Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
27 Aug

300 Pound Triathletes? Obesity Gets an Overhaul.

The latest battle in the fat wars: obese triathletes. A burgeoning movement these days, casually known as “fat but fit”, promotes the acceptance of obesity in sport. Just as we’ve known for years that overweight individuals can have low LDL cholesterol and blood pressure, the thinking goes that obese folks can be fit and healthy despite being, well, enormous. I’m going to restrain myself on the triathlon commentary (for now) but I do want to discuss the general issue here.

The movement lends itself to a larger debate over the alleged risks of obesity. For decades it was simply accepted wisdom that obesity meant increased risk for illness and disease across the board. CHD (coronary heart disease), type 2 diabetes, arthritis, depression, cancer, you name it, and obesity was likely to increase the chance you’d get it. And the wisdom was well vetted by literally thousands of peer-reviewed studies. The only thing obesity didn’t do was raise a person’s osteoporosis risk (carry around a lot of weight, and your bones are going to respond out of necessity).

Enter the counter arguments and the acceptance police. No one ever questioned the fact that obesity – even being slightly overweight – is flat-out bad for your health. Until Katherine Flegal, that is. Flegal is a CDC researcher who found that the statistics were actually bearing out an unlikely conclusion: being a little bit fat is better than being lean. Journalists and authors quickly published a slew of writing questioning the reigning fat hypothesis. Conspiracy theories followed in short order (of course doctors and drug makers would fuel the obesity-is-risky hype: there’s money to be made). Americans alone spend $33 billion a year on weight loss, and the number continues to increase (one reliable estimate that includes healthcare-related costs is triple that number). Obesity, so the debunkers claim, is pure myth manufacturing. Two-thirds of Americans aren’t obese; it doesn’t kill 400,000+ people a year; it doesn’t shorten your lifespan. And on and on.

There’s a great deal of romance here: just enjoy life and savor food, and the problem will take care of itself. We worry too much about calories. Americans are extremists – we hate carbs, then we hate fat, then we hate carbs again. Look at those French, enjoying their cheese and wine and croissants and managing to be trim – we could learn a thing or two. You could even make a rather persuasive “primal health” argument that obesity would be smarter in an evolutionary sense, since your body would have readily available fat stores with which to survive shortages or famine. Romantic and catching ideas, to be sure, but that’s the problem: no scientific studies bear any of this stuff out. Beyond that, the counter-evidence is lousy. For example, some of the lean folks in Flegal’s study were smokers and/or chronically ill. And in fact, a leading researcher points out that the “overweight people are healthier” case has been recycled several times in recent decades.

Good headlines, wobbly science (and the French are dealing with an obesity problem, too). The facts remain: both obesity and being moderately overweight are unhealthy.

That said, how do we define obesity? I think that’s a major issue we’ve got to address. Admittedly, the BMI is a near-useless metric. It can’t account for bone density, lean muscle mass, individual physique, or adiposity (fat). You can be rail-thin but in terrible shape, and get a clean bill of health if you go by the BMI. Likewise, you can have a bigger build, but be maintaining a very low body fat percentage, and you’re gonna get classified as obese.

Obesity is a problem, but so is the way we define it.

Further reading:

The Busy Person’s Guide to Losing Weight

Top 10 Health Scams

Why the Atkins Diet Works

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Hey, at least we’re well rounded!

    Ok, silly puns aside. I have a question. Are BMI scales standardized globally or from nation to nation. Would my BMI change in, say, China?

    Moe wrote on August 27th, 2007
  2. Moe, you bring up a good point. Even if the BMI is the same across countries, the methods of gathering data can vary widely (i.e. unreliable statistic) or is it one group of scientists accurately measuring the entire world?

    McFly wrote on August 27th, 2007
  3. It’s not globally standardized. Remember we use different measurements, too (kilos vs. pounds, cm vs. inches, etc.).

    Sara wrote on August 27th, 2007
  4. I don’t think we need to define obesity. I think we need to promote healthy diets and exercise. On Yahoo News, I read a story about a community in Germany that is providing cooking classes to low-income families to teach them how to cook nutritious meals with whole foods on a budget. That is what we need desperately in this country. People don’t know how to cook simple yet healthy meals and mistakenly believe that healthy food is unaffordable.

