Showing posts with label BMI. Show all posts
Showing posts with label BMI. Show all posts

Wednesday, January 2, 2013

Government Reports Extra Weight May Be Healthy. Really?

Is anyone else shaking their heads in disbelief over the new government study that shows that people who are overweight are less likely to die in any given period than people of normal weight?  This study was based on a review of 97 other studies.

First of all, many are calling the study proof of the "Obesity paradox," although the study clearly showed that obese people, that's people with a BMI above 30, had an overall increased risk of dying. Also this was an observational study, not a cause and effect one, which already makes the results somewhat questionable.

Second, if 67% or so of the population is overweight and 36% is obese, which means that 31% are overweight and not obese, that only leaves 33% of the population as either normal weight or underweight.  Included in the 33% are people who have lost weight due to illnesses such as cancer, eating disorders, hyperthyroidism, malnutrition, etc.

The study does not account for why people fall into the normal and underweight category (healthy or unhealthy lower weight) given the preponderance of people in the overweight category.

Third, it doesn't account for people who have normal BMIs, but high waist to hip ratios which signifies excess white fat, the dangerous kind of fat. A recent Mayo Clinic study showed  that among 14,000 study subjects, those with a normal BMI, but a high waist-to-hip ratio, were the most likely to die of heart-related disease during the 14-year follow up, even at higher rates than those in obese ranges.

Fourth, it is well established that people in advanced stages of cancer and diabetes do better with additional weight because as the body wastes away, it takes longer to do so. G-d forbid you should need excess weight for that reason.

Fifth, the study did not assess people who were underweight as it is known that such people have increased mortality. The underweight people were lumped together with the normal weight people to come up with a total death rate, so one can expect that the underweight inclusions skewed the numbers somewhat.

Sixth, the study did not address people who are overweight on the road to becoming obese, as opposed to those who are chronically overweight. By not knowing if recent illness is contributing to change in weight, we can't do an apples to apples comparison.

Seventh, the study underscores why BMI may not be the most reliable indicator of unhealthy weight because it does not take into account the muscle to fat ratio. Athletes, for example, could have increased muscle mass that will increase their BMI and put them into the overweight (even sometimes obese) category despite their otherwise good health.

Eighth, it is well know that excess weight, in and of itself, does not mean you are unhealthy if you don't have concomitant increases in cholesterol, blood pressure or blood sugar.

Ninth, is there a difference between a BMI of 25.1, which puts you into the overweight category and 29.9, which keeps you out of the obesity category? The study does not address gradations of being overweight.

Tenth, and finally, it not entirely clear to me what exactly is the point of this study. Is it to tell people that being overweight is not as bad as most people think? Should people who are overweight, but not obese be less concerned about their diet and lifestyle?

Of greatest concern, should people who are overweight, but not obese, make sure that they don't lose any weight as that may increase their risks for death?

I am not surprised that this is a government study as I find such studies to sometimes be the most generically misleading. Such a study would seem to offer comfort to the 67% of Americans who find themselves in the overweight category as you can rest assured that most people will not even bother to look past the headline that states that extra weight may be healthy. They will just take comfort in the notion that that extra piece of bread or serving of pasta may be health promoting.

G-d help us all if the government keeps doing these types of studies. Next thing we know they will tell us to cut out fats and eat more carbs. Oops, they did that already and we all know what happened.

Update, February 3, 2913:  A recent study offers support for the notion that far more important than BMI is the waist to hip ratio. This measurement of "belly fat" is more indicative of overall health because the build-up of white fat cells at one's midsection is more reflective of overall inflammation within blood vessels and risks for heart disease.  So those who took heart from the study that it's better to be heavier than be normal weight, please understand that this referred to well distributed weight and not weight concentrated around your gut.


Wednesday, August 1, 2012

What A Difference A Day Makes

Over the past few months, the big health related news was the Institute of Medicine's report regarding the increasing percentage of obese Americans. The expected increased girth of the nation raised alarms because of all the other medical problems that are likely to ensue.  Unfortunately, we will not have to wait because a new medical report by Virginia Fried and colleagues was just released by the U.S. National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention. The report titled, NCHS Data Brief, "Multiple Chronic Conditions Among Adults Aged 45 and Over: Trends Over the Past 10 Years," is truly frightening. 

According to new research, between 1999-2000 and 2009-2010, the number of Americans aged 45 and older with two or more chronic conditions has grown, with senior citizens especially at risk of developing both diabetes and high blood pressure. The study reveals that the percentage of Americans in the 45 to 64 year age group with two or more of the conditions grew from 16 percent to 21 percent and in the 65 and older age group, the percentage increased from 37 percent to 45 percent.

The report also revealed that 23 percent of adults aged 45 to 64 with at least two chronic conditions -- out of the list of nine -- either didn't receive necessary medical care or delayed it because of cost. That's up from 17 percent a decade earlier. The percentage of people in that group who didn't get necessary prescription drugs due to cost also grew from 14 percent to 22 percent over the period. Isolating individual conditions in people aged 45 or older, high blood pressure grew from 35 percent to 41 percent, diabetes from 10 percent to 15 percent, and cancer from 9 percent to 11 percent.

The most troubling part is that these numbers are expected to get even worse.  But I have reason for hope because of someone I spent time with today.

I met with a patient of MDPrevent today who has been participating in our LEAN Weight Loss program.  Prior to starting the program, her cholesterol was about 230, her fasting blood sugar was around 120, and her body mass index (BMI) was over 30. In the span of a few months, she has shed 16 pounds, dropped her BMI to 27.5, dropped her cholesterol to the 160s, and her fasting blood sugar to around 105. She accomplished this without any medications, surgery or supplements. She did it simply by changing the way she eats based on what she learned in our program. The best news is that her program was covered 100% by Medicare so it didn't cost her a penny.

Starting a new practice over the past couple of years has had its challenges. However, today it all came together when I witnessed first-hand again what a profound effect a change in lifestyle can have on someone's health. I am so proud to be part of such an effort and take great satisfaction in knowing that our team of Preventioneers are truly making a difference one life at a time. The best news is that our program is covered 100% by Medicare for those who qualify.