Obese Americans now outweigh the merely overweight

The one major flaw with BMI is that it does not factor in muscularity, and muscle is approximately twice as heavy as fat (think density). I am 5'11" @ 225 lbs. According to BMI I am morbidly obese. My wieght is supposed to be 187 lbs. I am not obese nor do I take any performance enhancing drugs (In today's sports climate that had to be mentioned..LOL). I am athletic and take care of my body, plus I enjoy competing in the Highland Games.
My point is that the BMI is a flawed approach. It does not take many contributing factors into consideration, it provides no clue to body composition. If you search the net you will see pictures of triathletes considered obese.

There is an old saying : "Liars figure and figures lie."

Sorry if I was ranting, however I have known several people who were is excellent condition and got hung up on the BMI index and really messed themselves up. They are not alone unfotunately in a society that is fixated on mere numbers.

I'll address the 'gaining' weight question, because the 'declining' and 'civilization slowly destroying itself' are a bit more multifactorial.

Technology has allowed us to be sedentary, and it has given us access to a huge abundance of calories. This is a phenomenon of the last few generations. A few generations ago there was no such thing even as a school bus, let alone Playstations.

Quite simply our bodies are physiologically adapted to the conditions in which we evolved, which were much different than those we have now.

Yes, we recognize physiologic patterns based on constellations of symptoms.

Have you ever bothered to ask why they've chosen what they've prescribed?

Chest pain can be caused by an aortic dissection, a pulmonary embolism, a pneumothorax, asthma, pericarditis, gastroesophageal reflux, a heart attack, anxiety, getting hit in the chest with a baseball, or about 1000 other things.

You go to the doctor and complain of chest pain. You don't get a pill for "chest pain" as a result. The doctor will ask you a million other questions to try and characterize your symptoms, including duration, nature, alleviating and aggravating factors, and the doctor will ask you questions about your past medical history, family history, social history, exposures, and medications. Then, the doctor will do a physical examination. Then the doctor may order some diagnostic tests. Then the doctor will treat and/or observe based on how he understands the process that is most likely causing your chest pain. If I think someone is having an asthma attack, I'm going to give them beta-2 agonist bronchodilators and antiinflammatory corticosteroids, because these both directly truncate the disease process itself. If I think someone is having a pulmonary venous thromboembolism, they get anticoagulated. And sure, I'll treat their pain with pain medication if they need it.

These therapies are evidence based -- compared with no therapy, people have improved survival and productivity as a result. Giving them a pep talk about deep seated fears isn't going to make the pulmonary embolism go away -- but anticoagulation WILL.

You are misusing the word "symptom". In medical terminology a symptom is something a patient complains of or subjectively experiences. Cancer therapy is directed at killing malignant cells. Period. People undergo potentially carcinogenic exposures and mutations all the time, only a minority of which result in a malignancy. So your "much greater and unknown cause" has a name: life.

WHAT is spreading so quickly? Obesity is -- but bubonic plague isn't; smallpox isn't; louse-borne typhus isn't; polio isn't.

Where on earth are you getting this stuff, Justin? Fear and lack? You keep using these words. Tell me exactly how your point A leads to point B. I'm supposed to just take that for granted?

We find "new diseases" because we have diagnostic technology that didn't exist until very recently. You think that we've had electron microscopes, polymerase chain reaction, and immunocytochemistry since the time of Galen? PCR, which is now invoked in every crime show on television, wasn't even invented until the mid 1980s.

Our state of public health, our longevity, our child mortality, our infant mortality, our nutrition, our hygiene, and nearly every possible measure of wellness has dramatically improved in the last century, and this is incontrovertable -- and it's true even in impoverished countries. Some diseases have been replaced by others, and others have emerged (just as they always have). Our living conditions, our risks, and our population dynamics have changed our susceptibility -- but to say that our state of health is declining is just ignorant. A century ago the average American life expectancy was around 50 years, 10% of all children died by the age of 1, and as many as 25% died by the age of 5. You want to go back to that?

