As if primary care physicians don’t have enough headaches already, now we have to deal with wildly differing estimates of obesity-related deaths in America. Is obesity the new #1 killer, surpassing smoking with 414,000 extra deaths per year? Or,as was reported in the Capital-Journal on April 20, is the real figure 26,000, making it #7 on the list?
Both figures came from articles published in the Journal of the American Medical Association, a highly reputable source. As an editorial accompanying the latest article asked, is there any value in trying to make such estimates if reasonable scientists come up
with wildly different figures?
Well, no. That’s the short answer. This is not science, it’s research roulette, and it serves no purpose except to confuse our patients. Here’s a short course on what was reported, and what it really means:
First, this study and all such studies are based on something called the Body Mass Index, or BMI. That sounds scientific, but it’s not. It’s just an old-fashioned height-weight table converted to kilograms and meters, then plugged into a formula. By BMI, Michael Jordan was overweight when he played for the Bulls; ditto Arnold Schwarzeneggar as Mr. Universe; and 56% of NFL players are, too.
That’s because BMI does not separate muscle weight from fat weight. Any conclusions drawn from BMI data are pure baloney. What we want to know is our fat percentage. That’s the figure we use in our medical practice, and you can purchase inexpensive home scales which will supply the same information.
Second, these studies have foolishly lumped together the truly obese and the merely overweight. The most recent found 112,000 extra deaths among the obese population, which would make obesity the #2 killer behind smoking. But the merely overweight had 86,000 fewer deaths than predicted. Subtracting the latter from the former
resulted in the figure of 26,000-- and an interesting, but misleading, headline.
Assuming that the data on overweight Americans means anything at all (remember, Mr. Jordan is included here), why would semisupersized Americans die less frequently than the rest of us? Nobody knows, but here’s a guess: they have more risk factors, but these get identified and treated by the new wonder drugs for diabetes, cholesterol, and
high blood pressure.
Third, research has made it clear that if you have to choose between being physically fit and achieving your ideal weight, you ought to choose fitness. Junk your diet and join a gym. Our national obsession with dieting is unhealthy and unhelpful. If you can’t lose
weight by reducing portions of the food you like to eat, forget it and take a hike.
Finally, here’s an assertion you can take to the bank: overweight people are at high risk of becoming obese, and both categories are consuming so much money for expensive treatment that health care is becoming unaffordable. What we need is self-discipline, and if we don’t find it, we’re heading for a health care train wreck.
