According to the Federal Centers for Disease Control (CDC), in 2014, nearly seven of every ten American adults was either overweight or obese, two terms this chapter defines. And movie titles aside, the kids are not all right. Overall, the 2013 National Survey of Children’s Health reported that more than 30 percent of children age 10 to 13 weigh too much. This excess poundage isn’t pretty, and it comes at a cost. The CDC puts the price of treating obesity-related illnesses at nearly $150 billion each year, an amount equal to about 10 percent of all medical spending in the United States.
If these trends continue, researchers at the Johns Hopkins Bloomberg School of Public Health, the Agency for Healthcare Research and Quality, and the University of Pennsylvania School of Medicine predict that by the year 2030, nearly 90 percent of American adults will be overweight, at which point the cost of treating their obesity-related health problems will approach $1 trillion a year. No wonder the American Heart Association says we’re in the grip of an obesity epidemic. And that is only one of the topics I cover in this chapter. Add on how much your own body should weigh, the methods by which to judge your obesity or lack thereof (and how to evaluate the acuracy of the numbers), plus the conditions that make obesity more hazardous to your health, and you have a lot to put on your plate about weight.
The Obesity Epidemic
The word epidemic conjures up images of polio, plague, flu, measles — a host of contagious illnesses that pass more or less easily from one person to another. But does obesity qualify? Believe it or not, maybe.
In 2007, Harvard sociologist Nicholas Christakis and James Fowler, a political scientist at the University of California, San Diego, suggested in The New England Journal of Medicine that gaining weight may be a “socially contagious” event. In other words, people in groups tend to adopt similar behavior, and gaining or losing weight right along with friends and relatives may be one of those activities.
To reach this conclusion, Christakis and Fowler analyzed more than 30 years’ worth of information for more than 12,000 volunteers in the famed Framingham Heart Study, the project that has tracked the incidence and causes of heart disease in a Massachusetts city since 1948.
The Framingham people were weighed during checkups every two to four years. When Christakis and Fowler toted up the results, they discovered that the risk of becoming obese rose nearly 60 percent for someone with an obese friend, 40 percent for someone with an obese brother or sister, and 37 percent for someone whose husband or wife is obese. And these people didn’t even have to live close to each other for the risk to rise: The coincidence of obesity existed even when the subjects lived in different cities, which leads right to the next section, stats showing the cities and states where overweight Americans are most likely to be found.
Observing the Obesity Map
For several years, Men’s Health magazine has rated the top fattest and fittest (leanest) cities in the United States. To do these rankings, Men’s Health looks at
The percentage of the city’s population that is overweight
The percentage of people in the city who have been diagnosed with Type 2 diabetes
The percentage of residents who haven’t left the couch in a month (the figures comes from the CDC Behavioral Risk Factor Surveillance System, an ongoing telephone survey)
The amount of money these people spend on junk food as reported by the Bureau of Labor Statistics
The number of people who ate fast food nine or more times in a month
Then the editors crunch the numbers to come up with the list of the fattest and fittest cities. The 2015 version is in Table 4-1.
In 2014, the Robert Wood Johnson Foundation collected data from the CDC to produce The State of Obesity, a report detailing the incidence of obesity in each of the 50 states. You can see a quick summary of its findings in Table 4-2. You can also check out www.rwjf.org/en/library/research/2014/09/the-state-of-obesity.html for a neat multicolor map of the weight state of the States.
Alabama, Arkansas, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Missouri, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas
30–35%
Alaska, Arizona, Connecticut, Florida, Idaho, Illinois, Maine, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, South Dakota, Virginia, Washington, Wisconsin, Wyoming
25–30%
California, Colorado, Hawaii, Massachusetts, Montana, Rhode Island, Utah, Vermont
20–25%
Robert Wood Johnson Foundation, 2014
What do the fattest cities and states have in common? According to Michael Wimberly of the Geographic Information Science Center of Excellence at South Dakota State University, the people living there are
Less likely to engage in physical activity
Less likely to eat five servings of fruits and vegetables a day
More likely to eat the “wrong” foods
More likely to be living somewhere pretty far away from a really good supermarket
Wimberly calls this an obesogenic environment, a situation that encourages weight gain.
Determining How Much You Should Weigh
Over the years, many health organizations ranging from insurance companies to the U.S. federal government have created charts and tables purporting to establish healthy weight standards for adult Americans. Some of these efforts set the figures so low that you can hardly get there without severely restricting your diet — or being born again with a different body, preferably with light bones and no curves. Others are more reasonable.
