overweight – Page 2

A New Commitment

October 21, 2017/in Memos/by Chet Zelasko

The numbers are in and the U.S. is fatter than ever: 39.6% of all adults over 20 years old are obese based on the Body Mass Index. That’s a rise of close to 2% since 2015, the last time the statistics were released. This isn’t affecting only adults; children 2–19 are also fatter than ever with 18.5% now considered obese. If we throw in those who are overweight, more than 70% of the population is fatter than ever.

I could review the causes, from refined carbohydrates to chemicals with estrogenic properties. I could talk about all the diets that could help. I could talk about supplements that may help to give people an edge. I’ve done that all before. There’s no single diet nor exercise program nor supplement that works for everyone. We all just have to find our own way. Instead, I’m going to tell you a story and issue you a challenge.

One of my best friends for the past 30 years, Dick Heller, died last week; he’d fought off cancer several times, but it finally got him just before his 80th birthday.

Dick and I were professors together in Buffalo. He was an excellent swimming coach and a competitive swimmer throughout his life. He was also a great teacher, especially when it came to helping people change their habits; he would help people identify what they wanted to achieve in the health and fitness classes he taught, have them write it down, develop a plan, and track the progress. Their grade was not based on how they compared to others; it was based on the goals they set.

To honor Dick, Paula and I are going to use that approach as we continue to improve our diet. Getting enough vegetables is a particular problem so we’re going to add at least one serving per day, every day, until it becomes a new habit.

Here’s my challenge to you. Pick one small health habit you want to improve, write it down, and start doing it every day until it becomes a new habit. Whatever small habit, if done repeatedly, that will help you achieve your goal. It may be related to your weight because, like I said, 70% of us are overweight or obese. It may be a different health goal. If people you know have died because of a health challenge, do it to honor them.

Identify. Write it down. Plan. Execute. Evaluate. I can’t think of a better tribute to Dick than that.

What are you prepared to do today?

Dr. Chet

Reference: https://www.cdc.gov/nchs/products/databriefs/db288.htm.

Normal BMI but Still Too Fat

August 12, 2017/in Memos/by Chet Zelasko

Last week the health headlines shouted “Study Shows Over 90% of All Americans Are Overfat!” The rate of overweight as assessed by Body Mass Index (BMI) is already 70%; now scientists want to say even more people are too fat? What’s going on? I’ll explain what overfat means first and then tell you about the study behind it.

For the most part, the greater the BMI, the greater the risk for cardiovascular disease, prediabetes, and hypertension. For those of you who aren’t sure of your BMI, check out your BMI in the Health Info section of our website. And if you think you’re just big boned, we show you how to prove it.

But there are people who have a normal BMI under 25.0 but still may be overfat. Considering Waist Circumference in addition to BMI may help but that could still miss some people. How? They may have lost muscle mass; the subtle loss of lean muscle with a gain of fat could lead to overfatness. That increases their risk for the diseases I mentioned earlier.

Here’s the most common example of someone who has a normal BMI but is overfat: a very sedentary elderly person who looks slim, but has very little muscle. As the saying goes “use it or lose it” and they’ve lost it.

A clinician from Arizona has taken it upon himself to redefine the terminology associated with excess body fat. He claims that overfatness gets missed in too many people. The problem he sees is that people who could begin treatment with diet, exercise, and medication if necessary are being missed. He outlined his arguments in a paper published in January 2017 (1), but it was his paper published in July that lead to headlines (2).

He and his co-authors examined the BMIs of people in countries all over the world. Using prior studies that estimated the number of normal-weight people who are overfat, ranging from 9.7% to 20%, he then applied that to the normal-weight populations (as assessed by BMI) in the top 30 developed countries in the world. That’s how they derived the headlines of over 90% overfat—not just in the U.S. but also New Zealand, Iceland, and Greece as well. To be fair, this applied only to males. Don’t rest on your laurels, ladies. All the same countries were greater than 80% for females.

The Problems

There are three with his approach in my opinion. First, adding another definition to replace BMI doesn’t really help people or their physicians as he implies. Confirming a person with normal BMI is overfat would require a more advanced exam or assessment of body fat. I’m not sure that’s practical.

Second, I looked at his work from every direction and couldn’t get the numbers to work. If 70% of Americans are overweight or obese and you add 20% of the remaining 30%, it adds up to 76% not 90%. Even if the numbers worked, the statistic would apply to a physician’s total number of patients. There would be no way to identify who is overfat without additional testing.

Third, there’s another group that needs to be addressed, and that would be those who are overweight according to their BMI but are metabolically healthy. In fact, that’s a significant problem today. Even after losing over 30 pounds, my BMI is still in the overweight category. By every test of metabolic fitness—blood pressure, cholesterol, HbA1c, or insulin—I’m at no additional risk of heart disease, yet I’m still classified as “at risk” due to my BMI. I think that’s a greater issue and will be more so as healthcare gets debated. Is your BMI over 25? You’ll pay more, even if your test results are stellar.

