[mandalinn82]

(Subtitle: How the heck do I know if I'm healthy??)

I'm currently reading "The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health" by Paul Campos. It's good. Anyway.

He seems to be making three arguments, all of which are supported from a research perspective (I keep looking up his referenced studies and shaking my head in amazement):

1. No studies have shown any health benefits for people who go from an Overweight BMI to a Normal BMI. The only studies where, statistically, overweight people have been shown to have higher health risks in general are those studies where they are lumped in with obese people (so, for example, the mortality rate for "obese and overweight" individuals might be higher, but that doesn't really indicate anything about just the "overweight" folks). Research is spotty, but a LOT of research, both larger and smaller studies, in varying populations, has shown that the lowest mortality risk is among people in about the 23-28 BMI range (stradding "Healthy" and "Overweight").

2. Among normal, overweight, and obese individuals alike, better health outcomes are statistically correlated with LIFESTYLE changes, even if no weight loss occurs as a result of those changes (exercise, healthier diet, lots of veggies, etc), but have never been really correlated with weight loss INDEPENDENT of lifestyle changes. We have taken people of all weights and tested various lifestyle interventions, and those improve health across the board, for all weight classes. There is no way to correlate WEIGHT LOSS itself with better health outcomes, because you can't induce weight loss without lifestyle changes. So no one knows whether losing weight actually has health benefits in and of itself, or if it only has benefits because of the lifestyle changes associated.

3. People who restrict food intake, or those who lose weight and then gain some portion of it back, are at a higher risk for death than those who had never lost weight or restricted intake at all.

This book and the research I'm reading to accompany it is making me question my fundamental beliefs about my weight. See, currently, I'm at a BMI of 25.6...just barely over into that "overweight" range. I've NEVER questioned whether it was healthier to be out of that range (though I have questioned, and continue to question, whether it would be possible for my body to do so in a sustainable way). I do lead what I would consider a very healthy lifestyle - lots of physical activity, whole grains, lean proteins, massive amounts of greatly varying vegetables and fruits. Still, there's a little sense of failure in the back of my brain - a belief that I could be doing MORE to make myself healthier by getting my BMI into that "healthy" range.

Anyway, I'm wondering if people have any thoughts on this. Am I deluding myself in thinking that I might be healthier and less likely to die an early death at a sustainable, well-nourished, physically active BMI of 25.6 than I might be at a less-well-nourished, less-sustainable BMI of 22? Should we always aim as low as we can ever dream to hit on the BMI scale, or should we consider other factors? Is being moderately overweight unhealthy in and of itself, or is it only unhealthy in that it is associated with an inactive lifestyle and a poor diet?

Want to put the necessary caveats in here - I'm obviously more healthy now than I was at 295 lbs, or even 200 lbs - I can feel it in my body and would never argue it (though whether it is due entirely to the WEIGHT being off vs. to the LIFESTYLE changes is another matter). I'm talking about the few pounds separating "overweight" from "normal", and whether that distinction is useful or meaningful.

[NightengaleShane]

Yeah, I don't think it is a big deal to just be a little overweight as long as your habits are healthy and you are in tune with your body.

Also, the BMI chart does not account for body composition. I think someone ten pounds overweight with a percent body fat of, say, 22 is healthier than someone of normal weight with a body fat percentage of 30 or more. I have seen A LOT of "normal weight" people with VERY high body fat percentages. I have also seen normal/healthy weight and thin people with heinous blood chemistry.

However... while I don't think it is a big deal to be overweight (or even borderline obese in SOME cases), morbid obesity is unquestionably a health risk. The body just isn't meant to lug so much around.

Am I deluding myself in thinking that I might be healthier and less likely to die an early death at a sustainable, well-nourished, physically active BMI of 25.6 than I might be at a less-well-nourished, less-sustainable BMI of 22?
Not in my opinion, as long as you are happy, healthy, and comfortable with your body inside and out.

Should we always aim as low as we can ever dream to hit on the BMI scale, or should we consider other factors?
I don't think aiming as low as possible is necessary. I must admit, when I hit my "ultimate goal" of 125, I secretly thought about losing even more and going lower. For a little while, I wanted to weigh 115, which would be the lowest possible healthy weight for my height. I tried to get down to 115, but my body didn't particularily enjoy my attempts. I then realized I was sneakily returning to my eating disorder tendencies and decided to completely turn my focus to muscle and body fat.

I think sometimes our bodies sort of direct us to what our ideal weight should be. Some of us ended up losing more than anticipated and others ended up rethinking their goals. I think people should choose a maintenance weight that they are comfortable at both physically and emotionally... along with being one they truly can maintain. If we choose a weight that is near impossible to stay at, hunger and discouragement may follow

[mandalinn82]

Shane - thanks. Part of my question had to do with mortality studies and where mortality "bottoms out" on the BMI scale. So if you look at mortality and BMI, you find that the lowest chance of death based on BMI is actually at a BMI of somewhere in the 26-27.4 range. There are at least two studies that have shown that.

