THE BLOG

Why Downplaying the Obesity Epidemic, Even in a Single Story, is Hazardous to Public Health

01/23/2013 05:51 pm ET | Updated Mar 25, 2013

With this being January, chances are good that you're more interested than usual in health and well-being, and that you're reading and hearing about diet and weight loss more often as well. The headlines this time of year usually tell us how to shed pounds fast and get healthy with a pill, a gadget, or a procedure. This year, however, the message has been slightly different.

Recently, I've seen a spate of stories about how obesity isn't such a big deal after all and a few extra pounds could be good for us. As a dietitian committed to helping make healthy living not only normal but fun, these stories are disturbing and downright dangerous.

We are bombarded daily by mixed messages regarding our health and nutrition, it is no wonder that consumers are confused. (Everyone is confused -- including fitness trainers and people who have been doing it for some time.) Most people don't know where to turn or whom to trust, which foods to eat and which to pitch. As they see their favorite fit celebs and experts endorsing supplements, weight-loss gimmicks, and fat burners, they're left even more confused.

With obesity rates continuing to climb, we can't waver for a moment about the importance of taking small, measurable steps toward better health. That's why these stories have disturbed me.

The story that drew the most attention was an analysis published earlier this month in the Journal of the American Medical Association, which reported that those with a body mass index (BMI) that placed them in the overweight category (or even slightly obese) had less risk of dying than people with a BMI in the normal category. I was shocked to read that, and you might be, too. According to that report, carrying around a few extra pounds may add a few more years to your life. The subsequent headlines shouted:

  • "Stop Fearing Body Fat"
  • "It's Time to Pack on More Pounds"
  • "Overweight? You Might Live Longer"

Before you ditch your January resolutions and plant yourself on the couch with a bag of chips, let me add some common sense to those headlines. Let's remember the cold, hard facts:

One-third of adult Americans are overweight, another third are obese, according to the Centers for Disease Control and Prevention. Conditions related to excess weight -- including heart disease, stroke, Type 2 diabetes, and certain types of cancer -- are among the leading causes of preventable death. We spend almost $150 billion a year on obesity-related medical costs. About 17 percent of children ages 2-19 are obese -- a number that has almost tripled since 1980.

With those facts in mind, we can examine that JAMA study more closely:

The study: Researchers compiled 97 studies with a combined sample size of over 2.88 million subjects and more than 270,000 deaths. Using meta-analysis, they compared mortality risk with the various BMI categories. In a nutshell, the analysis revealed a:

  • Six percent lower risk of death for someone in the overweight category,
  • Eighteen percent higher risk of death for all grades of obesity,
  • Five percent lower risk of death for grade 1 obesity, and
  • Twenty-nine percent increased risk of death for someone in the grade 2 and 3 obesity category

For perspective, let's look at the varying weight for a woman of average height (5'3"), based on the different BMI ranges:
Overweight (BMI of 25-<30): 141-169 pounds*
Obese (BMI of ≥30): 169+ pounds
Grade 1 Obesity (BMI of 30-<35): 169-197 pounds
Grade 2 & 3 Obesity (BMI of ≥35): 197+ pounds

*The average American woman weighs about 165 pounds.

Application: I'll be the first to say that BMI does have its limits as a marker of health and should be used as one of several standards when assessing a person's health and need for medical care. While the analysis included many studies and an overall large sample size, there are still a few additional points worth mentioning.

Health care: There is the strong possibility that subjects in the overweight and obese categories were receiving routine health care and treatment for conditions that are closely tied to one's weight, such as diabetes, metabolic syndrome, heart disease, and hypertension. The increase in routine visits, medical attention and treatment is more than likely adding years to one's life.

Apples and pears: It has been documented that the location of one's body fat is closely tied to health risk, rather than strictly looking at total fat. Belly fat (the apple-shaped body) carries a greater risk for disease versus fat on the hips, buttocks, and thigh (the pear-shaped body). BMI does not take into consideration the placement of body fat.

(Dietitian's Note: I was perfectly content writing the above paragraph about apples and pears until I recently read a study published in The Journal of Clinical Endocrinology and Metabolism indicating that the gluteal fat on a pear-shaped body can yield an increased risk for insulin resistance and metabolic syndrome. However, I will save that research for another blog.)

Quality vs. quantity: While the JAMA study evaluated risk of dying in relationship to weight, I professionally and personally am more concerned about the quality of those years, aren't you? Is living a few more years your goal? Or is it the quality of those years what is most important? You know what I mean. Would it be worth it to you to be alive if you couldn't shoot hoops with your children or grandkids? If you couldn't walk up a flight of stairs without being winded? If you could no longer care for yourself due to your size?

What if instead those last years were spent lowering your medication intake, or improving your medical markers like blood pressure, lipid profile, and blood sugar. Imagine having more energy, a better sex life, or a good night of sound sleep. Would those extra years then be worth it? Moving toward a healthier weight can definitely improve the quality of one's life -- this is well documented! Even small steps can make a big impact on your weight and your life.

Bottom line: Don't rely on any one analysis to determine your health and weight goals. Rather than finding a loophole to avoid improving your health, take small steps to make healthy living a part of your life, not something you check off a to-do list! Have regular visits with your doctor and review your complete treatment plan for optimal health and well being. And above all: Don't use headlines (even this one) as a substitute for your medical care.

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