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with Pamela Peeke, MD, MPH, FACP

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Tuesday, January 8, 2013

Weight A Minute: Being Overweight is OK?

By Pamela Peeke, MD

fitness

Is it possible that carrying an extra twenty pounds doesn’t increase the risk of death, but may actually be safer than being of average weight? If this sounds sacrilegious and confusing, you’re not alone. Millions of Americans watched the evening news to hear the results of new research conducted by the Centers for Disease Control studying the relationship between death and weight. Of course there was the predictable data showing that obesity was associated with a rise in the rate of deaths from all causes. Based on mountains of studies, we’d all agree that’s a keen grasp of the obvious. However, there was a hidden surprise that needs lots of clarification to help you interpret how this new study affects you personally. This is especially relevant as you start the new year and are setting goals for yourself.

The researchers look at almost 100 studies that included 3 million adults from all over the globe and over 270,000 deaths. Their data noted BMI, which is the ratio of weight in kilograms divided by height in meters squared. Please note that BMI only covers height and weight. It says nothing about body composition (amount of muscle, fat, bone), nor does describe where your fat is located (inside/outside your belly, hips, thighs).

Here’s what they found:

Compared to people of “normal weight” (BMI of 18.5-24.99):

  • Extremely obese (BMI >35) had a 29% increased risk of early death.
  • Overall obesity (from moderate to severe) had an 18% increased risk of early death.
  • Overweight (BMI 25-29.99) had a 6% lower risk of early death.

Media headlines quickly ran with this last finding and this led to collective head scratching and quizzical looks from most of you. Overweight is OK?

Let me help to clarify how to understand what seems to be a contradiction to what you’ve been taught to believe in for the achievement of fitness and health.

1)     “Normal” Weight Does Not Imply Good Health: The study’s normal weight category included anyone who was slender or of average weight. In this group you’re going to find people who are practicing healthy lifestyle habits. However, you’ll also find skinny smokers; the ill who had lost weight or were still losing weight; the “skinny fat” people who starve themselves all day and/or over exercise to maintain a particular size; slender or average size food addicts who eat junk but keep the calories and their size down; those with eating disorders; people who may have dropped weight using fad diets but will most probably regain; people post bariatric surgery who may have complications; and, average size men and women who are sedentary and don’t eat well. It’s also probable that average weighted folks are not garnering the attention of medical professionals who write them off as healthy based only upon their weight and basic lab values within normal range. Nutrition and fitness is rarely discussed and it’s estimated that over 40% of pre-diabetics are of average weight. Bottom Line: Having a “normal” weight may not indicate optimal health, fitness or wellness.

2)     Not All Fat is the Same: The study looked at total body weight, not fat distribution. People who carry excessive weight inside their belly are at much higher risk for heart disease, diabetes and cancer. Bottom Line: You cannot draw the conclusion that fat in general confers some protection.

3)     Clarifying Who the “Overweight” Are: Just as you cannot conclude optimal health because someone is of average weight, as well, you can’t state that all overweight are very unhealthy. I have patients who have dropped 100 pounds through excellent healthy lifestyle habits and then ended up 20-30 pounds above the approved upper limit for an ideal body weight. Their metabolic profiles on lab tests are normal, their blood pressure and pulse are healthy, and their waist circumference is upper limits of normal or elevated but it’s subcutaneous, not intra-abdominal fat. And, they are more fit and living a healthier lifestyle than many people in the “normal” weight range who may be sitting around with excessive belly fat. When one of these folks is in an accident, they may do better than an average weighted but unfit person. Some experts note that it is indeed possible to be fit and overweight, as physical fitness confers an independent protective effect on disease risk. As well, due to increased medical attention, many overweight people are getting more guidance and help with healthy lifestyle education which may be decreasing their mortality rates. Someone dropping weight but still overweight may be included in this group, as well as those from an average weight who are gradually increasing weight. In other words, you have a lot of moving targets in all of the groups. Bottom Line: The overweight group, like the normal weight, includes a wide array of body composition, medical history, and lifestyle habits.

4)     Quantity, Not Quality, of Life Was Emphasized: This research was reviewing the relationship between body size and life span. Nothing was noted about incidence of disease or mental (cognitive decline) or physical disability (joint problems). Bottom Line: Although there was a difference in death rates, the enjoyment and functionality of daily life was not addressed, nor was the potential probability of problems occurring in the future (silent pre-diabetes becoming fulminant disease).

Most experts agree that this issue of obesity and overweight is much more complex than had been previously appreciated. I’m glad to see this kind of provocative research as it focuses the discussion to exactly what are the optimal goals and objectives for people striving to become healthy.

As you embark on your own journey, I’d recommend that you keep your healthy living habits simple and consistent. When you set your goals, try these guidelines to help you:

Create your own A team which can include any combination of: your medical support system, physical activity professional, registered dietitian, counselor, friends, family members and don’t forget that pets count!

Measure your progress by improvements in: energy, mood, inclusion of whole foods and elimination of refined/processed products, regular physical activity, better your medical lab values (blood sugar, cholesterol), medical conditions (high blood pressure, diabetes), physical performance (in exercise as well as activities of daily living), waist circumference (reduction in waist size to within normal limits <35” women, <40” men), and a continuing decline in body fat%.

Don’t obsess about a single weight number. It’s never about achieving that one number as most people’s actual weights vary within a range. Instead, start the journey and keep practicing your healthy lifestyle, do your best and review your improvements with your A team, reassessing progress and future objectives as you go along. The key is to keep heading in the right direction, and at some point, with a full discussion about your unique holistic personal profile and the agreement of your support team, you’ll acknowledge a point when maintenance can begin for a lifetime of health and wellbeing.

Photo: iStockphoto

Posted by: Pamela Peeke, MD at 12:46 pm

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