> If you have the physical health of a 25 year old indefinitely, your medical expenses per year would be far less. Yes, you'd still occasionally get sick and eventually die of something, but a greater percentage of your life would be healthy and productive.

Having the health of a 25-year-old indefinitely seems unlikely ever to be achieved. If we can achieve that, then we will have eliminated virtually all inherited causes of death, and I would agree that we would save money. It seems more likely to me that we will continue to expand the gains that we had in the 20th Century: people will live better, longer, but will still ultimately age and suffer the consequences (though perhaps at 150-200 years instead of 65-100). If the former is true, then we'll save tons of money because we'll have eliminated chronic disease and aging. If the latter is true (which would fit with past experience), then we'll truly just have delayed the costs by a few years. If people are willing to work longer since they live longer, this won't be a problem. But if people were so noble, then we'd already be delaying Social Security and Medicare benefits until age ~75, since the average lifespan has widened since the programs were conceived decades ago.

At any rate, I wholeheartedly agree it would be a huge net benefit; I suppose whether or not money gets saved is dependent on how society decides to partition out the costs and benefits.

Jack LaLanne managed to have the health of an athletic 25 year old into his 50s. And the health of an athletic 50 year old until his 70s. I have a great uncle who followed LaLanne's advice and is 84 and looks like a 45 year old bodybuilder with a 65 year old face. In contrast his brothers are dead, except for my grandfather who is fat and has diabetes and mild alzheimer's and is basically confined to his retirement apartment. I would say we already know how to be a 25 year old for much longer than than expected - the key is to exercise a lot more and a lot differently than you would think, and eat a diet similar to that of a 7th day adventist. Unfortunately this lifestyle is in opposition to pretty much every cultural and marketing trend in every society on the globe today.

Personally, I would prefer to have the health of a 25 year old until I'm 90 and then croak, rather than live like an 80 year old until I'm 150.

Outward appearances of health are poor indicators of internal physiological conditions; just ask anyone with hypertension or hypercholesterolemia. But I think it's great that you know people who do right by their bodies. There's no reason everyone shouldn't do that, if that's what they care about. There's also no reason that everyone should, if they don't.

I used to have hypertension and it went away after I lost 55 pounds. Most fat people are hypertensive.

I intended that to be interpreted in the context of your specific point about healthy-looking people. A healthy-looking exterior does not indicate a healthy interior. An unhealthy-looking exterior almost certainly does indicate an unhealthy interior.

So my point is not that your obese self could have been healthy; there is almost no way it could have been. The pathophysiology behind obesity-induced hypertension is not that hard to imagine. In contrast, the fact that someone looks healthy doesn't mean that they don't have hypertension or hyperlipidemia.

Many patients make the mistake of thinking that what cured them will cure others. Sure, losing all of your excess weight will cure many cases of diabetes and hypertension. But not all people with diabetes have it because of their obesity; not all people with hypertension are obese. You won't see me telling a 70kg 5'10" male to drop some weight to cure his hypertension. But there is basically no diagnostic dilemma when you see a 100kg 5'10" male with hypertension, and the cure is clear.

I would wager that most people with hypertension have it because they are fat. I would also wager that if someone looks healthy, like a soccer player, there is a good chance they don't have any of the conditions now classified as "metabolic disorder." They might have brain cancer, or a cold, or even type 1 diabetes, but they probably don't have high blood pressure or type II diabetes. High cholesterol I know nothing about, so I wouldn't make any bets about that. I have other wagers about skinny people with hypertension, but it's getting too far off topic now.

I agree with your instinct about the cause of most hypertension. Most Americans are fat; obesity causes hypertension; therefore, most Americans who are hypertensive are so because of their obesity. With regards to your point about the soccer player, I cannot agree. You listed plenty of fine caveats to your point - in fact, the caveats outweigh your argument, in my opinion. These caveats only increase as you transition from a 25-y/o soccer player to a 50-y/o soccer player who "looks" 25. But perhaps that is just my American physician-style bias - to err on the side of caution. Most diseases that you and I will ever need to worry about do not have dermatological findings, so just looking at a person and noting a lack of obesity or other derm findings is a pretty poor screening test for ruling out disease.

High cholesterol primer: it is the most important disease based on the objective criterion of "causes the most deaths," has no physical findings, except for the 1/1000 who have recessive mutations that will cause them to have a heart attack in their 20s-30s unless they take statins. 80% of the cholesterol in your body is produced by your body, so you cannot typically blame diet for hypercholesterolemia.

Your post seemed to imply that Type II diabetes is caused only by obesity; this is not true, but it feels true because the recent obesity epidemic has made obesity the most important cause of T2D. Unfortunately for the patients, it's not the only cause.

The metabolic syndrome is a rule-based diagnosis: you must meet 3 out of 5 criteria, only one of which is obesity. Thus, you can have the metabolic syndrome without being obese. These patients are actually very interesting, because it suggests that they naturally have the same maladaptive gene expression profile that is caused by obesity. This is an opportunity for research into the molecular biology of obesity-induced diseases.

As an aside, we do treat obese hypertensives with ACE inhibitors and other proven medications, even though we know their hypertension is caused by obesity. Doing so still reduces their cardiovascular disease and kidney damage. If they lose weight and are no longer hypertensive, then we stop the meds. In the meantime, we do what we can to protect their vital organs.

Oh, also - congrats on losing so much weight! Most people have a devil of a time losing even 1/3 of that (and keeping it off for an appreciable amount of time is another story entirely.) What was your trick for losing it, and for keeping it off?

My trick for losing weight was that I stopped eating cheese, pasta, burritos, and pizza. I also quit drinking beer. I kept it off by not eating or drinking those things.

> I have other wagers about skinny people with hypertension, but it's getting too far off topic now.

I would like to hear this. I have read that hypertension may be caused by renal failure to excrete salts and is not connected with intake.