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Obesity, And Being Even A Little Overweight, Increases Health Risks

STEPHANIE NANO   12/ 2/10 12:44 AM ET   AP

Obesity

NEW YORK — Lugging around a few extra pounds? One of the largest studies to look at health and weight finds that you don't have to be obese to raise your risk of premature death. Merely being overweight carries some risk, too.

Obesity increases the risk of death from heart disease, stroke and certain cancers. But whether being merely overweight contributes to an early death as well has been uncertain and controversial. Some research has suggested being a little pudgy has little effect or can even be a good thing.

The latest research involving about 1.5 million people concluded that healthy white adults who were overweight were 13 percent more likely to die during the time they were followed in the study than those whose weight is in an ideal range.

"Having a little extra meat on your bones – if that meat happens to be fat – is harmful, not beneficial," said Dr. Michael Thun of the American Cancer Society, senior author of the study.

The study's conclusions, published in Thursday's New England Journal of Medicine, are similar to three other large studies, said the lead author, Amy Berrington of the National Cancer Institute.

"Now there's really a very large body of evidence which supports the finding that being overweight is associated with a small increased risk of death," Berrington said.

For their government-funded analysis, the researchers pooled 19 long-term studies of mostly white adults. They used each person's body mass index – a measure of height and weight – and checked to see who died during the follow-up periods, which ranged from five to 28 years.

They focused on people who were healthy at the beginning of the studies, excluding smokers and those with heart disease or cancer because those affect death rates and researchers wanted to see the impact of weight alone.

The lowest death rate for healthy women who had never smoked was in the high end of the ideal body mass index range – between 22.5 and 24.9. Compared with that group, those who were overweight had an increased risk of death of 13 percent. The increased risk ranged from 44 to 88 percent for those who were obese. The morbidly obese were 2 1/2 times more likely to die prematurely. The results for men were similar.

Most of the participants in the studies were white so the research focused on them. Results may be different in other ethnic and racial groups, Berrington said. She said evidence suggests that for the same BMI level, African-Americans might have a lower risk of death and Asians a higher risk.

Two-thirds of U.S. adults are either overweight or obese. Overweight begins at a BMI measurement of 25, obese at 30 and morbidly obese at 40. A 5-foot-6 person is considered overweight at 155 pounds, obese at 186 pounds and morbidly obese at 248 pounds.

Because of its size and the diversity of studies included, the research "provides strong evidence against the position that it's a good thing for health to be overweight," Thun said.

The notion that a "bit of reserves" would help keep you from getting sick probably stems from the days when food was scarce, he said.

The latest research was launched after a controversial 2005 study by the Centers for Disease Control and Prevention that concluded being overweight didn't raise the risk of death; that report included smokers and those with pre-existing illnesses.

University of South Carolina obesity researcher Steven Blair said the results were consistent with other studies and the "massive effort" was commendable. But he said there wasn't enough information available about fitness level or physical activity. A proponent of the "fit and fat" theory, Blair said his research has shown that obese people who are tested and deemed fit did not face increased risks of dying.

"If we want to get to the bottom of the health hazards of overweight and obesity, we have to have better data on physical activity," Blair said. "Until we do that, there's uncertainty of how important BMI is as an important predictor of mortality."

___

Online:

BMI calculator: http://www.nhlbisupport.com/bmi/

New England Journal: http://www.nejm.org

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NEW YORK — Lugging around a few extra pounds? One of the largest studies to look at health and weight finds that you don't have to be obese to raise your risk of premature death. Merely being ov...
NEW YORK — Lugging around a few extra pounds? One of the largest studies to look at health and weight finds that you don't have to be obese to raise your risk of premature death. Merely being ov...
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12:08 AM on 12/07/2010
This article leaves out plenty of key info. These BMI values are self-reported, so the true levels are higher than those shown. Almost half the data come from two other large studies that already show the same results, so it's not too surprising that they all agree. There are literally dozens of well-conducted studies with appropriate controls for smoking and illness that show overweight isn't associated with extra mortality. This new study carefully avoids doing an analysis that would be comparable - they never adjusted for current or former smoking (they just leave them all out) and they carefully never compare "overweight" (BMI 25-29) to "normal weight (BMI 18.5-24.9) which is the comparison that all the other studies make. You have to ask why they didn't do analyses that would be comparable to other studies - my guess would be that if they did that, they might not get the results that they wanted! As is, they had to delete almost 80% of the deaths in their sample to get their final results. You have to ask why they bothered with such a large sample to begin with if all they planned to do was delete most of it. Gee, could it be so they could claim they had a large sample when they really didn't have such a large sample?
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usamade
10:41 PM on 12/06/2010
Does anybody know how to control perimenopause weight gain? I've gained 10 pounds. I'm still under 125lbs but am worrying that more weight will come on.
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06:38 PM on 12/06/2010
My preferred theory, assumption, whatever, about obesity is that it is one co-morbid symptom of the health problems we tend to blame on weight, but I suspect pollution, such as heavy metals, endocrine disruptors ..., is, perhaps, at the root of both.

