BMI

proling: bad medicine

Abnormal cardiometabolic Prole 23.5% (16.3 million people) 1 48.7% (34.1 million people) 68.3% (42.0 million people) Normal cardiometabolic prole 76.5% (53.0 million people) 51.3% (35.9 million people)
2

TOTAL 100% (69.3 million people) 100% (70.0 million people) 100% (61.5 million people)

Untreated

Normal weight

Overweight Treated Obese

1 False negaOve 2 False posiOve

31.7% (19.5 million people)

2

Bacon and Aphramor, Nutr J., 2011, 10:9

Using BMI, 51% of healthy people are deemed unhealthy

Wildman, et al., Arch Intern Med, 2008, 168:1617-1624 Slide courtesy of Dr. Deb Burgard

Myth: BMI is meaningful

Body Mass Index
Not evidence-based Pathologizes certain bodies
Overweight? There is no weight over which one is necessarily unhealthy Many overweight and obese people live long, disease-free lives

All other weight/adiposity-based measures (e.g. waist circumference, % body fat) similarly awed
Bacon and Aphramor. Nutr J 2011: 10(9)

Myth: Fat Causes Disease

Several diseases are associated with obesity, but this doesnt mean that fat causes disease. Confounding factors play a larger role in disease incidence. Examples of confounders:
tness discriminaOon dieOng/weight cycling socio-economic status (+ many more)
Bacon and Aphramor. Nutr J 2011: 10(9)

Fitness vs Fatness: RelaKve Risk of All- Cause Mortality

Normal Weight 1 2.2 Fit Unt 3.1 Overweight 1.1

2.5

Obese

1.1

0 0.5 1 1.5 2 2.5 3 3.5 Wei et al. RelaOonship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men. JAMA, 282:1547-1553, 1999.

Socioeconomic Status (SES)

Consider type 2 diabetes (T2D)
Poverty is much more strongly associated with T2D than weight. Also, much evidence suggests that the insulin resistance that underlies T2D causes weight gain.

McDermof, Soc. Sci. Med. 1998;47(9):1189 Wamala, et al., Diabetes Care. 1999;22(12):1999

Fat/Health Risk: Summary

Fat is exaggerated as a health risk.
Overweight and moderate obesity are NOT associated with decreased longevity. Although many disorders are more common among larger persons, issues other than weight play a larger role.

Weight sKgma carries larger health risk than weight itself.

Bacon and Aphramor. Nutr J 2011: 10(9)

 Short-term studies

Myth: Weight Loss is Proven to Improve Health and Longevity

Example: if parOcipants lose weight on an exercise program, health improvement may be afributable to the exercise Examples of known adverse eects: toxin release from fat Ossue; inammaOon; most parOcipants will regain the weight (many contraindicaOons from repeated weight cycling including decreased self-esteem, increased cardiovascular disease, etc.)

cant control for habits that induce weight loss dont monitor adverse eects

Long-term (epidemiologic) studies nd weight loss is associated with increased mortality

Bacon and Aphramor. Nutr J 2011: 10(9)

Myth: Diet, exercise or surgery are eecKve for sustained weight loss
No exercise, diet, or surgery study has ever demonstrated long term maintenance of weight loss for any but a small minority.
Well-studied for diet and exercise programs The limited long term research for surgical studies show eventual weight regain

Mann, American Psychologist, 2007, 62(3): 220-233. Bacon and Aphramor. Nutr J 2011: 10(9)

Why dont exercise/diet work?

There are many contributors to energy balance Fat Kssue is homeostaKcally regulated
RegulaOon is long-term (slow) Lax resistance to weight gain Strong resistance to weight loss Vulnerable to up-regulaOon

Regulatory mechanisms can cause compensaKon; result: weight is regained despite conKnued diet/exercise behavior
Strohacker, et al., Front. Biosci. 2010;E2:98

Health at Every Size (HAES)

Weight neutral Supports body acceptance Encourages nourishing lifestyle habits. Examples:
IntuiOve eaOng (as opposed to dieOng) Joyful movement Meaningful work SupporOve relaOonships/community Stress management

Supports development of stereotype management skills Commifed to social jusOce, insOtuOonal and cultural change
(Not limited to individual intervenOon)
Bacon, Health at Every Size, Benbella Books, 2010

Thank you
AddiKonal informaKon can be found at www.LindaBacon.Org