By: Holly M. Thatcher, MD
Is it healthier to be pleasantly plump? Or should you skip all desserts and work out twice a day to be a ‘lean-iac’? No sooner did many of us make resolutions to exercise more, eat less, and either lose weight or vow to at least not gain weight in the New Year, did the Centers for Disease Control publish provocative research suggesting LOWER death rates for people who are overweight (defined as a Body Mass Index of 25-29.9) compared to those individuals with a “normal” Body Mass Index (BMI) of 18-24.9!
How can this be? Isn’t all extra fat ‘bad’? Well first of all, we need to critically exam the research process. This study was a conglomeration of multiple studies simply looking at BMI and death rates. This study of over 2.8 million persons did not address visceral fat or weight distribution. What is important to realize is that while BMI has a relationship to leanness and obesity, it is NOT a perfect marker. It is simply a number calculated by a simple mathematical equation related to height and body weight. It is not adjusted for the following:
- Sex
- Race
- Age
- Family history
- Co-morbid medical conditions
- Degree of fitness or athleticism
We have known for some time that weight gain around the middle (apple-shaped) is much more dangerous for one’s health than weight that is carried in the more typical ‘female-pattern’ hip and thighs (pear-shaped).
What does my BMI tell me about my body?
Recently, my oldest son came home from his physician visit for an annual exam and proclaimed, “Mom, I’m obese!” He measured 6’0″ and weighed 210 pounds, which calculates to a BMI of over 27 and considered medically overweight. Actually, he is muscularly ripped, was a national “Got Milk” scholar athlete and has such big biceps that he needs to get an extra vent in the arm sleeves of his shirts.
The point is that many men and many women are physically fit, muscular and have higher than “desired” BMI, yet do not have excess fat or excess medical risk. Conversely, one can have a normal BMI and have excess fat and not enough muscle. Depending on your genetics, some weight gain may confer greater risks for diabetes and heart disease than the same weight for another person. Bummer, but true. For some individuals, it is more important to be a lean-iac (maniacal about being lean) than for others. Furthermore, many people who are chronically ill lose body weight at the end of their life and this clouds the relationship between BMI and death rates.
What does this new study mean for you and your body weight?
So this study is not a license to throw nutritional common sense and the bathroom scale out the window, even though both activities are very tempting at times. This study did show that persons with higher grades of obesity had higher death rates. We know that weight gain in midlife confers higher rates of:
Diabetes
Breast cancer
Gallbladder disease
Hypertension
Heart disease
Arthritis requiring joint replacements
Sleep apnea syndrome
Waist to hip ratios (ideal under 0.8) give an assessment of how much visceral fat one has. In general, women should have a waist of under 35 inches and men a waist of under 40 inches, but the ratio is actually more important that the absolute number.
So, no, not all fat is bad. Just like there are heart healthy fats that your body needs, there is a difference in how and where fat is stored in your body and what affect it has on your health. If you are a muscular person or a curvaceous, pleasantly plump (voluptuous) woman who has a normal waist to hip ratio, normal blood pressure, normal lipids, normal blood sugar and good physical fitness, you do not have to obsess over your BMI number. You are more than a number!
Be Strong, Be Healthy, and Be in Charge!
Holly L. Thacker, MD is nationally known for her leadership in Women’s Health. She is the Director of the Center for Specialized Women’s Health at Cleveland Clinic with special interests in menopause and related medical problems, osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. She also is a sponsor for Holly Fulger’s Speaking of Beauty TV. Dr. Thatcher’s post originally appeared on Speaking of Women’s Health and is being reprinted with permission.
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