The Bottom Line

I agree with the concept that the author put forth: there are people with normal BMIs that are overfat, and they’re at greater risk for CVD and metabolic diseases. But new definitions aren’t necessary. What is necessary is identifying who is at risk. That will only occur when doctor and patient meet face to face. When was your last doctor’s appointment?

What are you prepared to do today?

Dr. Chet

References:
1. Front. Public Health 4:279. doi: 10.3389/fpubh.2016.00279.
2. Front. Public Health 5:190. doi: 10.3389/fpubh.2017.00190.

BMI, WHR, and Lifestyle

March 18, 2017/in Memos/by Chet Zelasko

The study we’ve been examining is interesting on so many levels: large numbers of subjects; new statistical techniques due in large part to progress in computing capabilities; genetic analysis that allows for rapid analysis and identification of polymorphisms. It’s all very exciting. You’re probably anticipating a “but” coming and you’d be correct.

This study demonstrated that when using genetic information, WHR is a risk for CVD and type 2 diabetes even with a normal BMI. But there’s still at least two factors to consider that are dependent on each other.

First, just because someone has a mutated gene or genes, it doesn’t mean it will ever express itself, i.e., turn on. More than likely, the second factor has a role to play and that’s the lifestyle of the individual. Some studies refer to it as environment, but they’re intertwined. Where you live may limit or provide you with easy access to healthier foods. It may be easier to exercise in the suburbs than in a large city, or just the opposite given the park systems in different areas of the countries.

Then there’s the home environment: what foods you ate growing up and what your diet is now. All these can impact whether some genes may be expressed. Others may express themselves only when you get to a specific weight or fat intake. The variables are too numerous to consider.

I’m not attempting to confuse the issue. I just want you to know that while this study provides insight that we didn’t have before, you don’t have to be overly concerned. If you keep to a normal BMI and WHR, less than 0.9 for men and less than 0.8 for women, your risk for CVD and type 2 diabetes will not be high.

When all is said and done, it still comes down to three things. Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

Reference: JAMA. 2017;317(6):626-634.

Waist-Hip Ratio vs. BMI

March 16, 2017/in Memos/by Chet Zelasko

In Tuesday’s message, I said researchers used a unique approach to answering the question of whether waist-hip ratio (WHR) is associated with cardiovascular disease and type 2 diabetes regardless of BMI. They found 48 genes which were associated WHR, a unique approach using the genetic information with Mendelian randomization of epidemiological data. If that isn’t a brain-full, I don’t know what is. Let me see if I can break it down for you.

As I’ve said many times before, epidemiological data cannot show cause and effect; they’re just observations. By using the genetic information related to WHR, researchers can analyze the data by statistically removing the effect of BMI. Because the genetic traits follow some randomization based on Mendel’s genetic work, if the WHR is still associated with the increased risks of disease, that means that where you carry your body fat is important, whether your BMI says you’re overweight or not.

They found that WHR is an independent risk factor for CVD and type 2 diabetes, confirming that the location of your body fat is important regardless of your BMI. That may be why people with a high BMI but low WHR have normal blood pressure and cholesterol levels while others with a normal BMI but a high WHR may have high numbers.

What are you prepared to do today?

Dr. Chet

Reference: JAMA. 2017;317(6):626-634.

Redefining the Risks of Extra Weight

March 14, 2017/in Memos/by Chet Zelasko

Studies show that 70% of the population is overweight; by definition, that means that their body mass index (BMI) is greater than 25 or more. But are all overweight people at the same risk? Just because you’re overweight, are you automatically at greater risk for cardiovascular disease and type 2 diabetes?

That’s what a group of researchers in the U.S. attempted to find out. They had the benefit of access to the U.K. Biobank, an independently funded databank that has collected biometric data on over 500,000 subjects in the U.K. and contains accurate measures of BMI as well as the waist-hip ratio (WHR) on all subjects. They also had one more thing: the genetic information on a large sub-group of subjects. They identified 48 genes that seemed to be associated with WHR and used a unique approach to tease out the effects of WHR from BMI. I’ll cover that the rest of the week.

In the meantime, check out your BMI and measure your waist and hip to calculate your WHR. Measure your waist about an inch below your belly-button and your hips at the widest point; divide waist by hips and you have your ratio.

What are you prepared to do today?

Dr. Chet

Reference: JAMA. 2017;317(6):626-634.

Recent Research: Milk and Obesity

April 14, 2016/in Memos/by Chet Zelasko

The second research paper included in many news articles that talked about the potential benefits of full-fat dairy products was a report from the Women’s Health Study (1). Researchers collected dietary data and self-reported body weight and height from over 39,000 women. The analysis included only about 18,000 middle-aged and older women who had a normal BMI when the study began; they analyzed the change in body weight over 11 years of follow up.

All women gained weight over time. Those who had the highest number of high-fat dairy products gained less weight . . .