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Obesity rate may be worse than we think
I think the BMI cutoff for obesity should be lowered. I also think that the "fat acceptance" movement in our society is out of control and doing nobody any favors.
Obesity is public health enemy #1 these days IMO, and should be treated as such, not as a diversity issue that should be celebrated.
Thoughts?
http://www.cnn.com/2012/04/03/health/obesity-rates-maybe-worse/index.html?hpt=hp_bn12
Obesity rate may be worse than we think
- BMI, researchers say, may be an overly simplistic measure for overall health
- BMI threshold for obesity should be lowered to 24 for women and 28 for men, authors say
- Authors: Patients who are not considered obese aren't being told about their health risks
(Health.com) -- Doctors and health officials have relied for decades on body mass index (BMI), a ratio of height to weight, to categorize people as overweight and obese.
A new study, however, suggests the use of BMI may be leading us to underestimate the already sky-high obesity rate.
BMI, the researchers say, is an overly simplistic measure that often misrepresents physical fitness and overall health, especially among older women. Nearly 4 in 10 adults whose BMI places them in the overweight category would be considered obese if their body fat percentage were taken into account, according to the study.
"Some people call it the 'baloney mass index,'" says lead author Eric Braverman, M.D., president of the Path Foundation, a nonprofit organization in New York City dedicated to brain research.
Bodybuilders can be classified as obese based on their BMI, he says, while "a 55-year-old woman who looks great in a dress could have very little muscle and mostly body fat, and a whole lot of health risks because of that -- but still have a normal BMI."
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Based on their findings, Braverman and his coauthor, New York State Commissioner of Health Nirav Shah, M.D., say the BMI threshold for obesity, which now stands at 30, should be lowered to 24 for women and 28 for men.
By that standard, a 5-foot 6-inch woman and a 5-foot 11-inch man would be considered obese at about 150 and 200 pounds, respectively.
The study participants -- patients at a specialized private health clinic in Manhattan -- aren't typical of the population as a whole, Braverman notes. Still, he says, the large discrepancy between BMI and body fat measures seen in the study suggest that BMI guidelines should be revisited.
"People aren't being diagnosed [as obese], so they're not being told about their risk of disease or being given instruction on how to improve their health," says Braverman, who is also a clinical assistant professor of neurosurgery at Weill Cornell Medical College, in New York City.
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James Hospedales, M.D., chief of noncommunicable diseases at the Pan American Health Organization, a division of the World Health Organization based in Washington, D.C., says that while one study is not enough to justify changing national standards, the findings do call for a discussion.
"We've known for a long time that BMI is not a perfect measurement, and that it's important to look at the overall picture," Hospedales says. "In this study, it turns out that a lot of people who are classified as just overweight in fact have a bit more to worry about, and those are indeed valuable findings."
But lowering the cutoff for obesity could create its own problems, Hospedales adds.
"We'd also be calling an increasing number of people obese who aren't, which could lead to issues with stigma, insurance policies, and other problems," he says. "We have to think quite carefully about the pros and cons."
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In the study, published today in the journal PLoS One, Braverman and Shah compared the BMI of roughly 1,400 men and women with their body fat percentage, which was measured using a type of scan, known as dual energy X-ray absorptiometry (DXA), that provides a detailed breakdown of fat, muscle, and bone mass. (DXA scans are also used to measure bone density.)
Overall, 39% of patients who were merely overweight by BMI standards fell into the obese category for body fat percentage, which the American Society of Bariatric Physicians defines as 25% or more for men and 30% or more for women.
BMI appeared to provide a far less accurate picture among women, possibly because women lose muscle mass faster than men as they age, the study notes. Nearly half of the women were considered obese according to body fat percentage but not BMI, compared to just one-quarter of the men.
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Testing for blood levels of the hormone leptin could boost the usefulness of BMI, the study suggests. Leptin, which helps regulate energy and appetite, was strongly associated with body fat percentage in the study, and it has previously been linked to obesity-related health complications.
Adjusting BMI to account for leptin levels would provide patients with a more accurate measure of their disease risk, Braverman says.
Lowering BMI obesity cutoffs, using DXA scans when possible, and incorporating leptin tests represents a "three-pronged approach," Braverman says. "Making these changes now can save the U.S. a fortune down the road, if it allows us to alert more people to their risks and prevent them from getting worse."
Re: Obesity rate may be worse than we think
By that standard, a 5-foot 6-inch woman and a 5-foot 11-inch man would be considered obese at about 150 and 200 pounds, respectively.
Ridiculous. 5 ft 6 at 150 pounds is not obese. Overweight? Maybe. Obese. no. I think by cramming more into the obese category to scare people will just cause people to dismiss the description, not scare people into better health.
