July 15, 2013
It Ain’t Over Till The Fat Lady Sings—But What’s Fat?
By Michael D. Shaw
Let’s start by defining our terms. According to the World Health Organization (WHO): The conditions of “overweight” and “obesity” are defined as abnormal or excessive fat accumulation that may impair health. These words are given more specific meaning when used in conjunction with the Body Mass Index, or BMI—a concept that dates back more than 150 years.
The BMI is calculated by taking a person’s weight in kilograms, and dividing that by the square of his height in meters. For measurements taken in pounds and inches, multiply the result by 703. Or, you can simply use this online BMI calculator.
| Underweight | BMI less than 18.5 |
| Normal | BMI from 18.5 to 24.9 |
| Overweight | BMI from 25.0 to 29.9 |
| Obese | BMI 30 or greater |
WHO takes this even further, with the following breakdowns:
| Pre-obese | 25.00-29.99 |
| Obese class I | 30.00-34.99 (Moderately obese) |
| Obese class II | 35.00-39.99 (Severely obese) |
| Obese class III | 40.00 and above (Very severely obese) |
Other terms are also used, including morbid obesity (40-44.9) and super obesity (greater than 45 or 50, depending on the source).
Since BMI does not differentiate between body fat and muscle mass, it may overestimate body fat in athletes and others who have a muscular build. Likewise, it may underestimate body fat in older persons and others who have lost muscle. For a variety of reasons, many authorities recommend a lower “overweight” range for Asians, such as 24-26.9, with 27 and over classified as “obese.”
We keep hearing about the worldwide epidemic of obesity, but what about its causes? There’s no escaping the fundamentals, whereby an energy imbalance between calories consumed and calories expended will produce a corpulent individual. Such a scenario is certainly promoted by the ready availability and increased consumption of energy-dense foods that may also be high in fat. And, let’s not forget an overall decrease in physical activity due mostly to improvements in technology.
Notably, as has been pointed out by nutritionist Diane Kress, calorie counting does not produce the same results in all individuals. Kress has identified what she calls “Metabolism B,” based primarily on a tendency toward insulin resistance (and thus weight gain). She believes that at least 50 percent of dieters are Met B. Unfortunately, the conventional low fat/high carb diet still recommended by clueless health authorities will be doubly bad for these individuals, as the high carb content will cause more insulin to be secreted, and thus promote more weight gain.
By the same token, “experts” who once praised the high-carb Asian diet, noting that there were few obese Asians, have gone conspicuously silent. At present, there is an explosion of obesity and type 2 diabetes in that region and ethnicity as a result of now plentiful quantities of their traditional high-carb fare.
Those searching for factors beyond too much caloric intake and reduced physical activity would be pleased with an article that appeared in the November, 2006 issue of the International Journal of Obesity. Boasting 20 authors (is there a BMI for author count?), the review posits ten more so-called “additional explanations.” Among them are sleep debt, reduction in variability of ambient temperature, decreased smoking, pharmaceutical drug side effects, and—ridiculously—endocrine disruptors.
On June 18, the American Medical Association declared obesity to be a disease—upgraded from a condition. “As things stand now, primary care physicians tend to look at obesity as a behavior problem,” said Dr. Rexford Ahima of University of Pennsylvania’s Institute for Diabetes, Obesity and Metabolism. “This will force primary care physicians to address it, even if we don’t have a cure for it.”
Certainly, doctors have been treating overweight people for centuries. Indeed, the American Society of Bariatric Physicians had its origins in 1950, and in 1996 was admitted to the AMA Specialty and Service Society. One of the country’s premier bariatric groups is the Khalili Center for Bariatric Care, of Beverly Hills, CA.
Founded by surgeon Dr. Theodore M. Khalili, the center is described as a patient-centered, service-oriented facility that offers a truly comprehensive, holistic approach to bariatric treatment—all under one roof. Staff surgeon Gregg Kai Nishi, MD, FACS told me this:
“The AMA’s recent classification of obesity as a disease has long been awaited. It will help people seeking weight loss surgery tremendously in that it increases awareness about obesity among the health care community, will increase the amount of information available to prospective patients, and will hopefully push insurance companies to lower the current weight requirements for weight loss surgery.”
“The U.S. Surgeon General’s office attributes 300,000 annual deaths to obesity. In fact, obesity is currently the number two preventable cause of death in this country, second only to smoking. At the Khalili Center, we have the expertise and resources to help patients overcome this disease called obesity.”
Maybe now, we’ll get it right. After all, way back in 1952, public health legend Lester Breslow M.D., M.P.H., Sci.D.—along with his colleagues—identified obesity as America’s number one health problem. And that was when the only McDonald’s in the country was the original store opened by the McDonald brothers in San Bernardino, CA; an entire six-pack of Coca-Cola contained less volume than one Super Big Gulp does today; and less than 10 percent of the population was obese.