmill makes you cry, don't get on a treadmill. Instead, think of something fun that you like to do, and do that. Even if it's "not real exercise", if it gets you moving, it counts.
For instance, I love martial arts. Most people wouldn't want to pay to be punched, but I love learning new moves even when I lose. Table tennis, yoga, larping, tag in the park. Find your fun!
It's unfortunately normal that getting older can put activities you used to enjoy out of reach. I don't know about your circumstances, but if you want me to help you brainstorm ideas, you can PM me.
It's only 20-30 minutes of cardio three times a week, but I've seen a huge benefit just from that. It's hard, but tolerable with an audiobook. The program looks like it has some major jumps that don't look achievable for someone with no prior exercise history, but stick with it and you'll surprise yourself. All you need is a good pair of running shoes and potentially an asthma inhaler.
I have plenty of prior (moderate but functional) exercise history, I have OA now so running isn't and never again WILL be an option (not a big loss, it's just about my least favourite form of movement anyway) but it also affects things that used to bring me joy like walking (in the British sense of going up hills and along clifftop tracks not in the American sense of "walking" round an indoor shopping centre) and am also postmenopausal and adjusting mentally to the fact that I NEVER will go up that (and that and that one too) hill again and all other portents of death and decrepitude is challenging mentally.
Thanks for the advice anyway, and there might be people who can use the encouragement!
I was trying to get into running when I got COVID in 2022 and after recovering, picked up some kind of mysterious cardiac problem (a GP did a blood test and found nothing, so I gave up on getting official medical treatment or officially diagnosing it as long COVID or whatever).
I found I couldn't really run anymore, and if I did push myself, I would struggle the next day. I had to come up with alternatives.
Recently, I've started an alternative "exercise" - tantrum.
Basically, I'd lock myself in the bedroom and just punch and kick the air, or something soft as hard as I could. I'd grab soft objects and throw them at clear spots. I'd grab things and grip/twist hard, like I was trying to strangle something or break things.
I found this really helpful. My primary immediate benefit from exercise is generally more mental health than anything, but I found that in the throes of tantrum, I would often end up pushing harder than when I was actively running (well, according to my fitness tracker). I wasn't worried about overdoing any particular part, because if something got sore or tired I'd almost instinctively do some other thing - I guess violence is something pre-programmed? And I think I get way more bang for buck from the destress/mental health side.
The downside is that this looks really alarming and is best done completely alone in a soundproof room. Also, I'm not a super self conscious person and other people might feel silly/undignified doing this (I did too, at first, but I recently underwent the process of asking for mental health related time off, and my dignity was already at an all time low, which made it much easier to start than normal).
I honestly suspect that emotion related physiological arousal and exercise related physiological arousal aren't all that different, and I'm making up for the mechanical stuff by doing some of the mechanical things.
I don't know how practical this is with your actual circumstances (and I'm not sure if you mean osteoarthritis by OA), but you might want to try taking up swimming if walking is no longer bearable.
P. S. I think we Americans call it walking when we walk around the block and hiking when we go somewhere pretty to walk. Maybe I'll tell my kids we're going on a 'British walk'.
I read a lot of history, which tends to be better for this than popular science. Sometimes the author is an interesting person and the memoir is actively enjoyable (Entangled Life, Braiding Sweetgrass). Sometimes I just suffer.
I'm skeptical that exercising ~7 hours/week (plus additional time costs) actually gives someone more life overall. That's over 6% of someone's waking hours (1 hours/day vs 16 waking hours per day), equivalent to 5 years of life!
It's clear that exercise has some ROI, but the optimal amount could be much smaller.
Would love to see a curve showing VO2 max vs amount of cardio but I haven't looked into this much. I would guess the most efficient amount would be ~2 high-intensity cardio sessions per week
You can stack many forms of exercise on top of e.g. listening to podcasts. I suppose it depends how many DALYs having to do a year of cardio counts as for you.
And I wonder whether supplementing creatine so i can exercise harder would make the exercise more effective at doing the things that make it good for you.
> Conversely, metabolically healthy obese people have no increased risk of mortality.