Weight charts and tables
In 1959, the Metropolitan Life Insurance Company published the first set of standard weight charts. The weights were drawn from insurance statistics showing what the healthiest, longest-living people weighed — with clothes on and (for the women) wearing shoes with one-inch heels. The problem? At the time, the class of people with insurance was so small and so narrow that it was hard to say with certainty that their weight could predict healthy poundage for the rest of the population.
Thirty-one years later, the government published the weight chart shown in Table 4-3. This moderate, eminently usable set appeared in the 1990 edition of Dietary Guidelines for Americans (more about the Dietary Guidelines in Chapter 16). The weights in this table are listed in ranges for both men and women of specific heights. Height is measured without shoes, and weight is measured without clothes. Because most people gain some weight as they grow older, the people who compiled these recommendations did a really sensible thing: They divided the ranges into two broad categories, one for people age 19 to 34, the other for those age 35 and older.
From Nutrition and Your Health: Dietary Guidelines for Americans, 3rd ed. (Washington D.C.: U.S. Department of Agriculture, U.S. Department of Health and Human Services, 1990)
Muscle is heavier than fat, so individuals with a small frame and proportionately more fat tissue than muscle tissue are likely to weigh in at the low end. People with a large frame and proportionately more muscle than fat are likely to weigh in at the high end. As a general but by no means invariable rule, that means that women — who have smaller frames and less muscle — weigh less than men of the same height and age.
Later editions of the Dietary Guidelines omitted the higher weight allowances for older people so that the “healthy” weights for everyone, young or old, became the ones listed in 1990 in the column for 19- to 34-year-olds. I’m going to go out on a limb here to say that I prefer the 1990 recommendations because they are
Achievable without constant dieting
Realistic about how your body changes as you get older
Less likely to make you totally crazy about your weight
These are a pretty good description of how nutritional guidelines need to work, don’t you think?
The BMI: Another way to rate your weight
The body mass index (BMI) is a number that measures the relationship between your weight and your height. Currently in the United States, a BMI below 18.5 is considered underweight, 18.5 to 24.9 is normal, 25.0 to 29.9 is overweight, 30.0 to 39.9 is obese, and 40.00 or greater is severely obese. Previously, other countries were slightly more lenient in their estimate of normal and overweight; for example, in Australia, a BMI of less than 20 was considered underweight. Today, the American standards are generally accepted around the world.
The equation used to calculate your BMI is called the Quetelet Index, named after the 19th-century Belgian mathematician and astronomer who invented the concept of “the average man” (see the nearby sidebar “The man who invented the average man”). The equation is W/H2, which originally meant weight (in kilograms) divided by height (in meters, squared). The American equation, however, divides your weight in pounds by your height in inches, squared. So if you are five foot three inches tall and weigh 138 pounds, the U.S. equation looks like this:
Or you could just run your finger down the screen showing the National Institute of Health’s BMI chart for men and women from four feet ten inches to six feet four inches tall, weighing 91 to 443 pounds with “normal” being within a pound or two of the healthful weights proposed for younger people in the 1990 Dietary Guidelines for Americans. You can find the chart athttps://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_tbl.pdf.
Understanding What the Numbers Really Mean
Weight charts, tables, numbers, and stats are so plentiful that you may think they’re totally reliable in predicting who’s healthy and who’s not. They aren’t. Real people and their real differences keep sneaking into the equation.
For example, BMI is not a reliable guide for
Women who are pregnant or nursing
People who are very tall or very short
Professional athletes or weight trainers with very well-developed muscle tissue. Remember: Muscle weighs more than fat, so a person with lots of muscle tissue may have a higher BMI and still be really healthy.
In addition, the value of the BMI in predicting your risk of illness appears to be tied to your age. If you’re in your 30s, a lower BMI is clearly linked to better health. If you’re in your 70s or older, no convincing evidence points to your weight playing a significant role in determining how healthy you are or how much longer you’ll live. In between, from age 30 to age 74, the relationship between your BMI and your health is, well, in between — more important early on, less important later in life.
Increasing the odds of accuracy
To make the BMI a more accurate tool for predicting the health risks of carrying extra weight, the National Institutes of Health suggests adding a second measurement, the waist circumference — in other words, the apple/pear test.
