Americans Carry a Lot of Weight, but Can They Stay Healthy with Extra Pounds? Fat Chance, Say the Experts
The experts took a day and a half to present their evidence, and they didn't always agree. When the 14-member panel of doctors and researchers convened by the National Institutes of Health emerged from all night deliberations, it issued a warning for 34 million pudgy Americans: Being just 20 percent over your ideal weight can seriously jeopardize your health. Some people, moreover, because of other physical problems, are at risk even before they reach that point. Dr. Jules Hirsch, 57, an obesity researcher at New York's Rockefeller University and chairman of the panel, talked with Assistant Editor Brenda Eady about the dangers of obesity and who should worry.
When is a person obese?
It's like tallness or beauty—there's no one point at which it occurs. What we're telling people is that obesity is any excess fat, and the danger increases on a sliding scale. We don't want to set an absolute point. Some people ought to lose weight at an earlier level of fatness than others. Everybody agrees that 40 percent over the desired weight is extremely hazardous obesity. We picked the 20 percent figure very arbitrarily, and it took a lot of discussion to reach a consensus. But some figure had to be picked at which too much fat becomes a health hazard.
What are the health hazards?
Here are some that people often don't think of. For example, osteoarthritis. At the 20 percent overweight level, you start putting enough weight on certain joints—the knees and lower back, for example—to make them go to pieces long before they ordinarily would. Gallstones and gout are also more prevalent in the obese. And according to data from the American Cancer Society, so is cancer. For example, postmenopausal women of extreme weight can have as much as a five times greater likelihood of having cancer of the womb than those who are not obese. Cancer of the breast is more common in obese women. In obese men, cancer of the colon and prostate are more frequent than in men who aren't obese. Now mind you, in these cases I'm talking about risks that aren't that much greater. We're talking about an increase of one-and-a-half to two times greater than it would be for the non-obese. But when there are about 34 million people at risk, that's a big number.
Your report also warns that people who are five to 10 pounds overweight are at risk. Isn't this going overboard?
With some groups, no. Take people who suffer what we call maturity onset diabetes. For these people, losing weight may eliminate the need to take insulin or other medication. People with hypertension, too, ought to consider losing weight. They might find they won't need to take drugs.
How can a person measure obesity?
There are ways of doing this in the laboratory, like weighing a person under water. But for the average person we recommend the height and weight charts that the Metropolitan Life Insurance Co. published in 1983.
Isn't that chart controversial forgiving higher weights than had previously been regarded desirable?
We picked this chart because it measures longevity. It answers the question: What is the weight at which people live longest? They called that answer the ideal weight. These tables might not be exactly representative, but they're the most recent thing we have.
How would you improve the table?
I'd like to see such a table revised to include allowances for age. For the older group of people, maybe a little more weight is acceptable, although there's a lot of disagreement about this point, too. The other way I'd like to correct the table is for body type. Some people tend to be fatter in certain parts of their bodies than in others—what we call regional fat. People who have their excess fat in the abdominal area—the paunch or the beer belly—run a higher risk of diseases than people with equal fat in other areas of their anatomy. These sites of fat accumulation are easily measured by the ratio of waist to hip circumference. If the waist is as big or bigger than the hips, the risk increases.
Why is that?
We don't really understand why this is, but these people are at greater risk for heart disease, stroke, diabetes and high blood pressure. It has to do with abdominal fat being more metabolically active. Several studies have documented the dangers of having excess abdominal fat. A lot of guys are going around with a beer belly and think it's okay, sort of macho. They could be in more trouble than people with fat hips and thighs.
Why is it that some of the studies presented were not as conclusive as others about all these risks?
Not all studies are as extensive as the one I consider best, which was done in Framingham, Mass. on 2,251 men over a period of 30 years. That analysis showed that any amount of overweight increases risk factors for heart disease. If you're on the chubby side, you're better off losing the weight if you can.
What is your own approach to avoiding extra pounds?
I'm almost 5'10" and I weigh just under 180 pounds. I'm overweight and I constantly fret about it. I play squash and I jog. I'm not a naturally thin person and I'd much rather eat a bagel dripping with butter for breakfast, but I know I can't do it. As a result of this panel meeting, I'm more convinced than ever that I ought to try even harder to lose weight. I'll make you a bet. If you come around a year from now, I'll be a few pounds lighter than I am now.
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