The Obesity Myth MythThursday, June 3, 2010
From time to time the media loves to write stories on the Obesity Myth.
These stories come in two flavours – the first one denies the very existence of an obesity epidemic, attributing the rise in obesity statistics to moving definitions that “suddenly” make everyone obese simply by shifting the goal post.
The second flavor of obesity myths acknowledges the increase in people with excess weight but states that carrying a few extra pounds or even having more severe obesity is not really detrimental to your health, ergo this whole obesity thing is vastly overblown.
Last week, news media around the world once again splashed Obesity Myth headlines on their front pages, this time of the second flavor – yes obesity exists, but it is really not a health risk.
These reports were based on a study by Brant Jarrett and colleagues from the Brigham Young University, Provo, UT, published in the International Journal of Obesity.
The researchers examined data from the 1988-1994, 2003-2004 and 2005-2006 US National Health & Nutrition Examination Surveys (NHANES) to determine the relationship between BMI, age, gender and current medication in 9071 women and 8880 men. Current medication (or medication loads) were considered a surrogate measure of current health status.
In both the 1988-1994 and 2003-2006 data sets, with few exceptions, medication loads did not increase significantly in overweight compared with normal-weight people, a finding that prompted the news headlines.
However, the paper did find increased medication load in people who were clinically obese (BMI>30), especially if they were 40 years of age or older.
In fact, the authors themselves conclude:
“Although obesity does not substantially affect current health in young people, it is likely that the increased medication loads in obese compared with normal-weight older people originates at least in part from an increased BMI starting at a younger age. Thus, age, gender and onset of high BMI all require consideration when using BMI to assess current health status.“
Given these findings, one can only wonder why the media chose to propagate the Obesity Myth based on this study, given that the authors themselves clearly found a relationship between excess weight and health status.
While the authors do emphasize that BMI is not a good measure of health risk, this is nothing new.
Regular readers of these pages will recall several previous posts on the limitations of BMI as an indicator of health and it were indeed these limitations that prompted us to develop the Edmonton Obesity Staging System as a more clinically relevant measure of obesity.
So, while moderate excess weight may not cause apparent health problems in the young, obesity remains a significant risk factor for poor health in middle-aged adults.
Jarrett B, Bloch GJ, Bennett D, Bleazard B, & Hedges D (2010). The influence of body mass index, age and gender on current illness: a cross-sectional study. International journal of obesity (2005), 34 (3), 429-36 PMID: 20010903
Thursday, June 3, 2010
I do agree with you that BMI is not a good indicator of obesty related health risks and our studies at Hyderabad also tell the same story, and now a days we rely more on waist measurement and TG values as defenite prognostic tools.
Thursday, June 3, 2010
Dr. Sharma: You have hit upon only a couple of the obesity myths out there. Other myths include 1) THAT the reason folks are obese is because their individual choices are bad (versus that we live in obesogenic environments are constantly swimming upstream to fight obesity); 2) that losing weight is the most important thing (versus maintaining lost weight or even just maintaining weight ); 3)_hat dieting works and that you can just go back to your old habits once you’ve lost weight and my favourite, that people in the medical profession, no matter what their background, are a good place to go if you have a weight problem. This latter is like going to a mechanic when you want to learn how to drive. You don’t really need to know the inner mechanics of a car as much as you need to know the rules of the road, the psychology of other people and how traffic affects you.
Friday, June 4, 2010
I find that the media most often propogates the story that obesity is a big killer and a major crisis. I rarely read stories in the mainstream that suggest anything else.
I don’t find it terribly useful to be told that I am likely to get sick and need a lot of medication because of my weight, considering that most obesity researchers say that there is no good way for people to permanently lose a large amount of weight. It seems bariatric surgery is not even the answer. If there is indeed a (reasonable) way to slim down permanently, I will start the program tomorrow!
