Is the "Obesity Epidemic" a fantasy?

[brynndragon]

One of the things I noticed when examining the requirements for the study I'll be participating in is the BMI cutoff is 27. Which seems strange because the BMI cutoff for "overweight" is 25. Apparently it *was* 27 until 1998 when the National Heart, Lung, and Blood Institute (NHLBI) decided to make it 25. I can't for the life of me figure out why they made that decision. They state, "The rationale behind these definitions is based on epidemiological data that show increases in mortality with BMIs above 25 kg/m2." with several references. But only one of the references implies that lowering the cutoff might be beneficial (the one that states "available evidence suggests that minimum mortality occurs at relative weights at least 10% below the US average", where the average according to this article (referenced in other places in that NHLBI document) is right around BMI = 25 for women and somewhat above that for men - which makes me wonder why the hell they picked 25). All the rest use overweight = 27 as their basis for making statements about the link between overweight/obesity and morbidity, except the WHO report (PDF). The WHO report doesn't say a damn thing about links between obesity and morbidity/mortality (being focused on malnutrition), nor does it give any specific recommendations at all about where to set BMI even for determination of malnutrition (for which it has good reasons involving the risk of overlooking important aspects of the link between height/weight/age and morbidity/mortality, and translating it into useful intervention, which the NHBLI seems to have completely ignored).

The thing I really want to point out is almost all of the data they use to support the notion that being overweight leads to increased morbidity/mortality involves a BMI >27, not a BMI >25. This might explain why the study I'm participating in uses the 27 cutoff rather than the 25 cutoff.

I probably only care because my BMI is 26. Well, that and the idea that over half of Americans are overweight is based almost entire on this change for which I've found pretty much no freaking evidence. The more I learn, the more dubious I am of our notions of healthy weight. . .

Comments

[perspicuity.livejournal.com]

oh, indeed... i have a large frame. i work out, and am fairly strong. i could be stronger in more rounded ways, but it's functional to what i like doing for the most part. i could stand to easily lose 30 lbs right now, but even at my most recent minimal weight, very trim, feeling nearly too skinny, i was at 199.

when i did gymnastics in college, i was 185 and super fit. i ran. i swam. i could hike all day. i could dance lift cute girls all day in the name of gymnastics :> i could walk on my hands (sigh). pushups until the cows came home. yar. also, pretty much ripped :)

went to my doctor for strep. they put me on a scale without my shoes, but with my typical loose baggy clothes on. < 190. measured my height. took my pulse (very low resting pulse rate, and still quite low). great blood pressure ranges.

he sat me down, and told me very seriously he was concerned about my weight, and said i should drop at least 20 lbs. i laughed. then i told him what i did at school for fitness. unicycling made my legs incredibly corded. best workout ever. as i was wearing shorts, i made a point of showing him.

this BMI stuff pretty much doesn't apply to people who are *fit* it seems.

i seem to recall that much of the actuarial data they have is based on civil war era soldiers. hungry, well exercised men. skinny but strong. great. nothing like most civilians, well, except the working class (which was a lot of them).

there's a tv show that reenacts a life style of 100+ years ago, pioneer valley? they take a regular family, and pretty much drop them in a cabin, and they get to live the life. so this regular guy, with 8+ hours of field work a day, eating pretty well, got all skinnied up. he thought he was sick or had parasites. eventually he got pretty damn taut, wirey, and a totally flat belly. he COULDN'T eat enough. heh. work work work.

last bit: a friend of mine "got away from it all", and went on walkabout in NZ for 3ish months, hiking with a backpack. always on the move. the change was dramatic. already somewhat fit and not in anyway fat, she lost 20+ lbs, and put on muscle to boot. very nice. nice enough, that i'm pondering doing just such a thing sometime before the decade is out. ponder ponder.

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[brewergnome.livejournal.com]

Thank God mine didn't. I would have laughed at him.

I miss gymnastics.

But yeah, it's ridiculous. My Mom's overweight, I understand this, she understands this. But the unrealistic goals have made her basically give up. She has broad shoulders and relatively heavy bones (actually denser, runs in the family) and some muscle from shoving around goats and sheep (and hiking and backpacking and carrying kids up stairs). The weight they tell her she should be? Ridiculous.