I am not sure about this. *Outlive* says this info comes from a meta-analysis, it doesn't cite a source but I believe it's from Hui et al. (2010), "Metabolic syndrome and all-cause mortality: a meta-analysis of prospective cohort studies", based on the fact that the book says the meta-analysis had "a mean follow-up time of 11.5 years" and that was the only meta-analysis I found with that fit that criterion. But I looked over Hui et al. and it doesn't say anything about how obesity or BMI interacts with metabolic syndrome, so I don't see what Attia is basing this claim on.
> Metabolic syndrome is (to vastly oversimplify) when your body sends calories to places in your body where they aren’t needed or are even harmful.
Worth describing how [metabolic syndrome is defined](https://en.wikipedia.org/wiki/Metabolic_syndrome) because it's pretty simple. Someone is diagnosed with metabolic syndrome if they fit at least 3 out of 5 criteria: abdominal obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL.
EDIT: I looked a bit more and found a [different meta-analysis](https://www.jacc.org/doi/full/10.1016/j.jacc.2010.05.034) that reports on BMI and metabolic syndrome (MetS), but only one out of 87 studies actually looked at BMI, that study being [Song et al. 2007](https://sci-hub.hkvisa.net/https://www.ajconline.org/article/S0002-9149(07)01619-0/abstract), "Comparison of usefulness of body mass index versus metabolic risk factors in predicting 10-year risk of cardiovascular events in women". And that one study contradicts Attia's claim. Namely, it found that obese women without MetS had more CVD than normal-weight women without MetS. (It didn't look at all-cause mortality.) Although it's still true that if you control for MetS, most of the harm of obesity disappears.
Here's the table of CVD incidence by BMI for MetS and no-MetS, respectively:
- BMI <25: 7.9% and 2.2%
- BMI 25-29.9: 7.1% and 2.4%
- BMI 30+: 6.1% and 2.6%
"Chapters 1-3 and 17 are entirely skippable."
Lol this is the part I need most from any review. "When does the filler end and the useful part start?"
So many books could have been pamphlets or blog posts.
Does it say anything about cognitive decline? I have a super strong family history of early onset Alzheimer’s, and if I can’t do anything to prevent that specifically I would rather not waste my time doing any longevity stuff.
Yep, there's a chapter on Alzheimer's. (But we don't have a solution that works better than 'try to be generically healthy.')
Great review.
Also the bit about exercise (and especially the ideal programme) makes me LITERALLY cry & want to develop a dignified and painless suicide plan for in about 10 years' time because all the other lifestyle advice pieces combined (including losing enough weight to stop being technically fat -- though I have no metabolic syndrome, so the only benefit would be mechanical, good for OA) seem like a doddle in comparison to that. But I've known this for a while so there's that. Some people drink themselves into early death, some smoke or eat or work themselves into same, and I'm clearly going to slob myself into it.
I do want to caveat that the ideal program is ideal. Most people don't have time for all that exercise! Exercise has a fairly linear dose-response curve-- any amount is better than no amount. (Of course, that doesn't help if any exercise makes you want to curl in a ball and cry, which isn't uncommon.)
Obviously exercise is worse than death, but some pleasant activities may actually secretly trick the body into thinking that you've exercised, even though you were having fun the whole time.
When I spend hours walking in the forest, I get sweaty, and occasionally out of breath if walking fast or uphill, and I may be sore afterwards. This is apparently a sign that I've found favour with the spirits of exercise, even though I wasn't performing ritual self-harm at all, just looking at some cool birds. I'm told swimming also counts.
The best exercise is the exercise you actually do. If the thought of getting on a treadmill makes you cry, don't get on a treadmill. Instead, think of something fun that you like to do, and do that. Even if it's "not real exercise", if it gets you moving, it counts.
For instance, I love martial arts. Most people wouldn't want to pay to be punched, but I love learning new moves even when I lose. Table tennis, yoga, larping, tag in the park. Find your fun!
It's unfortunately normal that getting older can put activities you used to enjoy out of reach. I don't know about your circumstances, but if you want me to help you brainstorm ideas, you can PM me.