I do not agree with using BMI as an indicator of obesity or overweightness. It is a flawed system.
Before I got pregnant I fell into the overweight category (by 1 lb but still). I actually think I have a great body. I worked out a ton, including weights, but still wear a size 4 jean. If someone would see me I am confident they would say I am thin. Anyways that is when I realized how bullshitty the BMI calculator is.
I would be more in support of continuing to use BMI if body fat index and other measures were incorporated as this article suggests.
As a person who's body falls outside the norm when it comes to BMI, I'd be irritated if I was considered obese again, since I just lost 10lbs and am now on the cusp of a 'healthy' BMI.
My current BMI is a 25, I wear a size 10/12 in designer sizing. I can run 13 miles, & dead lift 3/4 of my bodyweight. I'm far from unhealthy, but I have a large frame and more muscle mass than the average woman. I am working on losing 10 more pounds, and once I'm done will be at my ideal weight. Losing more than that would not look healthy on my frame.
So they admit that BMI is a bad measure of actual health, and yet they want to claim that a BMI which is currently "normal" (24) is not just overweight but OBESE for women?!
If the measure is flawed, come up with a new standard. Use body fat, for goodness sake. Sure, it's harder to measure, but if it's much more accurate why stick with BMI?
I should also add that I fully support using body fat % along with BMI.
Shouldn't a doctor possibly be having a conversation with a woman who is 5'6" and 150lbs though? What if she is age 22 and her body fat % is up around 35%?
I think helping doctors become more comfortable having a dialogue with patients about weight is the biggest benefit of lower the BMI threshold for obesity. Obviously people don't really get too scared by being in that catergory as it is, if they did the obesity rate wouldn't be skyrocketing.
I don't think "fat acceptance" means "bad health acceptance."
Fat does not automatically equate with bad health.
Yes, it could be indicative of bad eating habits or not enough exercise. But, being fat doesn't mean you're going to fall down dead at any minute.
Well I don't think fat shaming is the solution at all.
True.
In similar fashion, smoking does not always mean you will die prematurely or end up with cancer.
I think it's time we treated obesity the same way we treat smoking. Make it harder to be obese, just like we made it harder to be a smoker. Stop expanding junior clothing stores to include a huge amount of plus sizes, stop making seats bigger etc etc.
I guess if I went to my doctor at 5'6 and 150 pounds and they told me that I was obese, I would likely change doctors. It is one thing to say your body fat percentage is high and you need to do x, y and z to remedy that or there could be health consequences, but to me calling someone at that height and weight as obese would make me question what that doctor views as a normal body image.
of course I am not a health professional so my opinion is totally not based on anything scientific. : ).
I had a similar experience. When I started going to my OB, he said the chart put me in the overweight category, then told me BMI was BS, and that he classified me as healthy. He always told me how strong and toned my core was (not in a creepy way). That conversation always turned to swimming, which we both love.
It would be so easy if we could just take height and weight and that will tell us who is healthy and who is unhealthy. There are just too many factors that go into determining health.
I agree that there needs to be a better assessment in telling apart "skinny fat" people flying under the radar and "fat but fit" people who are likely healthy and at low risk for disease.
But why would you lower BMI cutoffs instead of tossing BMI altogether and going with body fat percentage plus whatever else is a better disease predictor? Waist to hip ratio perhaps? Also, is a DXA scan necessary? Can't a nurse or doctor get a ballpark body fat % with simpler tools?
And what are all of these newly obese people supposed to do with this information? A doctor isn't all that helpful besides giving you info you probably already know; you'd get the ol' eat less, move more, ditch fat spiel and if you're still fat after that then you must be lazy and a pig. Rinse, repeat and eventually cue the prescription pad.
5 ft. 6 and 150 pounds should not be considered obese. And I don't think obesity should be treated as "the enemy." We should not be acting like fat people are the enemy or bad or weak or whatever. Education, healthy school lunches, more opportunities for exercise are all great ways to help reverse obesity in our society. But we also need to teach tolerance and acceptance. People are fat for all kinds of reasons including insulin resistance, abuse, illness, genetic makeup and yes, just laziness. But everyone deserves respect, regardless of what they weigh.
I have lost more than 100 pounds, but I will likely never have a BMI that is not considered overweight. People are wired differently. Medical researchers are finding more and more genetic link to obesity, so we should be able have more understanding of why people get fat and how to manage weight. I think this is the key to controlling obesity -- understanding, not labeling obesity as "public enemy #1."
We treat smoking the way we do because it is a public nuisance. No one wants to smell your smoke or inhale second hand smoke. That is why it has been successfully outlawed from public places. In most cases someone being obese has no impact on my livelyhood. Sure they may take up part of my seat on the bus or on an airplane but otherwise someone's girth does not impact my daily life.