[perspicuity.livejournal.com]

mmm, that reminds me, how do they easily determine bone density? i do some exercise (punching kicking jumping lots) and load bearing that i'm assuming is good for my bone density.

i've never broken anything even with several spectacular crashes off bikes and motorcycles and such. i wonder if my density is high?

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[brewergnome.livejournal.com]

I'm trying to remember now and I'm blanking. I know MINE are dense 'cause I broke my arm. And instead of being the compound fracture it "should" have been, I got a compression fracture instead. And 45 minutes later there was already bone network growing across the break. My doctor was impressed.

[squibbon.livejournal.com]

I have major, major, problems with BMI as a measure. Also, I believe that the diet industry is to blame for many of the problems it claims to solve. Dieting wrecks your metabolism, and most people who lose weight on diets gain back more. So, someone can start off moderately "overweight" and end up weighing much more than they did to begin with if they just yo yo diet for a few years, which is quite common. If you google fat acceptance you can find a huge number of blogs and sites that talk about criticisms of the obesity panic.

[perspicuity.livejournal.com]

the dieting industry loves the no results part. it's great.

yo yo dieting is bad. people should practice weight management. permanently. the problem is: most people don't have a clue how.

oh, i'm aware of the criticisms of the so called obesity panic... can't quite get away from the fact people are probably heavier than they should be, and i'm talking carrying fat, not dense bones, or muscles, or metal implants.

also the "fat acceptance" thing. i used to weigh 290 apparently as a result of getting mono at 25 out college - it was pretty alarming. i didn't like or accept it. i set about to fix it. i'm constantly managing myself now, and sometimes i slip up, but it's a daily thing. i need to learn more, and mostly i need to workout at least an hour a day. motivation :)

imho, modern peoples is just to soft and they need to DO things, for hours a day. walk, dig, run, play, swim, be physical, get out there and do stuff. my profession (hacking) is esp bad for this.

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[squibbon.livejournal.com]

I'm not arguing that at all. The thing is- a lot of thin people don't exercise either, and eat terribly. Those kinds of behaviors are bad for you no matter what you weigh. I'm well within what is considered a healthy weight, even by BMI standards, but I could still really stand to make some changes to the way I eat and to my activity level. Good for you for making a change that was important to you, and for feeling good about it. The point of fat acceptance, as I understand it isn't that everyone should just sit around and do nothing, it's that no matter what someone's lifestyle is like, or what their size is, they still deserve respect, and the self hatred that fat people are often encouraged to feel really doesn't get anyone anywhere.

[perspicuity.livejournal.com]

a lot of thin people aren't very healthy either. they eat terribly and well, there you go.

i know some skinny folx that get "beat up" for being the way they are too. go figure. i'd like to see "body acceptance". people are what they are and do what they do. "people come in people shaped packages"

similar with smoking. people wanna smoke? great. they shouldn't inflict it on me, nor expect me to love them for/because-of it, but i'll accept it's their deal for the most part, not mine.

unfortunately, pick a thing about oneself, and there's a self hatred for it. fat, skinny, old, young, skin, hair, teeth, eyes, hands, feet, bones and organs. hah.

people just ain't rational :P

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[squibbon.livejournal.com]

Yeah, I've ranged from being pretty skinny to mildly/arguably overweight, the changes were mostly related to medication rather than lifestyle stuff. I actually found that people felt a lot freer to say mean things to me when I was very skinny, and a lot of it came from guys. Most men know better than to say negative things about a woman being overweight especially if they're interested in her, but for some reason calling me "skeletal" was OK (and actually, I wasn't underweight by a long shot.) It was also weird to have everyone around me assume I had been dieting when really I was chowing down on high calorie stuff like nuts and food with a ton of olive oil and protein shakes to keep from losing too much weight too fast.

Now I live in a neighborhood where most of the women I see on the street are a size 4 or below, and I'm on a different set of meds and gaining back some weight. Nobody is saying anything overt, but I do feel uncomfortable sometimes despite currently being around the middle of the BMI range. Even when I know I'm still a healthy weight, and that gaining some back is OK, it's still hard on me when I have to go shopping for larger jeans. You just can't win.

[squibbon.livejournal.com]

Just to clarify- none of the meds I'm talking about are weight loss drugs even remotely, I just tend to get the strange side effects that nobody else does.