Despite our country’s obsession with weight and appearance, most people who are overweight based on medical standards don’t realize it. According to the Center for Disease Control (CDC), more than two-thirds of Americans age 20 or older are overweight or obese: 34% are overweight, 35% are obese (meaning overweight enough to be at high risk for health problems), and an additional 6% are extremely obese (meaning that they are at even higher risk of developing health problems).
What we’re talking about isn’t “love-handles” or a body that doesn’t match the supermodels we see in magazines. Instead, we’re talking about weight that significantly threatens health, well-being, and longevity. Only cigarette smoking causes more preventable deaths in America than obesity does. That means that approximately 300,000 deaths each year are directly or indirectly related to obesity.
Certain groups are more prone to overweight and obesity than others. For example, women — who often tend to gain weight as they get older — are at higher risk than men. Black women are at higher risk than white women, and low-income minority women are the most likely to be overweight. In general, middle aged women are at the highest risk for becoming obese. Most troubling of all, children-even at very young ages – are more overweight and obese than ever before, setting the stage for lifelong weight-related health problems.
Research has found that overweight people who are “apple shaped” — with more belly fat around the waist — have more health problems than overweight people who are “pear shaped” (most of the extra weight below the waist). One study followed over 3,000 participants for up to seven years and used CT scans and physical exams to assess the fat deposits that accumulated in the abdomen region, liver, and muscle tissues including the heart. Over the next 7 years, the number of men and women in the study had 90 heart-related incidents, 141 cases of cancer, and 71 deaths from various causes. After statistically controlling for the effect of age, exercise habits, BMI and self-reported eating habits, the researchers concluded that those with more abdominal fat were more likely to develop heart disease and cancer. Although the reason is unknown; one possible explanation could be that belly fat is often an indication for too much fat around the internal organs such as the liver and heart.
Another recent study followed over 150,000 post-menopausal women, ages 50-79, for about 20 years. This study found that women who carry extra belly fat (an “apple” body shape) are more likely to die or develop cardiovascular disease or cancer, whether or not they are not overweight.
Women of normal weight with more belly fat (and a larger waistline) were found to have a 43% increased risk of dying compared to women with normal weight and no extra belly fat. Although these women tended to be older, nonwhite, with less education and income, and less likely to use menopausal hormones and to exercise, even when adjusting for these traits, this group of women still had a 31% higher risk of dying.
The following table shows the increase or decrease in risk of dying compared to women without belly fat who are not overweight or obese, after adjusting for the traits mentioned above. A particularly shocking finding was that women of normal weight with extra belly fat had the same increase in risk of death as obese women with extra belly fat.
Assessing Body Composition: BMI and Waistline Measurements
How do you know if you are medically overweight or obese? Doctors use a formula that takes both height and weight into consideration to come up with a standardized measurement known as body mass index, or BMI. The BMI is a reliable indirect way of measuring total body fat content.
Your health care provider can help you figure out your BMI, or you can use an automatic BMI calculator.
You can also calculate your BMI by hand:
1) divide your weight (in pounds) by your height (in inches) squared. Then
2) multiply the result by 703
For example, if you are 5′5″ (65″) tall and weigh 150 lbs:
[150 ÷ (65)2] x 703 = [150 ÷ 4225] x 703 = 24.96.
The interpretation of BMI is based on health risk, not on a judgment about physical attractiveness. In general, the higher the BMI, the higher your health risks will be.
- BMI for people at a healthy body weight falls between 18.5 and 24.9;
- A BMI between 25 and 29.9 is considered overweight. At this weight, your chances of dying early, especially from heart disease or cancer, are increased.
- A BMI over 30 is considered obese. Over 30% of Americans fall into this category, with dramatically increased risk of health problems and earlier death.
Even with a healthy BMI, however, white, black, and Latina women with a waistline measurement of 35 inches or more, and Asian women with a waistline of 31 inches or more, may still be at risk for serious fat-related medical problems. This is because the accumulation of “visceral” fat can be especially harmful. Measure your waist at the level of the points of your elbows when your arms are at your sides. Keep the tape measure parallel to the floor, and don’t pull it so tight that it compresses your skin.
Causes of Overweight and Obesity
Why are so many Americans overweight? At least three general factors contribute to adult weight gain: behavior, environment, and genetics. Although we can’t control our genetics, we do have some substantial control over behavior (our eating habits and physical activity) and of many aspects of our environment (things at home, school, and work that might affect our weight).
Behavior includes the personal decisions we make about diet and exercise. Many of us, perhaps tempted by appealing advertisements and the convenience of fast foods and take-out restaurants, eat more fattening and unhealthy foods than we intend to. Americans tend to favor large serving sizes and high-calorie, high-fat, and high-sugar foods, which provide little nutrition and add many pounds. This includes fast food, sodas, sugary cereals, and processed foods. Too often we don’t even realize it. For example, at some popular restaurants, one meal may have an entire day’s worth of calories and far more fat and salt than our bodies can process in a day. Our favorite latte can have one-third of a day’s calories.