    Last year I checked out from the local library “The Obesity Myth” by Paul something. The book had two themes: 1) fat people are demonized (no argument there); and 2) fatness is not the health problem it’s made out to be. The irony is that the author himself lost 50 pounds, which begged the question: if it’s okay to be fat, why lose the weight? It was through this book that I became aware of how the food and beverage industry are funding websites and organizations like “The Center for Consumer Freedom” to counter individuals, organizations, and government agencies that target unhealthy foods, rising obesity, and its consequences. Marion Nestle’s book “What to Eat” got two negative reviews spouting similar arguments about food nannies and personal responsibility before it even became available on Amazon.

    FYI, that graphic is for OECD countries only. Globally we are the world’s third fattest nation behind Saudi Arabia and Panama.

    One of the reasons I quit reading beauty mags like Glamour is that they would send conflicting messages of skinny models in fashion spreads and stories promoting “big is beautiful.” Rarely do women’s magazines feature healthy body images.

    Sonagi wrote on August 27th, 2007
  5. At the risk of sounding like a broken record — down with the BMI.

    I know I’m healthy, and I feel better having stopped worrying about having a beer or some wine, or horror of horrors an occasional cigar. I look at my grandparents, they always took care of themselves, but every afternoon like clock work was coffee and pastries, but they were happy, healthy and not overweight. They lived to be 98 and 100, if I can be so lucky…

    Brian wrote on August 27th, 2007
  6. Good points Sonagi.

    The first thing that came to my mind was if you can’t beat em, join em. People are throwing up their hands. Well, some people…

    BTW, it’s not just our athletes, our military is growing(wide).

    Crystal wrote on August 27th, 2007
  7. Brian, I don’t know what my BMI is and I don’t care. I own a mirror…

    Crystal wrote on August 27th, 2007
  8. Okay, forgive my ignorance here, but what’s the problem with using bodyfat percentages as a measurement? It’s a lot more revealing than the stupid BMI scale. Granted, it’s tough to determine how much of that is visceral fat and how much is subcutaneous, but don’t those two usually increase proportionately anyway?

    Caloi Rider wrote on August 27th, 2007
  9. Obese people have indeed become more accepted in sports recently. LaDainian Tomlinson, for example, won the Male Athlete of the Year award at the ESPY’s in 2006 — and his BMI of 32 makes him obese.

    maurile wrote on August 28th, 2007
  10. The BMI is counted the same way regardless of country: weight in kilograms divided by the squared length in meters: I weigh 68 kg and am 1.76 m tall. That gives me a BMI of 68 / (1.76*1.76) = 22. Since I eat fruits and vegetables and take the bike to work, I believe I am on the safe side.

    BMI maybe isn’t an excellent tool, but it is ok. It is (probably) better to be a bit overweight, but eating greens and working out, than being a normal weighted couch potato. But it must be beyond doubt that a BMI over 30 is unhealthy. It is not possible to have a healthy lifestyle and weigh that much! (Unless you have a disease, but I mean “normal” people, if such a thing exists.)

    Pelikan wrote on August 28th, 2007
  11. Pelikan, many of the healthiest, most athletic people in the world are overweight or obese according to BMI. I mentioned LaDainian Tomlinson in my previous comment: he has a bodyfat percentage of 6%, but is obese according to BMI. Take a look at him in this picture and see if you think that it is “not possible to have a healthy lifestyle and weight that much.” Tomlinson is the one in the middle:

    Shawne Merriman, with 11% bodyfat, has a BMI of 33. Does he look obese to you?

    The fact is that any males with even moderate amounts of healthy muscle will be overweight according to BMI. (Even Michael Vick has a BMI of 30. Does he look overweight to you?)

    maurile wrote on August 28th, 2007
  12. The images I tried to post above didn’t work. Here are the links:

    LaDainian Tomlinson
    Shawne Merriman

    maurile wrote on August 28th, 2007
  13. Great points, Sonagi. Thanks for taking the time to write that. Do you have a link by any chance to the other graphic? We should switch it out/add it to the post. Or at least include the link.

    Morning everyone! ;)

    Sara wrote on August 28th, 2007
  14. BTW…my great grandfather lived to be 104, though he claimed he was 108. Everyone was too scared of him to disagree ;) He was definitely a greasy breakfast and coffee kinda man. I think a lot of longevity has to do with your constitution as well as the lifestyle choices you make.

    Sara wrote on August 28th, 2007
  15. Maurile – your comment gets to the center of the problem with the BMI. Body fat is a much more relevant and critical health measurement.

