The Skinny on the Weight and Mortality Report
By Bob Woods
On January 1, 2013, Americans who awoke resolute to lose weight during the new year were greeted with some potentially confusing news. "Being Overweight Associated With Lower Risk of Death," read part of a headline in that day's Journal of the American Medical Association. JAMA was citing an analysis, by researchers at the Centers for Disease Control and Prevention, of almost 100 studies that included nearly three million adults. It concluded that while those with severe obesity had a higher risk of death, those who were overweight or grade 1 obese — by body mass index (BMI) standards — had, respectively, a 6% and 5% lower risk of mortality.
While the average American missed the JAMA article, popular media jumped all over it — and to potentially misguided and unintended conclusions:
- "Researchers say that being overweight may lead to a longer life." — Time
- "A Few Extra Pounds Won't Kill You—Really" — Wall Street Journal
- "A Little Extra Fat May Help You Live Longer" — NPR
- "Excess Weight Is Healthy…" — Gaia Health
- "…Encouraging news for food lovers everywhere" — The Idealist
On the surface, such sensational sound bites — suggesting without much context that being overweight is okay — fly in the face of conventional medical wisdom, which often associates excess weight as a harbinger of a host of chronic ailments, type 2 diabetes especially prevalent among them. A closer and fuller reading of the JAMA article reveals that the CDC research studied mortality, not morbidity, relative to weight, which is a crucial distinction that many media overlooked.
"Nowhere in the report is morbidity mentioned," says Ruth Lipman, PhD, chief science and practice officer for the American Association of Diabetes Educators. "There's a difference between quantity of life and quality of life. That's the distinction between mortality and morbidity. When you look at individuals who have diabetes, being overweight and obese increases the problems that they're going to encounter. So this look at mortality was not with respect to people with diabetes."
John E. Anderson, MD, president of medicine and science for the American Diabetes Association, likewise views the media firestorm as unnecessary when viewing the study through a more objective lens. "There is no question that the data on overweight and obesity leading to diabetes is incontrovertible," he says, pointing to numerous, long-term observational and clinical trials. "It is clear that overweight individuals with diabetes have higher morbidity and mortality than weight-matched, non-diabetic individuals."
Dr. Anderson also mentions the preponderance of scientific evidence regarding people with prediabetes and their weight. "Losing weight helps to prevent or delay the onset of diabetes," he states.
Beyond this incident, other reports and recommendations regarding obesity have sparked heated debates. Indeed, on January 2, the New York Times published an op-ed article entitled "Our Absurd Fear of Fat." The author, Paul Campos, referencing the JAMA report, stated that government figures claiming that nearly seven out of 10 American adults weigh too much "illustrates just how exaggerated and unscientific that claim is." Campos, who wrote The Obesity Myth: Why America's Obsession With Weight Is Hazardous to Your Health, went on to criticize the weight-loss industry and pharmaceutical companies, "which have invested a great deal of money in winning the good will of those who will determine the regulatory fate of the next generation of diet drugs."
In response to that op-ed and the JAMA report, The Obesity Society issued a statement on January 10. "It is likely that many members of the media and the public may incorrectly reason that cardiovascular disease and diabetes must…not be increasing along with obesity," it read in part, alluding to those two major causes of death in the U.S. "In addition, there is a long list of obesity-related morbidities, which include hypertension, fatty liver disease, sleep apnea, joint disease, depression, and stress, to name just a few."
It's Not All About the BMI
Even before this kerfuffle, Osama Hamdy, MD, PhD, medical director of the Joslin Diabetes Center's Obesity Clinical Program and an instructor at Harvard Medical School, has warned against relying solely on BMI to measure obesity. "There is a difference between obesity and metabolic obesity," he says, defining the latter as excess weight that affects the body's metabolism and can lead to diabetes, atherosclerosis and other medical problems.
"This kind of obesity is only in the central part of the body," Dr. Hamdy adds, explaining the difference in types of body fat and where it accumulates. Visceral fat in the abdominal area, he contends, creates much higher risk for diabetes and other morbidities than subcutaneous fat that accumulates in the extremities. "Measure BMI," he suggests, "but also measure the waistline." Although genetics and ethnicity are factors, generally a waistline greater than 40 inches in men, and 35 inches in women, is cause for concern.
So what's the takeaway from all this, especially for people with diabetes? Diabetes educators are still "going to talk about healthy eating and being active as critical components to managing their disease," Lipman says. Adds Dr. Hamdy: "Forget about your BMI. Look to your waist."
In other words, being overweight may not kill you, and being runway-model thin shouldn't be the end-all. But beware of the hype, and rely more on solid science and your care provider's informed advice.
Bob Woods is a freelance writer based in Madison, Connecticut.
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