Our environments contribute to weight control problems in a number of ways. The couch potato is a well-recognized example, and many of us fit that description since two-thirds of adults don’t get the 30 minutes of exercise a day that is needed to stay fit. With cars, remote-controlled TV’s (complete with frequent images of junk food), on-line shopping, and an array of labor-saving appliances at home and at work, many of us have become less active every year. Regular moderate exercise can get rid of the unhealthy visceral fat that accumulates around the waistline, even before the scales start to show an overall weight loss.
Scientists are still learning about how genetics affect obesity. The Center for Disease Control and Prevention (CDC) has found that some people are more likely to become obese, but they can’t explain exactly why. One theory is that thousands of years ago some humans developed genes that allowed their bodies to store more fat and helped them survive when food was scarce. Today, we don’t need fat storage for survival, but some people still have the fat-storing genes passed down from their ancestors. Such people would have a very high chance of becoming obese and would therefore need to work all the harder to avoid obesity.
Making a Commitment to do Something about being Overweight
People don’t need to be extremely thin to be healthy and happy. But being overweight or obese can diminish the quality and the length of your life. Some people can get their weight down on their own, and others can benefit from working with a health care provider, nutritionist, trainer, buddy, or proven programs like Weight Watchers®. Everyone is different so do what will work for you. The important thing is that you take steps to keep or get to a healthy weight.
Eating a healthy diet with the right foods can help you lose and manage weight. It’s important to know that not all foods are created equal! Some foods, such as nuts, are high in nutrients and essential vitamins, while others lack nutritional substance, such as products containing added sugars. Nutrient-dense food” provides substantial amounts of vitamins and minerals and relatively few calories, but leaves you feeling fuller while also supplying valuable fuel for your body. A person is more likely to stick to a diet – while feeling better and healthier-if calories are nutrient – dense.
What you drink might be more important than you think. In a 2016 study, researchers found that middle-aged adults who drank at least one sugar-sweetened beverage (such as regular soda) each day had gained about 27% more “belly fat” over the next 6 years than those who didn’t drink those beverages! Belly fat is fat in the abdominal cavity that surrounds some of your vital organs. It increases your chances of developing type 2 diabetes and heart disease. Obviously, sugar drinks are not the only cause of belly fat. And, of course, those who drink sugary beverages are more likely to eat foods with added sugars, fewer fruits and vegetables, smoke, and exercise less.
Empty calories from simple carbohydrates found in processed and refined sugars, such as candy, pasta and bread made from white flour, and foods with corn syrup, leave you hungry again soon after, craving more food. This is because simple carbohydrates quickly turn into useless sugar, whereas complex carbohydrates, such as vegetables, whole-grain breads and cereals, and low-fat yogurt and milk, provide long-lasting nutrients, improve digestion, help stabilize blood sugar, and keep your energy at an even level. Although foods such as fruit are also considered simple carbohydrates, they contain vitamins and nutrients that occur naturally, unlike those found in processed and refined foods.
A 2011 study found that certain foods were linked to weight change more than others. After following participants for an average of 17 years, researchers found that weight increase was most strongly linked to foods such as potato chips, sugar-sweetened beverages, and unprocessed red meats. Foods such as vegetables, whole grains, nuts, fruits, and yogurts were closely linked to preventing weight gain.
Also, adding or increasing regular exercise to your daily routine can help gain control and maintain a healthy weight. Research has shown very clearly that 30 minutes of moderately strenuous daily exercise is one of the most important requirements for disease prevention-even for people who are already at an ideal weight. The exercise you choose doesn’t need to be elaborate, or to take place in a gym. Walking, biking, swimming, or gardening can do the trick, and getting a friend or family member to exercise with you can turn this into a valued part of your daily routine. Learn more about the health benefits of physical activity and how to get started from the CDC.
Beware of drugs that are advertised for weight loss. Recently, Contrave, a drug which was approved by the FDA for weight loss, was put on the 2017 “Watch List” for risks of losing consciousness. Sustained and healthy weight loss cannot be achieved by a pill!
All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.
- Mozaffarian D, Hao T, Rimm, EB, et al. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. The New England Journal of Medicine. 2011;364:2392-404. http://www.nejm.org/doi/pdf/10.1056/NEJMoa1014296
- Ogden CL, Carroll MD. Prevalence of overweight, obesity, and extreme obesity among adults United States, trends 1960 -1962 to 2011-2012. National Center for Health Statistics, Centers for Disease Control and Prevention. 2014.
- Paddock, C., PhD. (2013, July 12). Heart and cancer risks of belly fat. http://www.medicalnewstoday.com/articles/263270.php
- Pew Research Center. American See Weight Problems Everywhere But In the Mirror. April 2006.
- Sugary Drinks Tied to Increase in Deep Belly Fat: MedlinePlus. (2016, January 11). https://www.nlm.nih.gov/medlineplus/news/fullstory_156625.html.
- Sun Y, Liu B, Snetselaar LG, Wallace RB, Caan BJ, Rohan TE, et al. Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women. JAMA Network Open. 2019;2(7):e197337. https://www.ncbi.nlm.nih.gov/pubmed/31339542.