Overall, obesity-related cardiovascular death rates tripled from 2.2 per 100,000 people to 6.6 per 100,000 during the study period, according to the researchers

From 'Body Positivity' Is Literally Killing People, Science Finds by Andrew Stiles.  The subheading is No, this isn't healthy.  

Its from The Washington Free Beacon which occasionally has interesting information unreported elsewhere but is definitely of a particular ideological bent.  And indeed, Stiles' focus is more on the schadenfreude of a shibboleth of the left being unseated than he is focused on the actual science.  

To be fair, Stiles actually does marshal some of the empirical evidence.

What happened: The number of heart disease deaths in the United States linked to obesity was three times greater in 2020 than in 1999—even though overall heart disease deaths declined nearly 20 percent during that period—according to a new scientific study.

• Obesity affects about 115 million Americans, including 42 percent of adults and 20 percent of children, according to the Centers for Disease Control.

Why it matters: The alarming scientific findings coincide with the rise of the left-wing "body positivity" movement, which seeks to achieve social justice by celebrating fatness and attacking critics for pointing out the enormous health risks associated with obesity.

But then he gets to:

In recent years, liberal cultural elites have embraced obese female celebrities and lauded them as icons of feminist empowerment. Lifestyle magazines such as Cosmopolitan have featured obese women on the cover alongside science-denying taglines such as, "This is healthy!"

And the attendant illustrations, covers from magazines such as Rolling Stone and Cosmopolitan, are indeed horrifying.  That anyone might consider the photos of the morbidly obese to be healthy is an afront to the sight and to the mind.

There is absolutely clear debate about what constitutes a healthy weight for an individual with some reasonably solid evidence that for some, at some points in their lives, a few extra pounds can be health enhancing.  But not the morbid obesity celebrated in these magazines.

It took me awhile to actually find the original study.  The Washington Free Beacon link took me to the Washington Post.  The Washington Post link took me to a Journal of the American Medical Association press release.  The press release had a link to the journal but not to the study.  After some refined googling, I finally found Racial Disparities in Obesity‐Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020 by Zahra Raisi‐Estabragh, et al.  From the Abstract:

Background

Obesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesity‐related cardiovascular mortality in the US population between 1999 and 2020.

Methods and Results

The Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and age‐adjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281 135 obesity‐related cardiovascular deaths demonstrated a 3‐fold increase in AAMRs from 1999 to 2020 (2.2‐6.6 per 100 000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individuals had the greatest temporal increase in AAMRs (+415%). Ischemic heart disease was the most common primary cause of death. The second most common cause of death was hypertensive disease, which was most common in the Black racial group (31%). Among Black individuals, women had higher AAMRs than men; across all other racial groups, men had a greater proportion of obesity‐related cardiovascular mortality cases and higher AAMRs. Black individuals had greater AAMRs in urban compared with rural settings; the reverse was observed for all other races.

Conclusions

Obesity‐related cardiovascular mortality is increasing with differential trends by race, sex, and place of residence.

Well . . . In associated reporting from Obesity-related cardiovascular deaths tripled in the last two decades, new study finds by Deborah Balthazar, we have: 

In the new study, researchers analyzed data on cardiovascular disease deaths in which obesity was listed as a contributing factor. Under cardiovascular deaths, they included medical codes found on death certificates for ischemic heart disease, heart failure, hypertension, cerebrovascular disease, and other forms of heart disease. They also looked at race and gender and compared individuals living in urban versus rural settings to understand how different population groups were affected.

Researchers relied on data collected on 281,135 deaths between 1999 and 2020 from the Multiple Cause of Death database, which includes mortality and population counts from all U.S. counties — 43.6% were women; 78.1% were white; 19.8% were Black; 1.1% were Asian or Pacific Islander; and 1% were American Indian or Alaska Native.

Across the racial groups, the most common cause of death was ischemic heart disease followed by hypertensive disease. Overall, obesity-related cardiovascular death rates tripled from 2.2 per 100,000 people to 6.6 per 100,000 during the study period, according to the researchers. They also found that mortality, adjusted for age, was highest among Black individuals (11.6 per 100,000 people in 2020), followed by American Indian adults or Alaska Native adults (6.7 per 100,000).

Black women had the highest rates of obesity-related heart disease deaths than all others. The opposite was true for other racial groups: Men experienced more obesity-related cardiovascular deaths.

Since obesity itself does not cause heart disease, there has to be concern about the integrity of the methodology.  Obesity drives type 2 diabetes, hypertension, and dyslipidemia and similar conditions which in turn affect the heart.  Consequently, the causal links are complex to say the least.  You add in the fact that deaths from heart disease are declining and the picture becomes even more obscure.  

Their key finding is that Black Women are at greatest risk for elevated age‐adjusted mortality rates.  This sets up an oddity.  In all other groups, men have a higher death rate from heart disease than women.  Why the inversion?  The answer might be suggested from a long distant recollection. 

Decades ago in university, I shared a house with a graduate student in public health.  He was deeply immersed in reading tables of data, trying to tease out causal relationships and seeking patterns among conditions.

One afternoon he wandered into the living room where I was working.  "This is an interesting correlation.  The group most likely to be significantly overweight are Black Women.  The group most likely to be significantly underweight are Black Men."  

His point was along the lines of the old rhyme.

Jack Sprat could eat no fat,

His wife could eat no lean.

And so between them both, you see,

They licked the platter clean.

Was his observation true then, and does it hold true now?  I don't know but it seems credible.  If obesity causes the conditions which make a person more prone to death from heart disease, and if Black Women are more prone to obesity than black men, then it makes sense that unlike other groups, Black Women would have an AAMR greater than Black Men.

Aside from some concerns about the methodology, there is a further concern.  If we accept the findings as is, we still have a relative versus absolute issue.  

We know that "Overall, obesity-related cardiovascular death rates tripled from 2.2 per 100,000 people to 6.6 per 100,000 during the study period, according to the researchers."  We also know that cardiovascular death rates fell in the same period.  Among the causes of heart disease, the importance of obesity is rising compared to other causes, but overall death rates are falling.  

But what is the baseline of heart related deaths to which we are comparing obesity-related cardiovascular death rates?  Kind of a critical piece of data to understand the context but it does not seem to be provided.  From Abstract 10094: National Trends in Deaths Due to Heart Disease and Cancer in the Elderly: 20 Year-Data by Abdul Minhas, et al, we have in the Abstract:

Deaths were represented as age-adjusted mortality rates (AAMR) per 100,000 population. 

[snip]

Results: AAMR related to heart disease decreased from 4587 in 1999 to 3235.6 in 2019 (average APC -1.8[95% CI, -1.9 to -1.6]). AAMR was higher in men (4375.6) than women (3287). 

If I am reading these studies correctly, deaths from heart disease stand at 3,325.6/100,000 AAMR having fallen roughly 30% in two decades whereas obesity-related cardiovascular death rates stand at 6.6/100,000 AAMR having trebled in two decades.

I almost have to believe that I am misreading something somewhere when I compare 3,325.6 to 6.6.  But if so, I cannot find my error.  In which case, the relative importance of obesity and disparities by race and gender are almost inconsequential to the overall trend.  Whatever we might do to get rid of disparities in obesity-related cardiovascular death rates will make virtually no difference in the overall rate of cardiovascular death rates.

The journalistic eye is drawn to the press-release bauble of a trebling of obesity-related cardiovascular death rates without the context of the 500 hundred times more important 30% decline in all cardiovascular deaths.