An article entitled “Good to Be Fat” (2007) is a reactive response to the study conducted by Flegal et al. (2005) and the resulting statements from US media sources that being overweight was good for you. This reaction article is in agreement with the Flegal et al. (2005) study and points out few flaws, while expelling the ‘good for you’ myth the media portrays. The reaction article mentions that while the media sources reporting on the Flegal et al. (2005) study did accurately include the study’s results, the information given led to the misleading impression that being overweight was a positive thing (“Good to be fat,” 2007). It also recommends that nutritional habits and physical activity are not altered as a result of the media circulation. The facts are that individuals who are clinically obese or overweight do face serious health concerns. Both states can and do lead to many serious, and life-altering health conditions such as kidney problems and heart disease, as well as social issues. However, the approach to prevention of obesity and being overweight by reducing it to focusing on the weight as the problem is distracting from the real issues at hand.
Overweight and obese people face unwarranted stereotypes that are often detrimental to their psychological state and generally portray a warped view of health. They are commonly labelled as being lazy, having little self-control and having stubborn or wilful personality traits and further, they grouped together as if they are all the same. The effect of stereotypes and the focus on the states of overweight and obesity instead of the causes of them creates negativity around the issue on all sides. This leads overweight and obese individuals to distinguish weight as the cause of their problem and to consequently desire the opposite: loss of weight in any form rather than a healthy lifestyle change which is overlooked.
In order to help those who are obese make changes to their health; lifestyle and nutritional changes must be applied. Gronniger (2006) states there is sufficient evidence to support the positive results of diet and exercise but not enough evidence to say the same for weight loss. In agreement with this, it is clear that a move must be made away from the popularised use of BMI in order to achieve change in the so-called obesity epidemic; as it distracts from the issues surrounding why a person is unhealthy, overweight or obese and merely focuses on the problem i.e. the BMI number. Better estimates of mortality risks in older adults are required in order to arrive at an accurate estimate of the deaths attributable to obesity (Flegal, Williamson, Pamuk & Rosenburg, 2004). And deeper, more complex investigation must be conducted, assessing issues surrounding food such as psychological, physical, environmental and emotional influences. Simply classifying the issue as obesity or being overweight through the use of BMI is not providing the weight-carrying person with the means to remedy their health, nor is it supplying them with accurate or beneficial psychological influences based on what the range states they should weigh to be healthy. It is simply creating confusion and stalling the progression to lower obesity rates.
To its credit, BMI does provide a useful indication of whether a person is in a healthy range based on their body weight. But unless grouped with other assessments, that is all it should remain: an indication. Limitations should be carefully considered when use of BMI is required, especially when concentrating on issues of obesity:
- Children and adolescents experience an increase in body weight greatly during their life stages. Consequently, low BMI values can often be produced or in the case of babies, higher BMI values due to body fat percentage being higher. A special range designed for these life stages should be used when measuring their BMI.
- Elderly people experience a loss in bone mass coupled with a loss in lean body mass. Ranges in the BMI become distorted in comparison to their actual weight and health.
- Ethnicity also has an effect on whether BMI values correlate with actual body fat as different populations have varying degrees of body fat distribution and bone density.
- Athletes should not use a BMI in any other manner than a basic guideline. As muscle weighs more than fat and most athletes have a higher muscle mass and lower body fat percentage than ‘normal weight range’ individuals, a false indication of healthy weight will be observed.
- If a person falls in a healthy weight range, it does not necessarily follow that they are indeed healthy. Dependant on the distribution of body fat, the frequency and type of physical activity and their dietary factors, a seemingly ‘healthy’ person under the BMI could actually be leading an unhealthy lifestyle. Conversely, the same lifestyle factors apply to those who fall above the ‘healthy’ range.
With such limitations, the use of BMI leaves much room for error. In order to reduce this error other means of measurement should be included when conducting research and even when simply performing a personal health assessment. Conducting a waist-to-hip ratio, as well as total body water, skin-fold measures and DEXA (measure of bone density) give a higher accuracy of results in relation to fat distribution when grouped with BMI. Body fat percentage especially, and its distribution around body areas and body shape is an essential factor in determining a person’s mortality, level of obesity or when calculating the risks of health complications caused by being overweight and unhealthy. Central obesity – that is, fat distributed mainly around the abdominal region – is directly associated with an increased risk of health problems like heart disease, gallstones, stroke, diabetes and some cancers, independent of a person’s BMI or total body fat values. (Whitney and Rolfes, 2008) Having a BMI of 29 (classed as overweight) does not mean that the implied excess body fat is situated around the same area of the body in every individual whom BMI assigns this number to. Some could carry the extra fat around the thighs and buttocks – females, for example, tend to carry fat this area – and have a healthy lifestyle; while others, could solely carry the fat within the circumference of their waist or abdominal region, as is more common amongst males.
Other factors that increase health risks and mortality must also be considered before including everyone in the same category. Cholesterol ranges, smoker status, physical activity, alcohol consumption and hereditary disease risks must also be considered in conjunction with sympathy to the limitations aforementioned, in order for accurate and valid statements of a person’s health to be made.
In addition to the practical measurements, other factors must be addressed in order to aptly approach the issues surrounding obesity and being overweight. Environmental aspects, such as locality to supermarkets and fresh food vendors and ability to conduct exercise locally have an effect on whether a person eats healthily and is active. Social dynamics have more of an influence on eating habits than most would like to think, eating out is often coupled with overeating, peer influence can cause changes in usual dietary habits and alcohol can have a more prominent place, all leading to increased energy intakes and possibly weight gain. Psychological influences are one of the most detrimental in the road to gaining healthy eating habits; stress causes some people to consume more food that is higher in energy density while others severely decrease their energy intakes for the same reasons. Similarly, rewarding with food is common in an unhealthy diet. A person’s upbringing and the influences and habits learned from their parents have effects on how, when, where and why they eat; this can mean the difference between gaining weight due to unhealthy eating habits and maintaining a healthy weight due to good dietary habits.
Gronniger (2006, p. 177) suggests that “individuals who are overweight and mildly obese face no or very little increased mortality risk relative to normal weight individuals”. So rather than focusing on obesity and being overweight and using the BMI as a be-all-end-all, steps should be taken to draw the focus away from popularising these issues and towards providing practical solutions to those that wish to change their health status. It is clear that many limitations of the body mass index scale exist, so caution should be used when applying the scale, data should be cross-checked with other measures of body fat assessment and education around the appropriate circumstantial use of a BMI scale would be beneficial, especially when creating health guidelines. Consideration should be paid to those who suffer from health issues due to being overweight or obese; there is not one sole reason causing their problem but many reasons. Each issue should be addressed according to individual needs, and then perhaps a change in obesity and overweight statistics will be seen.
References
Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H. (2005). Excess Deaths Associated With Underweight, Overweight, and Obesity. Journal of American Medical Association , 1861-1867.
Flegal, K. M., Williamson, D. F., Pamuk, E. R., & Rosenburg, H. M. (2004). Estimating Deaths Attributable to Obesity in the United States. American Journal of Public Health , 1486-1489.
Good to be fat. (2007, November 8). Retrieved April 12, 2010, from National Health Service (NHS): http://www.nhs.uk/news/2007/November/Pages/Goodtobefat.aspx
Gronniger, J. T. (2006). A Semiparametric Analysis of the Relationship of Body Mass Index to Mortality. American Journal of Public Health , 173-178.
Whitney, E., & Rolfes, S. R. (2008). Understanding Nutrition 11th Edition. Belmont: Thomson Wadsworth.