So according to that data, if someone with a BMI of 26 loses weight, their chance of dying will actually go up.

http://www.halls.md/bmi/mort.htm

http://archinte.ama-assn.org/cgi/con...ct/160/17/2641

I just don't know what to think. This book really challenged a lot of my assumptions about where weight "should" be.

[KforKitty]

Personally, I believe that providing you are otherwise healthy and have no other problems (heart disease, high blood pressure, diabetes) then having a BMI in the overweight range is fine.

Kitty

[Mudpie]

BMI is a number. It's merely an indicator of a range of "healthy" body weights. It should be used just as one of the many tools we have to measure our health.

IMHO it's not that accurate either. I am in the very high BMI normal range for my height because I carry a lot of muscle and I have a medium bone structure.

I work out every day and I walk all day too. I score really, really well on all the health tests at my annual physical. I wear size 6 clothing. I eat mostly lean proteins, veggies, and fruit, whole grain carbs (with the occasional cookie/candy binge thrown in but I'm not a saint).

I carry almost no fat in my abdomen (which is one of the highest health risks).

I am the healthiest I've ever been in my life, yet my BMI indicates that I'm not. I don't believe that the BMI is the deciding factor here. How I look and feel and what my doctor tests with my annual physical guide my lifestyle, not just one number.

Dagmar

[midwife]

Very interesting questions, Amanda.

My answer is, heck if I know!!! I think there is so much that the scientific community is learning about weight, weight loss, the health of the formerly obese, and how the formerly obese differ from the never-obese.

I was thinking that I want to drop another 10 pounds....mainly cause I think it will make me faster when I run....but (and here's the big buts!) I am maintaining pretty easily right now, eating well but not perfectly, I have an exercise regimen I like and can maintain, and my body just seems to like this weight range. Perhaps it is a new set point for me. I also like the muscle I have worked so hard to gain and I don't want it to go away. I have a normal BMI but it is upper normal, definitely not lower normal.

The BMI has so many limitations that I'm not sure how it even applies to those of us who are reduced obese and lift weights. I think right now there are more questions out there than answers. I haven't read the book you reference (and I probably won't---not for lack of intellectual curiosity but for lack of time). I do think that this is the old chicken and egg question: what is more beneficial: the behaviors or the weight the behaviors help our bodies to live at? My supposition is that it is the behaviors---and that our physical selves crave and respond to those behaviors in such a way that we lose enough fat to balance out at a new set point....even if >sob< it means we might never see 149 on the scale....

All disclaimers (YMMV, just opinions, it's obnoxious for me to make such general statements, etc.) apply.

[paperclippy]

Amanda, that sounds like a really interesting book. I agree that it doesn't make sense that a BMI of 25.1 should be more detrimental to your health than 24.9. It makes sense that your diet and exercise are really the things that make a difference -- it's just that often those things lead to weight loss, I think. There are very few overweight people I've known who got that way by eating massive quantities of healthy food, although of course it is possible.

I'm not sure what to think about the study that people with BMI of 26 have lower mortality. I'd have to do more reading on it (I admit I didn't read the links you posted yet).

Personally I am at the very top of the normal BMI range right now. My goal weight is a BMI of 22.3 assuming I am 5'4" and 23.0 if I'm 5'3" (doctor says I'm 5'3" but I've been told I'm 5'4" the rest of my life). I was perfectly happy maintaining at my goal weight, and never had much interest in losing more than that. I'm not comfortable with my current weight, but my gain the past year was due to thyroid problems, not due to my diet or exercise changing.

[kaplods]

I think the goal of weight loss for health, and the goal of weight loss for beauty are sometimes at cross-purposes. For many people, the goal of beauty far outweighs the goal of health. People do a lot of horrendously unsafe and unhealthy things to lose weight (and a lot of them are even published as magazine articles or books). This could explain why some of the lower BMI's might have a higher death rate. Also, there is the fact that many diseases cause appetite loss and wasting, so an increase in low BMI deaths could in part, be attributed to the fact not that low body weights cause death, but that some diseases contribute to lower body weights and higher death rates.

I think there are far too many variables to determine the optimal weight/fitness for everyone (whether that's a set number for us all, or a number that could be determined for any individual). There's also the question, of even if there is an optimal level, what is required to get there, is it possible or feasible for everyone. Does everyone need to regularly run marathons? How fit is fit enough?

At this point, for me it's all academic, because I have so much progress still to make. I don't have to ask how healthy do I want to be, because it sure isn't where I am now. When I get closer to goal though, it will become more of an issue. An important part of what I'm learning now, is paying attention to my body and how food and activity levels make me feel. I'm getting better at recognizing hunger cues, and I'm finding I have more of them as I make progress (for a very long time, I thought I just didn't have an appetite switch. Now I realize that it's there, carbs and bad habits just drowned it out).