An apple is a body with lots of fat around the middle: your waist. A pear has fat around the hips and thighs. Apples have a higher risk of diabetes, high blood pressure, and heart disease.
To identify your body type, wrap a measuring tape around your middle, just above your hip bones. Take a deep breath. Let it out. See what the tape says. That’s your waist.
Table 4-4 shows the relative risks of Type 2 diabetes, hypertension, and heart disease associated with different waist measurements.
Table 4-4 Estimated Risk Linked to BMI and Waist Size
BMI category
Risk at Waist size <40 Inches (Men), <35 Inches (Women)
Risk at Waist Size >40 Inches (Men), >35 Inches (Women)
No one factor, such as weight, gives a complete picture of how healty — or unhealthy — you are. Regardless of your BMI or any other measurement, the risk of health problems rises if you have more than one other common problem. Here is a sample list:
High blood pressure
High levels of LDL (“bad”) cholesterol
Low levels of HDL (“good”) cholesterol
High levels of triglycerides (a kind of fat found in blood)
A family history of premature heart disease, meaning one or more close relatives who suffered a heart attack before age 50 for a man or age 60 for a woman
Not being physically active or being a smoker
If the profile fits, check with your doctor about a sensible weight-loss plan.
Facing the Numbers When They Don’t Fit Your Body
Right about here, you probably feel the strong need for a really big chocolate bar — not such a bad idea now that nutritionists have discovered that dark chocolate is rich in disease-fighting antioxidants that benefit your various organs (as long as you stick to a 1-ounce, high cocoa content daily “dose”).
But it makes sense to consider the alternative — realistic rules that enable you to control your weight safely and effectively.
Not everybody starts out with the same set of genes — or fits into the same pair of jeans. Some people are naturally larger and heavier than others. If that’s you, and all your vital stats satisfy your doctor, don’t waste time trying to fit someone else’s idea of perfection. Relax and enjoy your own body.
If you’re overweight and your doctor agrees with your decision to diet, you don’t have to set world records to improve your health. Even a moderate drop in poundage can be highly beneficial. According to The New England Journal of Medicine (www.nejm.org), losing just 10 to 15 percent of your body weight can lower high blood sugar, high cholesterol, and high blood pressure, reducing your risks of diabetes, heart disease, and stroke.
The number you really need to remember is 3,500, the number of calories it takes to gain or lose one pound of body fat. In other words, 3,500 food calories equal one pound of body weight. So if you simply
Cut your calorie consumption from 2,000 calories a day to 1,700 and continue to do the same amount of physical work, you’ll lose one pound of fat in approximately just 12 days (approximately because different bodies burn calories/energy at different rates).
Go the other way and increase calories from 1,700 to 2,000 a day without increasing the amount of work you do, approximately 12 days later, you’ll be one pound heavier.
Moderation is the best path to weight control. Moderate calorie deprivation on a sensible diet produces healthful, moderate weight loss; this diet includes a wide variety of different foods containing sufficient amounts of essential nutrients. Abusing this rule and cutting calories to the bone can turn you literally into skin and bones, depriving you of the nutrients you need to live a normal healthy life. For more on the potentially devastating effects of starvation, voluntary and otherwise, check out Chapter 14.
Be more active. Exercise allows you to take in more calories and still lose weight. In addition, exercise reduces the risk of many health problems, such as heart disease. Sounds like a recipe for success.
Although many Americans should work at losing weight, the fact is that many larger people, even people who are clearly obese, do live long, happy, and healthy lives.
To figure out why some overweight people’s health status doesn’t follow the “rules,” many nutrition scientists now focus on the importance of confounding variables — science speak for “something else is going on here.”
Here are three potential confounding variables in the obesity/health equation:
Maybe people who are overweight are more prone to illness because they exercise less, in which case stepping up the workouts may reduce the perceived risk of being overweight.
People who are overweight may be more likely to be sick because they eat lots of foods containing high-calorie ingredients, such as saturated fat, that can trigger adverse health effects; in this case, the remedy may simply be a change in diet.
Maybe people who are overweight have a genetic predisposition to a serious disease. If that’s true, you’d have to ask whether losing 20 pounds really reduces their risk of disease to the level of a person who is naturally 20 pounds lighter. Perhaps not: In a few studies, people who successfully lost weight actually had a higher rate of death.
But it makes sense to consider the alternative — realistic rules that enable you to control your weight safely and effectively.