I would recommend looking into the couch to 5k plan here: https://c25k.com/c25k_plan/
It's only 20-30 minutes of cardio three times a week, but I've seen a huge benefit just from that. It's hard, but tolerable with an audiobook. The program looks like it has some major jumps that don't look achievable for someone with no prior exercise history, but stick with it and you'll surprise yourself. All you need is a good pair of running shoes and potentially an asthma inhaler.
I have plenty of prior (moderate but functional) exercise history, I have OA now so running isn't and never again WILL be an option (not a big loss, it's just about my least favourite form of movement anyway) but it also affects things that used to bring me joy like walking (in the British sense of going up hills and along clifftop tracks not in the American sense of "walking" round an indoor shopping centre) and am also postmenopausal and adjusting mentally to the fact that I NEVER will go up that (and that and that one too) hill again and all other portents of death and decrepitude is challenging mentally.
Thanks for the advice anyway, and there might be people who can use the encouragement!
I hope you find something that works for you!
I was trying to get into running when I got COVID in 2022 and after recovering, picked up some kind of mysterious cardiac problem (a GP did a blood test and found nothing, so I gave up on getting official medical treatment or officially diagnosing it as long COVID or whatever).
I found I couldn't really run anymore, and if I did push myself, I would struggle the next day. I had to come up with alternatives.
Recently, I've started an alternative "exercise" - tantrum.
Basically, I'd lock myself in the bedroom and just punch and kick the air, or something soft as hard as I could. I'd grab soft objects and throw them at clear spots. I'd grab things and grip/twist hard, like I was trying to strangle something or break things.
I found this really helpful. My primary immediate benefit from exercise is generally more mental health than anything, but I found that in the throes of tantrum, I would often end up pushing harder than when I was actively running (well, according to my fitness tracker). I wasn't worried about overdoing any particular part, because if something got sore or tired I'd almost instinctively do some other thing - I guess violence is something pre-programmed? And I think I get way more bang for buck from the destress/mental health side.
The downside is that this looks really alarming and is best done completely alone in a soundproof room. Also, I'm not a super self conscious person and other people might feel silly/undignified doing this (I did too, at first, but I recently underwent the process of asking for mental health related time off, and my dignity was already at an all time low, which made it much easier to start than normal).
I honestly suspect that emotion related physiological arousal and exercise related physiological arousal aren't all that different, and I'm making up for the mechanical stuff by doing some of the mechanical things.
I don't know how practical this is with your actual circumstances (and I'm not sure if you mean osteoarthritis by OA), but you might want to try taking up swimming if walking is no longer bearable.
P. S. I think we Americans call it walking when we walk around the block and hiking when we go somewhere pretty to walk. Maybe I'll tell my kids we're going on a 'British walk'.
> exercise regularly, eat fiber, avoid drinking alcohol
> try to be happy
Make up your mind!
> Attia seems to believe that his self-help and popular science book would be more interesting if it were also a memoir.
To my great chagrin, this seems true of all non-fiction books except textbooks. Where do you find books that don't?
I read a lot of history, which tends to be better for this than popular science. Sometimes the author is an interesting person and the memoir is actively enjoyable (Entangled Life, Braiding Sweetgrass). Sometimes I just suffer.
I'm skeptical that exercising ~7 hours/week (plus additional time costs) actually gives someone more life overall. That's over 6% of someone's waking hours (1 hours/day vs 16 waking hours per day), equivalent to 5 years of life!
It's clear that exercise has some ROI, but the optimal amount could be much smaller.
https://www.greaterwrong.com/posts/bZ2w99pEAeAbKnKqo/optimal-exercise#How_much_exercise_
https://www.painscience.com/articles/strength-training-frequency.php
Would love to see a curve showing VO2 max vs amount of cardio but I haven't looked into this much. I would guess the most efficient amount would be ~2 high-intensity cardio sessions per week
You can stack many forms of exercise on top of e.g. listening to podcasts. I suppose it depends how many DALYs having to do a year of cardio counts as for you.
And I wonder whether supplementing creatine so i can exercise harder would make the exercise more effective at doing the things that make it good for you.