I'm thinking (or maybe just hoping) that paying attention to my body, I'll be able to find my personal optimal weight/fitness. If I lose weight beyond my personal best, I'm thinking maybe there would be signs that I've gone too far. Feeling weaker instead of stronger. Seeing perhaps signs of immunity changes, as in less resistance to colds and flus. Finding it difficult to maintain the weight without anxiety and stress...

I don't have any facts to back this up, so maybe it's just wishful thinking.

[paperclippy]

Kaplods - I love using immunity changes as a sign of health. When I was heavy, never exercised, and ate a terribly unhealthy diet, I was sick all the time. A flu season couldn't go by without me having at least four illnesses. Since I've been eating healthy and exercising, I have had maybe two colds over the past three years, each of which only lasted a couple days.

[Circebee]

What a wonderful, sane discussion of weight loss and health! I wanted to put in my two cents as well. One factor that may be involved in the higher mortality rate of lower BMI individuals is that some of these people are putting their bodies through tremendous stress to remain there if the natural , healthy, genetic "set point" of their body was intended to be a bit higher. This stress may take an effect on the body in the form of a lowered immune system. Even if it is through a good diet (at a low caloric level), and intense exercise, this can take it's toll over the long run. Just ask professional athletes! I realize that just maintaining a low BMI and low % body fat may be the peak of health for some, but I personally have experienced more upper respiratory infections and urinary tract infections (I know, TMI) at a very low-normal BMI WITH GOOD NUTRITION AND EXERCISE, than at 130 pounds WITH GOOD NUTRITION AND EXERCISE. I know that my efforts to stay at 115 pounds are for vanity only, and maybe I'll be able to let this need for a low number go in the future. Another factor affecting even low wieight, low % body fat, people is that they have little to no reserves if they become ill, and it is well researched that 10% underweight people have a much higher risk of mortality when ill than do others of normal or overweight status (obesity is its own issue). If you are sitting at a BMI of 19, hey, a nasty flu can really wipe you out weight-wise and put you at risk for complications. Just another opinion, here!

[jimaterry]

all the charts to calculate my bmi that i have found online only ask for height and weight.. when i was 18 i was 5'4 and 130 lbs...according to the charts my bmi was 22.3.. now my bmi is 52.6.. but...and this may be TMI here.. my breasts weigh 7lbs each.. they did at 18 at 130lbs.. and they do now at 297lbs.. i havnt gained or lost any in my breasts..so i personally dont put a whole lot of stock in bmi.. i think eating right, feeling good etc is much more important.. those calculators dont take into acct weather you have poundage in your breasts or are flat chested lol..no matter what i weigh at any given time, i take off a stone ( in my head only lol) and think.. that is what i would weigh if i were flat chested lol..

and yes, i looked rediculous that small at 18 with my huge breasts... i got so tired of people staring i got a t shirt that read....

president of the itty bitty (you know what) commitee figured if they were gonna stare i would give em a chuckle

just realized this was in the living maintanace group.. obviously im not there yet.. just thought it was an interesting topic ...didnt mean to intrude

[Circebee]

See, KAPLODS, you are just wisely doing the mental and physical prep-work for being in the best health you can be at the same time! You are so ahead of me in the weight sanity department. I love to read your posts, as I find myself nodding my head and saying, "YES! That's what I WANTED to say"!
I just love this forum!
-Circebee, 3FC Fangirl

[JulieJ08]

Originally Posted by mandalinn82

So according to that data, if someone with a BMI of 26 loses weight, their chance of dying will actually go up.

I'm not sure you can actually say that. Are any of the studies prospective trials? There's a big difference between calculating risk or longevity at different BMI's, and saying that changing your BMI will change your risk or longevity.

The same thing is true with, say, blood pressure. Studies show various risks are higher in people with higher blood pressures. But not all interventions that decrease blood pressure decrease those risks. Some do, but not all. Same with cholesterol levels, or even blood sugar levels in diabetics.

It's a very important distinction. Correlation isn't the same thing as causation.

[midwife]

Originally Posted by jimaterry

just realized this was in the living maintanace group.. obviously im not there yet.. just thought it was an interesting topic ...didnt mean to intrude

Everyone is welcome to post here. Just cause you are not at goal, doesn't mean you are not a maintainer. I am assuming you would prefer to not regain the weight you have already lost, right?

[CountingDown]

I echo the thoughts of those above.
I believe that the line between normal and overweight BMI is not a demarcation of "health". I do believe lifestyle is a very important factor, more important than BMI.

For those in the normal weight category being more likely to die sooner - that does make sense. If you think of all the frail little old folk that you have seen over the years, they may be in a normal BMI group, but they are very prone to falls and fractures - as well as nutrition related ailments. They would factor into that statistic.

For those that bump into the overweight BMI, but exercise, eat well, and practice other healthy habits, I don't think BMI makes any difference.

Abdominal fat and extra weight affecting joint health are the only two concerns I would have. So, unless those come into play, I think that we ALL know our bodies best. Science is still murky on how all the factors play together. Each of us has genetics and a whole host of other factors that help determine what is healthy for US. No chart should be the deciding factor.

Amanda - I think you are probably exactly where you should be.