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Big doesn't mean poor health: MD

Obese people can live longer

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One of Canada's top obesity doctors says it's time to stop recommending weight loss for everyone who meets official criteria for obesity.

Dr. Arya Sharma says being obese doesn't necessarily doom people to poor health and that weight-loss recommendations should be targeted at those most at risk because of medical problems.

Many people who meet the body mass index criteria for obesity "are really not that sick at all," says Sharma, chairman for cardiovascular obesity research and management at the University of Alberta and scientific director of the Canadian Obesity Network.

"It's not unusual to find someone come into your practice whose BMI is 30 or 32 (technically obese). This might be someone who is physically active, who is eating a good healthy diet. If you followed the guidelines to the letter you would be prescribing obesity treatment when there's really no reason to do that, because they're not medically obese."

"It's not enough to just know how big someone is. In order to make medical decisions, you need to know how sick someone is."

His appeal comes as evidence begins to mount that a significant proportion of fat people are metabolically healthy. One in every three people who are obese -- and half of those who are overweight -- may be resistant to fat-related abnormalities that increase their risk of cardiovascular disease, according to new research from Albert Einstein College of Medicine in New York.

The concept of "benign obesity" has been known for more than 20 years. Only now are researchers discovering the scope of the phenomenon.

"There is at least a proportion of obese individuals who at this point don't seem to be at elevated cardiovascular risk," says Rachel Wildman, an assistant professor of epidemiology and population health at Albert Einstein College. Not only is their risk fairly minimal, "in some instances it's better than individuals who are normal weight."

Hardly a week passes without a headline warning the overweight are eating their way toward a premature death, and there's a huge amount of money to be made by encouraging hysteria around the issue. The weight-loss industry is worth $50-billion in the U.S. alone.

But there's growing recognition that the risks associated with obesity are not uniform.

In Wildman's study, nearly 17 per cent of obese men and women possessed not one of the heart or metabolic abnormalities the researchers considered.

"What's very clear is that people in the range of 25 to 30 BMI -- the 'overweight' category -- live longer than lighter people," says Paul Ernsberger, an associate professor of nutrition at Case Western Reserve University School of Medicine in Cleveland, Ohio.

Researchers have shown that while overweight people are more likely to have a heart attack and heart failure, they're also more likely to survive it.

Ernsberger and others believe the concept of "overweight" should be abandoned, "because that implies that you are over the ideal, that there is some magical weight you shouldn't be over." He says a person's weight begins to affect their health at around a BMI of 30.

-- Canwest News Service

And on the flip side...

LONDON -- Being obese can take years off your life and in some cases may be as dangerous as smoking, a new study says.

British researchers at the University of Oxford analyzed 57 studies mostly in Europe and North America, following nearly one million people for an average of 10 to 15 years. During that time, about 100,000 of those people died.

The studies used Body Mass Index (BMI) to determine obesity. Researchers found that death rates were lowest in people who had a BMI of 23 to 24, on the high side of the normal range.

The study was published online Wednesday in the medical journal Lancet.

The study found that people who were moderately fat, with a BMI from 30 to 35, lost about three years of life. People who were morbidly fat -- those with a BMI above 40 -- lost about 10 years off their expected lifespan, similar to the effect of lifelong smoking.

-- The Associated Press

Republished from the Winnipeg Free Press print edition March 18, 2009 A10

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