Resolved: Find New Ways
to Think about Weight
One year ago this month, an article that appeared in the Journal of the American Medical Association challenged the ideas that many of us have about weight and health. The article presented an analysis of a large number of studies involving weight and risk of dying—the analysis found that, during the average study period, the risk of dying was actually 6 percent lower for people classified as overweight than it was for those classified in the “normal weight” category. And people classified as mildly obese were not more likely to die than those whose weight was deemed to be normal. That article caused quite a stir. Twelve months later, we are once again starting a new year and millions of Americans are making resolutions about weight loss. Before beginning another diet, let’s stop and consider that it might be very helpful to find new ways to think about weight.
Problems with definitions of overweight and obese
First, we can question the official definitions of “overweight” and “obese.” Typically, body mass index (BMI) is used in the definitions—the index is calculated as weight in kilograms divided by the square of height in meters. A BMI calculator or table can be used to determine a person’s body mass index. According to the Centers for Disease Control, a person with a BMI of at least 25 but less than 30 is labeled overweight; a person with a BMI of at least 30 is labeled obese; and someone with a BMI of 40 or above is labeled extremely obese. In 2009-10, based on these categories, 33 percent of Americans age 20 and over were classified as overweight, 36 percent as obese and 6 percent as extremely obese. This means that 69 percent of American adults were classified as overweight or obese.
However, there are all kinds of problems with how BMI is constructed and used. To begin with, it was devised as a tool to be used in studying human populations; it was not meant to be applied to individuals as a health-assessment tool. Furthermore there is no solid physiological reason to look at the relationship between weight and the square of height when assessing an individual’s health.
On top of this, the BMI cutoff points of 25 and 30 are somewhat arbitrary. Prior to the current focus on 25 and 30 as key BMI levels, the cutoff points in official statistics that associated health risk and excess weight were 27.3 for women and 27.8 for men. The analysis in the January 2013 JAMA article does not support focusing on the cutoff points of 25 and 30, because it indicated that adults with a BMI of at least 18.5 but below 25 (which is the range for the “normal weight” category) do not have a lower risk of dying than adults with a BMI of at least 25 but lower than 35.
Another important consideration is that BMI cutoff points for adults are not adjusted for age, as well as not being different for men and women anymore. It seems reasonable that what is considered to be a healthy weight for a given height could vary based on a person’s age and sex. On top of all of this, BMI does not take into account the differences in the densities of muscle, fat and bone. Many athletes—both professional and amateur—would be classified as overweight or obese because of their muscle mass.
In sum, body mass index is, in theory and practice, highly questionable as a tool for assessing the health of a population or individual. There is a growing trend towards utilizing measures involving waist size when assessing health risks related to body fat. Recent research indicates that such measures are better predictors of health problems than BMI.
Gaining weight as we get older
A second way we can rethink weight involves age. What if it’s natural and healthy to put on some weight over the decades? There appears to be a cultural expectation that we should reach an ideal weight in our 20s and then maintain it indefinitely. (One exception is when women experience pregnancy and childbirth, but even then, there is often social pressure to return to pre-pregnancy weight as soon as possible after the birth.) However, maintaining a specific level of weight for decades does not seem at all natural for most people. If food is plentiful, the majority of adults seem to put on weight over the years. This was as true in prior centuries as it is now. It appears that it may well be natural for most adults to gain weight over the decades (as long as sufficient food is available).
Why might it be healthy to gain a moderate amount of weight over the years? There are a number of possible answers. Having natural padding offers older adults a degree of protection if they fall. Because of changes in eyesight, balance and muscle strength, older adults may be more likely to fall than younger adults; additionally, an older adult’s bones may tend to be more fragile than those of a younger adult.
Another possibility: If a person contracts certain diseases, having energy reserves to draw on (in the form of fat) can aid in the recovery process. And energy reserves can be useful if someone is experiencing grief and has little appetite for an extended period. In addition, some of the fat that women tend to put on in their 40s and 50s produces estrogen that substitutes partially for the estrogen that is no longer produced by their ovaries after menopause. That natural form of estrogen replacement may help reduce the risk of osteoporosis and there may be other health benefits from it as well. Together these possible benefits from a moderate amount of weight gain could account for why it can be so hard to lose those “last 5 pounds” (or last 10 or 15 pounds). It might be that your body is holding onto that weight for good reason.
Nonverbal communication and weight
A third way to look at weight differently involves nonverbal communication. Picture in your mind an ideal grandmother and grandfather. You might picture a pair of smiling older folks who are at least a little plump. The presence of that padding may convey gentleness and approachability to young people. Plus, acquiring some padding may increase a person’s huggability. Of course, someone who is thin can be a terrific grandparent, but a bit of padding might make it easier to be terrific in that role. And these ideas about nonverbal communication don’t just apply to older adults. Parents of young children may find that natural cushioning is helpful when holding and hugging their offspring.
Before finishing, let’s clarify a couple of things. This discussion about weight should not be regarded as medical advice, but rather as a presentation of thought-provoking ideas for your consideration. And this discussion is not an endorsement of reckless eating habits—routinely eating until we feel completely stuffed or primarily eating “junk food” is clearly not going to promote our well-being.
As we start a new year, let’s remember that there are notable problems with the definitions that are commonly used when weight is discussed. It might be that over half of us are at a weight that can genuinely be viewed as sensible. Let’s be open to the idea that it’s natural and beneficial for most of us to put on some weight as we go through adulthood. Let’s think about how some weight gain may affect our nonverbal communication in positive ways as we grow older. We might come to the conclusion that we don’t need to lose those last 5 (or 15) pounds. If that is our conclusion, we can take the time and energy that we would have devoted to attempts at weight loss and instead use those resources in ways that are more productive and satisfying.
-- By Mary Jablonski