The following news article suggests we need to set our research sites on the environment:

http://www.the-scientist.com/news/display/57821/
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french queen13
my beloved is mine and I am his
08:23 PM on 12/04/2010
"Increased risk of death" always makes me smile. We will all die, 100%, no exceptions. And frankly I'm not looking to live into my seventies or eighties or nineties, God forbid.
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dartagnan
07:08 PM on 12/03/2010
The BMI number can be very misleading. LaMichael James, the star running back for the University of Oregon, is 5'9" tall and weighs 190. His BMI is 28.9 -- almost "obese." But virtually all his weight is muscle, as anybody who's watched him play knows.

This study sounds like it needs much refinement.
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01:41 AM on 12/04/2010
We like LaMike. GO DUCKS!
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rcthomp
06:14 PM on 12/03/2010
But what did they die from?
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Devontate
PrObama
03:02 PM on 12/03/2010
Wow. Thanks. Now those of us who were trying to accept the fact that we are carrying a few extra pounds can begin to hate ourselves anew.
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yogini4
Think deeper!
02:25 PM on 12/03/2010
Obesity is correlated with early death; there is not sufficient evidence to suggest that it is causal. If we really understood what causes obesity (let's look at traumatic stress and the impact on the HPA axis) we might be able to have a more compassionate and realistic conversation. I would also refer readers to the refreshingly cogent book, The Obesity Myth, which takes on the JAMA nurses' study and demonstrates that being up to 50 pounds overweight is actually correlated with better outcomes than being 10 or more pounds underweight. We need to get past this kind of simplicity.
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dartagnan
07:11 PM on 12/03/2010
Excellent post. There is a subtle moral stigma attached to being fat, or even slightly overweight, which I believe is a relic of our Puritan/Calvinist heritage. Fat/overweight people are lazy and/or overindulge in food, the thinking goes; therefore they are morally inferior, and if they get sick it's because they "deserve" it as "punishment" for their (supposed) "sins."
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yogini4
Think deeper!
11:10 PM on 12/03/2010
Agreed, fat is the last "legitimate" prejudice and scapegoat.
10:35 PM on 12/06/2010
I agree with what you say except that maybe the stigma is not as subtle as you suggest.
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Raphi
09:31 PM on 12/03/2010
Your post is interesting.

I was wondering about another factor usually ignored. That of class, of income level. The life expectancy of blue collar workers is significantly lower than that of the upper middle class. Which is also a reason that raising the age for social security would be devastating.

What happens to people whose jobs do them considerable physical damage over time? Blue collar people are 51% of this country. Add to that the stress of nasty backbiting of corporate office jobs. And the stress of long commutes, job insecurity, falling wages. How many people total? With all the rushing, few take the time to eat carefully.

Yet these factors are virtually ignored. Far easier to denigrate the de facto economic victims for what they look like than to question a destructive system.
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yogini4
Think deeper!
11:12 PM on 12/03/2010
Yes, this issue is so much more complicated than "calories in, calories out". In Boston, where I used to work, the inner city neighborhood groceries would all raise their prices on "mother's day", the day welfare checks came out. Since these people didn't have cars they were forced to buy nutritionally deficient foods to get their families full (often cupboards are bare at the end of the month). You sound like a social worker or at least a person who has given the matter much thought. Thank you for that deep post.
11:16 AM on 12/03/2010
As only the abstract is available for free online and not the full data, I wondered about how the researchers defined and controlled for activity levels. I see here in this article that Steven Blair addresses that point as well. I have many clients who's overweight does not translate into any diagnostic criteria for metabolic syndrome [no increased insulin resistance, blood sugar, triglycerides, blood pressure or inflammation] except for their waist measurement, because they are regular exercisers and they are fit. Also, that whole BMI thing, I wish researchers would not use it as it does not measure fatness.
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dartagnan
07:12 PM on 12/03/2010
"Also, that whole BMI thing, I wish researcher­s would not use it as it does not measure fatness."

Roger that. It is a very crude measurement.
04:52 AM on 12/03/2010
BMI and Body Fat percentage are not the same at all, as fat distributes differently around tha body, and fat on the upper part of the body, like the abdomen, the arms, etc. is not the same as fat on the legs or hips. The BMI is a very broad tool of measurement, Body Fat percentage is more precise.

For example, my BMI is 22.8, which puts me in the perfect range. However, my Body Fat percentage is 32, as measured on the upper body, which makes me borderline overweight.

Surely, this would be a better way to measure health implications than simply BMI.

Body fat percentage is measured on the abdomen and on three points on the upper and lower arm. That's the fat you don't want to have. Once fat starts lodging in your abdomen and upper body, your health is at risk, no matter how little you weigh.
11:33 PM on 12/02/2010
Lots of people are noting that there are better ways to measure healthy lifestyle, but with care you can still derive useful interpretations from this type of study. BMI is a proxy for overall fitness; the researchers and clinicians know this. But when looking at many thousands of people it would apparently be fair to say that those with high BMIs are generally unhealthier. This categorization would catch those who carry a few extra pounds but generally eat well and exercise enough. Statistically it doesn't matter because it also includes those who reached a high BMI by poor lifestyle. So despite the exceptions the results are not invalid. That said, I don't see that this changes things at all. The more insightful study would be to look at people with good lifestyle habits that are both ideal weight and slightly overweight and compare them, not just pull in all the slightly overweight people who got that way by too many french fries and lump them with the conscientious overweight people.

