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With one startling report on the effects of excess weight, obesity went from being the second-leading cause of death in America to just another overhyped health threat.

After telling Americans that fatness killed nearly 400,000 Americans annually, federal health officials reversed course last April with a new study that found only 26,000 excess deaths caused by too much weight. More surprisingly, the federal study found that moderately overweight people died less often than those of normal size.

Then, a couple weeks ago, Americans opened the newspaper and learned that low-fat diets may not prevent cancer and heart disease.

It’s enough to make any diet-conscious American ask "what’s going on?"

While federal officials initially overestimated weight-related deaths, obesity is still clearly linked with serious health problems, including a surge in diabetes. But the dangers, if any, related to being overweight but not obese are hard to determine for any one person.

"The real important message here is that although weight is a marker for problems, it isn’t necessarily exactly the problem. More important is ’are you healthy?’" said Dr. Mary Vernon, a Kansas doctor who is president of the American Society of Bariatric Physicians.

Someone can be healthy and still classified as overweight in terms of body mass index, a common measure accounting for weight and height. Arnold Schwarzenegger and many professional football players would be considered overweight under this technical measure, yet remain fit and healthy, Vernon noted.

On the other hand, someone may be thin and have health problems often associated with the obese. Vernon said medical professionals e category called "metabolically obese, normal weight," to describe thin people with problems like abnormal blood sugar levels and high cholesterol.

"What matters is you individually, not statistics," Vernon said. "You can’t ever make an assessment about your personal health by betting on the numbers. It’s not Powerball."
Yet public health professionals have tried to "bet on the numbers" by calculating how many people die each year from being overweight. These calculations, it turns out, can be anything but exact, and when federal health officials are wrong they open themselves to accusations they exaggerated the dangers to scare people into staying thin.

In 2004, the U.S. Centers for Disease Control and Prevention issued a study that claimed 400,000 Americans die each year from weight-related causes, and said excess weight was on pace to overtake tobacco as America’s top preventable cause of death.

The agency was later forced to admit its calculations were way off. A new analysis using more refined calculation methods and better data attributed 112,000 excess deaths each year to the obese, but found 86,000 fewer deaths than expected among people who are overweight under the BMI scale.

That means overweight and obese people together account for an extra 26,000 annual deaths, but raises the question of whether a few extra pounds can be protective of health.

The new study gave ammunition to food manufacturers who want to convince the public that the dangers of being overweight have been exaggerated. A food industry-backed nonprofit called the Center for Consumer Freedom released a book called "An Epidemic of Obesity Myths," which said the body mass index measure classifies Mel Gibson, Tom Cruise, Sylvester Stallone, Mike Tyson and many other seemingly fit Americans as "obese."

Some say the CDC calculations indicating fewer deaths among the overweight were flawed. The lead study author herself said it would be an exaggeration to claim the results show benefits related to extra weight.

People with a BMI rating of 25 or more are technically overweight, and a rating of 30 or more is an indication of obesity. A 5-foot, 8-inch tall person who weighs 165 pounds is considered just barely overweight, and becomes obese at 200 pounds

Many studies have found the lowest mortality rates among people with a BMI of 24 or 25, said Katherine Flegal, a senior CDC research scientist who authored the CDC’s obesity/mortality study.

"I wouldn’t say overweight is protective," she said. "There’s just a slight hint that there’s something there, but that’s about it."

One Framingham researcher said the 86,000 fewer deaths found among the overweight are misleading, because the study failed to take into account "reverse causation," when people with chronic illnesses like cancer lose weight yet are deathly ill.

"People who smoke lose weight," added Dr. Caroline Fox, medical officer at the Framingham Heart Study. "When people stop smoking, they gain weight."

Overweight people are more likely to develop hypertension, diabetes and other conditions, Fox said.

Because Americans on average have become heavier, many people may not realize they are too fat, she said.

"It’s really hard because we’re all calibrated to today’s society. The average BMI does fall in the overweight category," Fox said. "But just because something’s average doesn’t make it healthy."

The question of when someone should lose weight is not cut and dry, doctors say. Dr. Alan Cole, a diabetes specialist in Natick, said he wouldn’t tell someone with a high BMI to lose weight unless they have co-existing concerns like high blood sugar, blood pressure and abnormal cholesterol levels, which raise the risk for heart disease.

BMI also isn’t the only measure of obesity, he noted. Doctors are now measuring abdominal girth -- the distance around one’s waist, near the belly button -- as one potential risk factor for heart disease, Cole said. Forty inches around the waist for men and 35 for women would be considered overweight, he said.

Cole worries that too many Americans are getting little or no exercise.

"Exercise is helpful not just in terms of weight loss. It’s an individual factor that improves health independent of weight loss," he said. "I think we’re all really sedentary. The thing that concerns me is our lifestyles have changed so much. We don’t have gym as part of school curriculum necessarily anymore, and people do more and more work sitting at computers."

People who want to lose weight are faced with many choices, from fads promising weight loss without exercise or dieting, to more effective options stressing physical activity and dietary restrictions.

Perhaps adding to confusion, a new study on 50,000 post-menopausal women found that women on a low-fat diet for an average of eight years saw no improvements in rates of colorectal cancer, heart disease and stroke.

Government dietary guidelines recommend restricting fat to 20 to 35 percent of caloric intake, but some experts say overall fat levels may be less important than saturated and trans fats.

Vernon, co-author of the book Atkins Diabetes Revolution, said she believes saturated fats may not be harmful unless combined with lots of sugar. High intake of sugar and carbohydrates, she said, are "pretty clearly linked to the disastrous health outcomes we have in America."

The simplest answer for dieters is to consume fewer calories, and burn more.

"I think you really need to restrict your calories to lose weight," Fox said. "The energy balance equation is energy in, energy out."

Source: Metrowestdailynews

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