You've completely lost me. But you and I have a fairly fundamental disagreement about Walter Russell and his work, so we should probably just agree to disagree.

Hi there,

Yes, I was never comfortable with BMI and pretty much ignore it. However, lately, a better indicator has been proposed, that is, the waistline (gut) to hip ration. This makes sense to me.

Rich

This is true. And it also doesn't factor in plasma volume, which in women varies with different parts of the menstrual cycle.

There are other ways of measuring body composition. I used to do research on protein-energy malnutrition in Africa, and we would use measures like skinfold thickness to estimate fat content and upper arm circumference to estimate muscle mass.

But to be fair, BMI is a better and more predictive measure than weight alone in terms of risk stratifying people. MOST people with elevated BMIs are not so because of muscle.

And no one should be using BMI without looking at the patient, of course. You don't need a BMI calculator to know that Arnold Schwarzenegger isn't obese.

---------- Post added 08-16-2009 at 09:14 PM ----------

I don't follow this literature all that closely, but as I understand it this measure has more predictive value for dyslipidemias and diabetes risk (i.e. central obesity is much more risky than peripheral obesity).

That said, a ratio cannot give an absolute number, so there still needs to be some quantitative measure of just how obese someone is.

Weight isn't a great measure unless you normalize it for height. Traditionally people used "weight-for-height" curves, especially when studying protein-energy malnutrition in developing countries. BMI has begun to replace it as a more predictive measure and one that's easier for population-based norms. People also used to use body surface area (weight / height^2), but this is now almost exclusively used for drug dosing.

(there are other conditions, like ascites, that will give people large guts without fat, but you'd know this just by looking at someone)

Overeating and lack of exercise are both behavioral problems and therefore have a "mental" component. I am not sure what it means to say that they are a "state of mind".

Much human behavior occurs below the level of consciousness and eating excess calories in the presence of plenty in order to store energy for times of scarcity is probably hard wired somewhere in the survival system of humans. Also there is a calories in are either used or stored so there is some hard data component as well..

In any event the only successful weight loss regimens involve changes in behavior (fewer calories, more exercise) and there are not very many successful long term weight loss approaches (advertising not withstanding).

You can not really just think your way to weight loss (change your mental state)you have got to consume fewer calories (eating) and burn more calories (exercise).

There are also differences between individuals in their BMR (basal metabolic rates) the number of calories needed just to sustain life without exercise. These differences are generally not large enough to separate obese from non obese individuals. I am afraid it is primarily calories consumed versus calories used (primarily simple math). More physics than psychic.

The problem I find with this equation is that it does not factor in the quality of nutrition that the body receives. Calories in the form of vegetables does not equal the same number of calories in the form of sugar. One latter leaves the body/mind hungry and seeking more food to satiate its need to survive.

Rich

---------- Post added 08-16-2009 at 09:12 PM ----------



Paul,

It has also been associated with heart disease and ultimately with probably most other chronic diseases. Here is a short article discussing its link to heart disease and predictive value of the ratio:

Waist-to-hip ratio: A risk factor for heart disease? - MayoClinic.com

It is my conjecture, that the reason for the link between the gut and disease is that fat accumulating around the gut collects toxins over time as well as prevents proper fluid movement in that region which is critical to the life of the body, because that is the location of all the organs. We want that area to be as clean and as fluid as possible.

The reason I like this ratio is because it really hones in on the problem. Fat surrounding the vital organs.

Rich

Eat
Real food (not refined, processed, etc, but pretty much as it comes from nature)
mostly plants (nuts, fruits, berries, vegatables, limited meats, cheeses, milk)
not too much (watch your calories).

In the end though it is all about calories (there are no empty calories). The calories in carbohydrates, fats and lipids all have the same energy and fat producing potential and your body will store them (evolution has seen to it).

Thanks for the link, Rich.