Now relating these types of findings to individuals is not so straightforward. It is probable that diet and exercise trump a few extra pounds with regards to an individual's health. It's just that when you study 1 million people it's a lot easier to use one number to them all than a long list of descriptive and subjective (ie, inconsistently applied) fitness and diet metrics.
12:10 AM on 12/03/2010
The BMI does work for most people but it's important to know if you're one of those for whom it does not work. I am definitely firmly in that category, so I use BF% as my indicator. Based on my BF% calculations, if I were to lose every ounce of fat from my body, I would still be "overweight" according to the BMI charts.

Also, if you go on an exercise program and lose fat but gain muscle, you may not lose weight and, therefore, your BMI won't change, but your physical health will improve drastically.
03:38 AM on 12/03/2010
Since that is the goal, lose body fat, gain muscle mass, be healthier and the BMI does not indicate that, then the BMI does NOT work for most people. I would be so bold as to say just the opposite. If someone is losing weight both fat AND muscle, I would say that he or she is not getting healthier. The BMI is illogical. I am like you, who fit in that category. I have extra large bone structure and carry a lot of muscle on my body. Just one of the genetic freaks. But, working in fitness for a long time, I see people obsessed with the bogus BMI measurement, thinking that they are getting healthier by lowering it. The are not. It's all about leanbody mass/body fat balance. The ones that are the healthiest are the ones with a reasonable amount of muscle on their bodies, with a reasonably lower BF measurement--NOT a low BMI measurement. Think about it... Brad Pitt is considered overweight/obese. So, yeah, the BMI is absolutely useless.
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dartagnan
07:17 PM on 12/03/2010
"It is probable that diet and exercise trump a few extra pounds with regards to an individual­'s health"

And it's quite possible that heredity trumps everything. We all have known people who "did all the right things" and died at an early age, as well as people who "did all the wrong things" and lived into their 80s and beyond.

We want to believe that the game of life is fair and that we can win by doing "the right things," but the deck is stacked.
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alieninvader
11:05 PM on 12/02/2010
Is it any coincidence that this story comes out at the same time as the FDA might approve weight loss surgery for the "just overweight"?http://www.nytimes.com/2010/12/02/business/02obese.html?_r=1&ref=health
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alieninvader
11:02 PM on 12/02/2010
Did they take into account the fact that the overweight were probably less likely to exercise? What if they compare activity level along with weight, or better, body f@t percentage?
09:35 AM on 12/03/2010
Yes.

"Methods
We used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between BMI and all-cause mortality, adjusting for age, study, physical activity, alcohol consumption, education, and marital status in pooled data from 19 prospective studies encompassing 1.46 million white adults, 19 to 84 years of age (median, 58)."
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Reno Fickler
Head Lifeguard/Dead Sea Marina
10:09 PM on 12/02/2010
Ever seen a 100 year old fat person?
Neither have I.
12:31 AM on 12/03/2010
Most people who get to 100 are of average weight, or are a little bit overweight.
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mssreader
eat, read, sleep, read and be happy
12:53 AM on 12/03/2010
I know several women who are nearing 100 and one who is 101 and 1/2 and all are range from 4'11-5'2 and all are thin and skinny but probably very slim. and most of them I've known for years and none have been overweight and not one, to my knowledge, ate junk food or prepared food.
03:40 AM on 12/03/2010
My mother is 87 and is overweight. My father weighed 155 pounds and was 5'8--he died at 72. Hard to get around genetic predisposition.
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thebearschick
09:50 PM on 12/02/2010
I am skinny and have a low BMI but definitely eat a high-fat diet. (I love cookies, sorry). I think I'm still at risk for heart disease. I don't think it's about weight, I think it's about fitness and diet.
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mssreader
eat, read, sleep, read and be happy
01:00 AM on 12/03/2010
thebearschick, I'm an thin and have a very low BMI and eat a plant based diet and no meat since 1970 and eat next to no fat except what comes with the grains, legumes and fruits and veggies. My bp is a beautiful 112/67 and am not at risk for heart disease. I seldom have other than fruit for dessert and use a minimum of salt and cook all my own food which is mainly soups and salads. My doctor says he'd be surprised if I ever had a heart attack. I think it is about weight, fitness and diet. It all goes together in my HO.
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Devontate
PrObama
03:05 PM on 12/03/2010
Healthy, or obsessive?

Don't forget the occasional marathon runner who drops dead at 35 from a heart attack.
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dartagnan
07:32 PM on 12/03/2010
"It all goes together in my HO."

You O is not at all H, IMNSHO.