These days most of the fitness instructors and sports medicine specialists I encounter tell me not to diet because it will eventually cause increased weight gain. Instead, they say, adopt a “healthy lifestyle.” I exercise over an hour every day and eat pretty well. Is that not a healthy lifestyle? I hardly drink and don’t smoke either. Yet my BMI is 37! Not sure what exactly I am supposed to change in order to reduce my risks.
I find so many health experts talk out of both sides of their mouths: “lose weight” but “don’t diet.” Does anyone see the contradiction with that?
Friday, June 4, 2010
Jennifer: I think that “lose weight “and “don’t diet” are not necessarily ideas that are diametrically opposed. It is not a contradiction since dieting implies a short term program with an end. I have found that in order to lose weight, and keep it off, I had to make a decision to change what I was doing, which incidentally was eating pretty well most of the time too, and decide to no longer have food as a significant source of enjoyment in my life. I had to accept the idea that, for the rest of my life, I would eat only to live – essentially that I would be on a diet for the rest of my life. I was successful in losing weight and keeeping it off only by constantly reminding myself that these foods, which for me are essentially sugars and starches, would not be part of my diet for the rest of my life. Also, I had to accept that I could not have a huge meal occasionally because my weight is a cumulative number reflective of my whole life’s eating events and occasional binges do add up.
I thought I was eating well by following canada’s food guide, but I have learned through experimentation on my own, that CFG has far too many servings of grains to allow me to either lose weight, or keep it off, irrespective of whether those grains are whole grains or not. I don’t believe that my way of eating will work for everyone, but I do think that eating only foods that are real foods, not overly processed, is the only way that the majority of us will slim down. This is because we are meant to eat real food, the kind of food that has been eaten for thousands of years. The hundreds of “food” products in the store are not real food and our bodies have no experience of dealing with them since we might as well just pour in a slurry of sugar, salt , oil and starch. My suggestion is to follow the advice in Michael Pollan’s books in terms of the kinds of food you eat, continue to do what is right for you, including exercising because no matter what you weigh, you are better off to be healthy and fat, than unhealthy and fat, and listen to your body by really paying attention to the feedback you are getting from it. If you are a stress eater check out emotional brain training.
Friday, June 4, 2010
Well, that is what it comes down to then: a permanent diet. I don’t know if you are familiar with the work of Dr. Jeffrey Friedman. He says, that with few exceptions, people are not able to maintain a permanent diet:
“Those who doubt the power of basic drives, however, might note that while one can hold one’s breath, this conscious act is soon overcome by the compulsion to breathe,” notes Friedman. “The feeling of hunger is intense and, if not as potent as the drive to breathe, is probably no less powerful than the drive to drink when one is thirsty.
“Who is it that can resist a drink of cold water when their lips are parched? This is the feeling the obese must resist after they have lost a significant amount of weight.
“The power of this drive is illustrated by the fact that, whatever ones motivation, dieting is generally ineffective in for achieving significant weight loss over the long term.” – Jeffrey Friedman: http://runews.rockefeller.edu/index.php?page=engine&id=104
Monday, June 7, 2010
Jennifer, I think you’re looking at the word diet as if it is some kind of attempt to deny you foods. Katja is correct, you have to make lifestyle changes including food choices. I too have lost weight and kept it off for going on 10 years now. When I decided to give it one last shot I had been eating in what I thought was a reasonable way and exercising frequently. Yes I did have to change my eating habits but I told myself it was only for 6 months to see what happened. It was long enough to make the changes a new habit.
I am quite sure if I thought of myself as being on a diet forever I would feel llike I’m being ripped off. If I think about food all the time I do feel deprived but I have found alternative foods I like to eat, different ways of rewarding myself for successes and enjoyable activities so exercise isn’t a chore. I’m fortunate, I admit. I don’t get a lunch hour, I stand and walk as part of my job and don’t have any medical issues to prevent me from being active.
I hope you can get past the idea of *being on* a diet rather than your food choices being your diet and moving on.