Is it okay to be overweight?
A widely publicized study in the Journal of the American
Medical Association in April seemed to answer yes.
Government researchers analyzed
large national surveys and concluded that obesity could
be linked to about 112,000 deaths annually in the U.S. That's
a lot of deaths, but far less than previous estimates. What
caused the most shock waves was the finding that people
who are slightly or moderately overweight (but not obese)
may actually have a lower death rate than those at normal
weight. Columnists had a field day, making fun of overzealous
government health experts as well as people who have struggled
to stay thin. And food-industry groups launched a self-serving
ad campaign claiming that some people have been misled about
weight.
First of all, what is normal,
overweight, or obese? That, of course, is the crux of the
matter. The study used the standard ranges based on the
body mass index (BMI, a weight-to-height formula). Normal
weight is defined as BMI between 18.5 and 25. Overweight
is 25 to 30; obese is 30 and above. Accordingly, for someone
5' 8" tall, normal is 122 to 164 pounds; overweight,
165 to 196; and obese, 197 and over. (To figure out your
BMI, click
here.)
There always has been debate
about these numbers and what optimal weight is. Before 1998
the ranges were looser. At 5' 8", overweight didn't
begin until 180 pounds. These lines are hard to draw, and
this study (as well as some other research) suggests that
the normal range may now be too low.
The good
news: If the new study is correct, fewer people are
dying of obesity-related illnesses than expected, particularly
after age 60. One explanation is that things have changed
in recent years. In fact, another study in that same issue
of JAMA showed that Americans, especially those overweight
or obese, are at far lower risk for cardiovascular disease
than 20 to 40 years ago because they have lower blood pressure
and cholesterol, on average largely thanks to
medication and perhaps better diet and much lower
smoking rates. Remarkably, overall death rates from heart
attacks have been cut in half since 1980.
The bad
news: Headlines about these new studies may make
some people think it's okay to pack on lots of pounds.
However, there's no question that obesity increases
the risk of heart attacks, strokes, diabetes, osteoarthritis
of the knees and hips, and some cancers, and that it can
shorten lives. Diabetes rates are skyrocketing. Obese people
who lose weight benefit greatly. The new study looked only
at death rates just the tip of the iceberg
according to the researchers not at how obesity impairs
quality of life and increases disability and health-care
costs.
The confusing
news: Calculating the adverse effects of overweight/obesity
is complex, and this study is not the last word. The Centers
for Disease Control and Prevention is still reviewing the
new findings, and is not softening its campaign against
obesity. The fact is, no one knows how many people die as
a result of obesity. Obese people often have a poor diet
and are sedentary, so it's hard to tell whether it's
obesity itself or these other factors that put them at risk.
The health risks of being merely 10 or 20 pounds overweight
are especially unclear.
Words
to the wise: Your optimal weight depends on many
factors notably your fitness level, family history,
risk for various diseases, and genes. If you are 5' 8"
and weigh 185 pounds, that's overweight. But if you
exercise regularly, don't smoke, and are healthy in
other respects, you don't need to make big changes.
On the other hand, if you have borderline-high blood pressure
or blood sugar, or not-so-great cholesterol levels, one
of the most important things you can do is lose weight.
If you have diabetes or a family history of premature heart
disease, this is essential.
For many people, being a little
overweight is not a health problem, except that it often
leads to greater weight gain. Thanks to medical advances,
we are better at treating obese people, thus prolonging
their lives. But the cost, in dollars and quality of life,
is great.
What's
your BMI?