    Mark wrote on August 28th, 2007
  16. …but the big problem with body fat measurement is that it is very difficult to get an accurate and standardized reading. The two best methods are hydrostatic weighing and dual x-ray absorptiometry (DXA) and both are expensive and time-consuming. Those Tanita scales are way off many times. One of the cheapest and reasonably accurate tests is the one done with calipers by your health club trainer. When all is said and done, you know by pinching yourself whether or not your need to take action

    Mark wrote on August 28th, 2007
  17. It used to be difficult to get an accurate body fat percentage. But these calipers available for $20 are generally within 1.1% of the results from under water body weighing, and can be used to self-administer a body fat test very quickly and easily.

    maurile wrote on August 28th, 2007
  18. It used to be difficult to obtain an accurate reading of body fat percentage. But these calipers are cheap and easy to use (with no partner needed), and give results generally within 1.1% of those from an underwater body weighing.

    maurile wrote on August 28th, 2007
  19. never base your health by the bmi…
    so inaccurate and taking so little into account when calculating your “health”.
    my philosophy for staying healthy?
    simple: exercise regularly, eat fruits and veggies, stay away from fatty fried foods and desserts!

    Jennifer Lin wrote on August 28th, 2007
  20. Here’s the link, Sara, courtesy of the Global Taskforce on Obesity:

    http://www.iotf.org/database/GlobalAdultTableJune07.htm

    RE: the BMI debate – the problem is that the examples of people who don’t fit the BMI – fit folks here and athletes – are NOT the norm for the population in general. Honestly, how many of those 30% obese do you suppose are muscled athletes? Look around you. In my community, I see a lot more pudgy people than ripped bodies.

    The only way to measure fat accurately and quickly is through calipers, right? Compiling more accurate national and international statistics on obesity would require a lot of belly-pinching. I understand the arguments against BMI; I just don’t see a pragmatic alternative means of assessing for compiling statistics. People who are athletic know they’re athletic, so they’re not going to sweat a high BMI.

    Maybe what we need is a national promotion of fitness standards to help people assess their physical conditioning.

    “BTW…my great grandfather lived to be 104, though he claimed he was 108. Everyone was too scared of him to disagree He was definitely a greasy breakfast and coffee kinda man. I think a lot of longevity has to do with your constitution as well as the lifestyle choices you make.”

    Everybody knows an old codger who smoked, drank, and ate bacon every morning yet still lived to a ripe old age. However, most of the old codger’s relatives and friends dropped dead long before. Diabetes pioneer Elliott Joslin gave us this oft recited quote about the interplay between genes and lifestyle:

    “Genes load the gun. Lifestyle pulls the trigger.”

    Our genes are not our destiny. Even if we have a genetic disposition to disease, it is our environment and lifestyle choices that will determine if and how those genes are expressed. The 25-year Okinawa Centenarian study claims that 2/3 of the longevity of the participants can be accounted for by lifestyle factors and only 1/3 genes. (http://www.okicent.org/news/boston_globe.php)

    Sonagi wrote on August 28th, 2007
  21. Sonagi: “Everybody knows an old codger who smoked, drank, and ate bacon every morning yet still lived to a ripe old age. However, most of the old codger’s relatives and friends dropped dead long before.”

    Absolutely. I wouldn’t recommend anyone following a certain lifestyle just because someone else had success with it (even in my own case of switching to a higher fat diet). You have to research and find what’s best for your body.

    I like your point about genes and destiny. I just saw a piece about how children’s distaste for vegetables is genetic. Oh, brother…

    Sara wrote on August 29th, 2007
  22. Sonagi—legitimate point about national statistics. So for national statistics’ sake, we’ll keep the BMI. But anyone who can afford a bodyfat analysis should probably take the time to get one.

    Here’s something else to take into account (link at the bottom, if you want to check it out):

    “Even people with normal Body Mass Index scores — a standard obesity measure that divides your weight by the square of your height — can have surprising levels of fat deposits inside.

    “Of the women scanned by Bell and his colleagues, as many as 45 percent of those with normal BMI scores (20 to 25) actually had excessive levels of internal fat. Among men, the percentage was nearly 60 percent.

    “Relating the news to what Bell calls “TOFIs” — people who are “thin outside, fat inside” — is rarely uneventful. “The thinner people are, the bigger the surprise,” he said, adding the researchers even found TOFIs among people who are professional models.”

    http://www.msnbc.msn.com/id/18594089/

    Caloi Rider wrote on August 30th, 2007

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