Yeah, I know body mass index (BMI) is an imperfect tool for measuring adiposity and health risks. But like the American form of government, it’s better than all the alternatives.

BMI, with all its imperfections is still, however, valuable because of its ease of use. You need only know height and weight to calculate it. This huge analysis of over 10 million people, published in The Lancet, is important because of its breadth.

The key findings: overweight and obesity will kill you. The unstated corollary: for most people most of the time, you have a choice in this matter. No one is holding your family hostage when you go to the grocery store, and no one is keeping you from leaving Facebook, Twitter, or however else you waste your time online to go for a walk.

What most people don’t realize is how much daily choices shape health risks (and the subsequent medical care spending) over time. A lifetime of bad choices will almost certainly put you at much higher risk for premature disease and death compared to a peer adult who is physically active, eats wisely, and maintains a healthy bodyweight. If you don’t do these things, I’ve got no problem with you paying a risk premium. One of the great flaws of Obamacare is that it doesn’t demand individuals take financial responsibility for their own habits. Sorry, but if you refuse to take care of yourself, it is not my job to subsidize you.

As these data from The Lancet clearly point, the notion of healthy obesity is a total lie.

The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations.

Source: Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents – The Lancet