And all of the bigger clothes, bigger seats etc are market driven. They want to make money and they know where the market it. They shouldn't be responsible for changing our acceptance.
I am fully on board with doctors taking a more direct approach. But that more has to do with the medical community rather than shaming a larger amount of people by labeling them as obese.
So no clothes or seats for fat people. oookay.
You know that is stupid, right?
This happened with my OB as well lol. She took one look at me and said "Well your chart says this but you are proof that BMI is a crappy measurement."
Yes, because making fat people miserable and uncomfortable will certainly give give them incentive to lose weight. You know that when people feel bad, then tend to eat, not jog, right?
Doesn't it though? Obesity is a major contributing factor to heart disease, diabetes, stroke etc etc. which impacts the cost of our healthcare right?
What if the obesity rate climbs to 60% or 70%? Should we as a society just say the hell with it and not care? What about raising kids in that society? Talk about an uphill battle in helping them understand why it's important to stay at a healthy weight, eat right and be active when Jimmy and Jane next door are too obese to play kickball.
I don't think it's stupid to stop expanding the amount of plus size everything we have at an exponential rate. I didn't say take it all away, but I also understand that these things are profit driven so if people are buying, they will be more and more available.
Someone who thinks we should make it harder for fatties to find clothes that fit has obviously not had to shop for fattie clothes recently.
As for the rest, I just can't. Sometimes I think the constant obesity talk just makes it worse. Constantly thinking about whether you're too fat, whether other people think you're too fat, whether what you eat at your next meal will make you fatter - it can make a person really miserable. I mean, not that I'm speaking from experience here or anything. That's what my friend told me.
I am pointing out your argument about smoking verse obesity is flawed. I can get lung cancer from second hand smoke, thus why it is now not allowed in most public places. I can't catch the fat by sitting by someone in a public place.Two different things.
stop expanding.
don't take it all away.
So, some fat people will have to go without?
Some doctors claim that they lose patients when they try to discuss these issues so find themselves avoiding the topic or being obtuse. Other surveys of doctors have found that while they want to discuss being overweight they don't feel qualified to say much because they don't have training in weight management or nutrition. Apparently only 39% of obese people have been told such by a health provider.
As someone who was 5'6" and 155lbs prior to getting pregnant, I CAN tell you that I was still about 15lbs overweight. This was agreed by both my GP and personal trainer. Most people wouldn't have considered me to be overweight, but that is largely because fat IS the new normal. My mother, with the exact same body frame, started WW 30 years ago because she hit 145lbs at that height and she was larger than most of her friends.
While the BMI system itself may be flawed, and body fat % a better indicator, the fact remains that as a society when we get larger, we view what is 'fat' or 'obese' to be different.
This reminds me of all the posts on the Bump where people freak out when their doctor (or nurse, God forbid) tells them to slow down the weight gain. I mean, the doctor couldn't POSSIBLY be right?!? **says someone whose GP advised them to slow down the weight gain at 32 weeks pg**.
Yes.
Also, we shouldn't treat obesity like smoking because it ISN'T like smoking. I don't have to smoke some to live. I do have to eat to live.
hawkeye, I think you're oversimplifying this issue to a very great degree.
No, but there is a huge social component to eating, diet and food that gets passed down from parents to kids.
Yes, I'm sure genetics are involved but if a parent models a poor diet, lack of exercise, etc it's likely their kids are going to learn from that, no?
I'm not even sure what to say in these threads anymore. So I guess I'll just condense and repeat what I usually say.
1) Everyone should feel good about themselves. Feeling good leads to more confidence, which leads to a more positive attitude, which leads to trying new things like new foods, new activities, more friends, etc.
2) No one feels good about themselves in muumuus or after five hours of trying to find a pair of jeans to fit their ass. Not feeling good about yourself leads to couch surfing, comfort eating, and self loathing which leads to more couch surfing, more comfort eating, and then disordered eating.
3) Food sources are a red herring. Yes, I said it. We should be more aware of what we eat and where it comes from put people aren't fat because of it. YWIA!
Click me, click me!
Well I am fairly certain there are plenty of plus size clothes to go around, perhaps not the most current on-trend skinny jeans and tunics, but I don't think fat people will exactly be walking around naked any time soon.
Look, I get it. My smoking analogy is not great because of the impact of second hand smoke. Being fat is most cases is directly related to lifestyle though. The true medical issues that cause serious obesity are in the minority.
But yeah, obesity is deadly and it is a public health enemy. I'm sorry if that is offensive, but it's true. Our food sources need to change, gov't funding needs to change, school lunches, fast food- we need a huge shift in mentality. I think ONE way to urge that change is to stop making everything bigger. I guess maybe I am evil fat shamer then, but I see a scary future in terms of health if this obesity trend continues.