I think the real explanation (as far as I've read and heard) has to do with the so-called "metabolic syndrome", or the constellation of obesity, hypertension, dyslipidemias, and diabetes. This is a multi-systemic disease that most likely has to do with the endothelium (the lining of blood vessels), which is very much part of the disease process in type II diabetes, in hypertension, in dyslipidemias, and in vascular diseases like stroke and heart attack.

It seems most likely that the abdominal fat is a marker of this syndrome rather than a cause. Kind of like acanthosis nigricans -- this is a hyperpigmentation, most commonly on the back of the neck, seen in people with type II diabetes and impaired glucose tolerance. This is a disease harbinger, but it's certainly not causal.

---------- Post added 08-16-2009 at 10:35 PM ----------

I hear what you're saying, but Rich is 100% spot on: it's not just about calories. A diet needs to be well-balanced. There are high quality carbohydrates and low quality carbohydrates. There are polyunsaturated fats and there are trans fats.

If the discussion is just about weight, then calories are of course central. But if we're talking about disease prevention, then you need to factor in limiting saturated fats, eliminating trans fats, increasing omega-3 and omega-6 fats (of which ones from fish are the most bioavailable), eating whole grains, eating fruits with monosaccharides rather than sweets with disaccharides, eating fiber, etc.

Someone can lose weight if their diet solely consists of 1200 calories of Pepsi a day -- but are they going to be healthy?

Ah! So we disagree. I do not think it is about energy. I think it is more about quality of the energy. I believe that the human body is designed to function optimally with regard to specific types of energetic patterns. The energy of a vegetable is much different from the energy of gasoline (if I can be extreme in my example). Therefore, what one eats does matter. It is more than calories. Such is my view.

Rich

---------- Post added 08-16-2009 at 09:44 PM ----------



Yes, this is precisely what I am thinking. Thanks.

Rich

Well, we do not actually disagree all that much.
Weight loss is one thing, health that is something else.
If you want to lose weight eat fewer calories.
If you want to lose weight and be healthy too, eat fewer calories and see the above suggestion about real food and plants.

But this is what happens if you don't eat the nutritious foods. The body remains unsatisfied and hungry. So it keeps eating until it is satisfied. If it never becomes satisfied, then you have obesity from constant eating.

Small amounts of nutritious foods satisfy. Non-nutritious foods do not satisfy and begat endless eating binges.

Rich

I am not against eating nutrious foods! I have advocating it all along in each post. I am just saying "count calories" too:bigsmile:

Balance is another key. I've noticed I myself can gorge on one food in an unsightly way even though I don't have a propensity to do this. Eating a lot of food groups (even a little of each) at a meal quickly satisfies. Although the volume of food ingested is exhorbitant, the appetite may not cease because a certain type(s) of nutrient is sought and not received.

Perhaps lower income groups are depending too much upon a low-cost staple food to meet budgets while they unknowingly take in much more food volume-wise.

I'm still astonished that I'm reading in this thread that obesity is a global problem! Quite shocking...and a little nauseating. :whoa-dude: But I guess it would make sense given the above factor be a true one. Education as well as affordability is up there as well. I doubt the lower socio-economic group is reading up on the benefits of whole grains, antioxidants, and so forth.

Hi,

Yes, this is my also observation. 1) The body needs certain nutrients in order to stay alive. 2) The body/mind sends a signal to itself that it needs these nutrients with the feeling of hunger. 3) In previous times, before modern chemical food, this hunger would be satisfied naturally by eating from living foods that surround us 4) However, with the advent of mass produced junk food, we now have the option of eating junk food that does not satisfy the body's need for nutrients, thus 6) the body is in a perpetual state of hunger and keeps eating in order to satisfy this emotional urge.

The mind/body is doing what it needs to do to stay alive and healthy. When it doesn't get what it needs, then it falls into illness. Sometimes very bad illness as the body deteriorates.

Rich