Is fat the new fit?

Recently, a report published by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) made a number of recommendations designed to ward off cancer, the most trumpeted of which is the need to maintain a ‘healthy’ weight. Specifically, we are encouraged to keep our body mass index (BMI) between 21-23 (the traditional ‘healthy’ BMI range extends from 18.5 to less than 25). This week, here in the UK we had a home-grown story with the same line: a study published in the British Medical Journal warns that excess weight will cause around 6,000 British women to develop cancer every year. The underlying message of recent times is that carrying ‘extra’ weight is a serious hazard to our health. But is it?

Last Friday, my blog highlighted the evidence showing that individuals traditionally regarded as ‘overweight’ enjoy health that is at least as good, if not better, than those who fall in the ‘healthy’ BMI category. One study I chose to mention specifically was one published in 2005 in the Journal of American Medical Association (JAMA) which found that overall risk of death was lower in ‘overweight’ individuals than individuals of ‘healthy’ weight [3]. One commenter (Esther)was worried about my: tendency to seep [I think she meant sweep] away many studies that show one result, and offer one that disagrees.� I am genuinely happy to review my stance on things – in the light of good evidence. So I’ve asked Esther for the ‘many studies’ she refers to. Let’s see what turns up�.

In the meantime, I want to share with you research published this week on the same theme. The 2005 JAMA study’s lead author was Katherine Flegal, a scientist at the National Center for Health Statistics and the Centers for Disease Control and Prevention in Hyattsville, Maryland, USA. This week, Katherine Flegal has had published a more detailed analysis of the data on BMI and death. In this newest study, again published in the JAMA, Dr Flegal and her colleagues have drilled down to look at the relationship between BMI and not just death, but different causes of death. In particular, they divided causes of death into 3 categories: cardiovascular disease (CVD) deaths (e.g. heart attacks and strokes); cancer death; and non-CVD/non-cancer deaths.

Here’s what they found:

People in the ‘overweight’ category were not found to be at increased risk of death due to CVD or cancer.

Individuals in the ‘overweight’ category were not even found to be at increased risk of death from forms of cancer traditionally thought of as obesity-related (e.g. cancers of the breast, colon, ovary and womb).

Risk of death due to non-CVD/non-cancer causes was lowest for those in the ‘overweight ‘category, and this was ‘statistically significant’.

Again, overall risk of death was found to be lowest in individuals in the ‘overweight’ category, and this was ‘statistically significant’.

Individuals in the ‘obese’ category (BMI 30 and above) was associated with an increased risk of death overall, and this appeared to be due to an increased risk of CVD.

Individuals in the ‘obese’ category were not at significantly increased risk of death from cancer or non-CVD/non-cancer conditions.

So, could fat be the new fit?

Well, one thing is for sure: being ‘overweight’ according to the BMI scale does not mean someone is ‘fat’. That ‘additional’ weight may be, after all, the result of muscle, bone or whatever. And even if there is a bit of ‘padding’ present around the body, is this necessarily a bad thing? It might be a sign of greater ‘nutritional reserve’ which can be drawn on in times of need. Which, by the way, may reflect an evolutionary adaptation that has helped to ensure survival during times when food supply was limited. While starvation is less of an issue for the population analysed in the recent JAMA study, what may be relevant is that individuals of higher weight have been found to be at reduced risk of death in certain circumstances including critical illness and surgery.

Whatever the explanation, I believe there is now abundant evidence which shows that the conventional advice given to individuals around maintaining or attaining a ‘healthy’ BMI is simply not justified. So, until it seems we have good evidence to the contrary, my suggestion that we do not urge people to strive to conform to a body weight that may be quite unattainable and perhaps even detrimental to their health.

References:

1. Are the recent recommendations designed to ward off cancer justified?

2. Reeves KR, et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ doi:10.1136/bmj.39367.495995.AE (published 6 November 2007)

3. Flegal KM, et al. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;20;293(15):1861-7

4. Flegal KM, et al. Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity. JAMA. 2007;298(17):2028-2037

4 Responses to Is fat the new fit?

  1. audrey wickham 9 November 2007 at 12:28 pm #

    You reminded me of a friend who went on holiday to North Africa and came back with some awful disease. She was a tad overweight when she went to NA and lost an awful lot of weight because of the disease she caught. Her doctors’ told her that her recover was hastened by the fact that she was overweight and had the fat to lose.

    On the other hand: Another girlfriend was sent home without having surgery because she was too fat.

  2. Hilda 9 November 2007 at 1:46 pm #

    Could it be because there are all sorts of reasons for being overweight? Some people genuinely do have low thyroid but not low enough to be treated in the UK. They may eat good food and not much of it and stay overweight. This is different from somoeone who gorges on junk food. Genetics is also important for some people. You can see a familiy of 5 come into a resturantant. THree look like dad and are thin. THe other two look like mum and are not.

    If overweight causes these diseases rather than just being associated with them, what is the mechanism? I do think that in many cases it is that a poor diet and lifestyle can cause obesity and it is that which causes the ill health and not the weight per se. Hilda

  3. helen 12 November 2007 at 9:44 pm #

    overweight & morbidly obese are two different things – all the fat phobics will be sad that their many hours in the gym are not benefiting them. Maybe they should be looking at things like free radical damage caused by excessive exercise. What is all this one size fits all nonsense anyway the “fittest” man i knew my swim coach dropped dead at 35 from a massive heart attack so much for all that radical vegan diet & gym time he professed & tried hard to foist on us meat eaters!!

  4. Carolyn 14 November 2007 at 5:17 pm #

    I agree with several of the other people who have commented on this and the previous cancer report. The cancer report clearly has been influenced by the purveyors of weight loss drugs. Four of the people on the panel are members of the Internatioanl Obesity Task Force, which is basically a drug-company funded lobbying group masqueradint as a scientific organisation. There’s plenty of evidence that the so-called overweight category is not at increased risk for mortality anyway. The cancer report was covered as though it was an amazing finding that six specific cancers were linked to obesity, but you can find plenty of lists on the internet and in fact sheets that already showed that anyway, so i’ts nothing new at all.

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