There is a challenge with body mass. We have been seeing increased discussion about being "obese." The problem is growing. The British Broadcast Corporation (BBC) reported last year that Half of (the) world (is) on track to be overweight by 2035 Half of (the) world (is) on track to be overweight by 2035.
2035 is closer than it sounds. Coincidentally, Florida's workers' compensation law celebrates its centennial in 2035, so I have been otherwise focused on that year. We are less than a dozen years from that mark.
The story says that this could impact about "four billion people," and the greatest risk is to children and the "low or middle-income countries in Africa and Asia." The focus is on a report from World Obesity, and the impacts are clearly on health and on the economic aspects of this "chronic, relapsing disease." Fat, they say, is a disease.
I have been advocating for better personal habits for years. One of my late-life realizations has been that fat kills. In 2020, I noted the BBC reporting on defining what "obese" means. See What is in a Name (August 2020). That also highlighted some of the spending we see on obesity.
But, further back, I started raising the topic of obesity and its definition. See Obesity Can Kill Me? What Could Be Worse!? (March 2015). What is obesity, how do we define it, is our trajectory in that regard appropriate and efficacious?
I have highlighted a variety of paths people have elected regarding weight reduction. There was Stool Transplant (October 2019). But the fact is that we spend billions on losing weight. A great many people are so bent on their physique that they take drugs. Some of those have the assistance and advice of a physician, others not so much.
The popular course today is a diabetes drug. Some people are taking it to lose weight, which may deprive a diabetic of the benefits it could bring. We can discuss whether obesity is a disease. I am doubtful, but I am no doctor. We cannot discuss whether diabetes is a disease. It is. It is a systemic failure of the body. Ozempic may help it. But, the supply is impacted by those using it to trim and slim.
Some worry that taking such drugs may become a lifetime commitment. There are those who warn that bodies will adjust to the drug, and that cessation of it will lead to body challenges. The New York Times reported last year that "going off these drugs can take a toll." They suggest that for ex-users, appetite may be a problem and some report being "hungry all the time" in the wake of using the drug.
Whether being fat is a disease remains a discussion. In today's world of "see it my way or face ostracism," perhaps some will throw hate for my having said that. But I think we can rationally discuss what causes fat. Certainly, I can accept that many diseases impact body mass, energy, and more that contribute to the problem. In other words, many disease processes can contribute to and cause obesity.
But, I struggle with obesity itself being a disease. Fat is fat. If a medical issue causes or contributes, then fat may be a symptom. But is it actually a disease? And it if is not, then "treating" it is of particular curiosity. See Disease or Choice (March 2023)
Yes, a disease may cause or contribute to fat. And, as prominently, fat may contribute to an array of other issues. We often see the Comorbidity of Obesity (October 2021). Being overweight can aggravate and complicate a raft of other medical conditions. Obesity puts strain on joints and other orthopedic structures. It can stress the heart, lungs, and more.
More recently, the BBC reported that obesity may already be a greater problem than we have thought. It claims that "millions of middle-aged people have been mistakenly led to believe they are not obese." A new Italian study has been looking beyond the constraints of the Body Mass Index (BMI) that has been our fat standard for decades.
I have been critical of BMI. See The BMI Conundrum (August 2022). I have also been curious about the trend to changing definitions as if that will change the facts of obesity. See Obesity yet Again (January 2023). If we change the parameters, and the definitions, will it make us healthier or not? I suggest that whether you call it this or that, the fact is that body fat and mass have an impact on health.
So, this most recent pronouncement is about Italian research that considers "body fat instead of weight related to height (which is BMI)." This research is said to focus on the presence of fat, and that deals with the conundrum that large, muscular people are often mislabeled as "obese" using the BMI. Their weight-to-height ratio labels them obese, but they are not fat. They are muscular and that muscle is heavy.
The Italians propose more expensive testing (scanning). They are critical of the BMI, a "quick and easy method, supported by the World Health Organization (WHO)," and their study supports that the BMI may reach an untoward diagnosis in some instances. Their research concluded that of their test subjects
"Just 38% of the men and 41% of the women had a BMI above 30 - but when their body fat percentage was calculated using scans, 71% and 64% were found to be obese."
That means that BMI is underreporting obesity. To make the BMI decision, you need a scale and a tape measure. The Italians suggest we should have more expensive tests.
Nonetheless, a number of muscular people with little fat are being included in "obese" using the BMI and a seemingly much larger number of obese people are being told they are not obese because the BMI is too simple and underinclusive. The cynical among us might wonder if the new definition is a pursuit of more scans, more drugs, and more doctor visits.
The challenges are significant in both instances. Telling someone they are obese may result in various measures like diet, exercise, and even prescription medications. Some treat fat as if it is a medical condition. Special foods are prescribed for fat. Drugs are prescribed for fat. All drugs present a potential for side effects, and the Ozempic discussion suggests that some may contribute to long-term body changes even when one stops taking them.
The results of the Italian study are simple. They recommend that the BMI be dropped. Either quit using it, or lower the standard. That is, with our path projected to half the world being fat in 2035, the Italians suggest we lower the threshold for that label, and increase the obese. This is not an irrational guess or gesture. Their suggestion is based on the fat research and their amazing conclusions regarding obesity and the BMI.
At the end of the day, the decrease in the threshold would also perhaps justify more scans for more people, more drugs for more people. The fact is that doctors will not prescribe medication for weight loss for those who are not obese. The proposal to decrease the threshold and create a larger population of obese for treatment might thus be viewed cynically.
In the end, the bottom line, is that weight loss is a reasonably simple calculus of calories consumed versus calories burned. Your body will be different than others. Your metabolism will be faster or slower than others. In large part, this will be what you were born with, but your choices can have influence. In the same manner, as unfair as it is, some people can eat piles of food and never gain a pound while others of us get fat looking at cheesecake across the room.
The problem is not in definition. The debate should not be about thresholds, treatments, and drugs. The fact is that fresh foods, whole grains, and protein are both good for us and expensive. Cheaper foods, processed foods, and preservatives likely not so much. We can each choose more exercise, less calories, and better health. Or, we can resort to drugs and fads.
What we need is to focus on the real problems. More on that in a post to come.