A Few Extra Pounds May Save Your Life: Latest Research Indicates Being a Little Overweight Can Reduc

Nov 07, 05:38 AM

Current Headlines: By Carrie Peyton Dahlberg, The Sacramento Bee, Calif.

Nov. 7--Just in time for Thanksgiving comes the word we've been longing for: People who carry a little extra weight are dying at lower rates than their counterparts of "normal" size.

The latest research, published in today's Journal of the American Medical Association, stirs up unresolved conflicts about the true risks of those love handles.

For years, a public health drumbeat has argued we're eating ourselves into early graves, risking cancer, heart disease and other ills. Skinny mice live longer, we're told. Losing even a few pounds will improve your health.

Yet a counter-rhythm also has been gaining volume, as studies of large groups of people document that moderately chunky folks aren't actually dropping dead as anticipated. They're outliving those of normal size.

Even the federal Centers for Disease Control and Prevention has flip-flopped, sharply lowering its estimates of obesity-related deaths over the past three years.

Now federal officials are downplaying the death-risk angle and instead telling people that their daily lives and health care costs will improve if they weigh less.

Those who study obesity -- and those who study obesity researchers -- suspect two things are going on.

First, the relationship between weight and health is much more nuanced and personal than can be explained with a simple weight chart or a single study. Blood pressure, cholesterol, blood sugar, family health history and even waist circumference play a role.

And second, we have such a cultural horror of fat that we're predisposed to believe even a little is bad for us.

"We see our data through cultural lenses, and the cultural lens that most of us wear in contemporary American society is one in which thin is better," said Abigail Saguy, a UCLA sociology professor who is writing a book on medical and political debates about weight.

Katherine Flegal, lead author of the latest study and a senior research scientist at the National Center for Health Statistics, puts it differently.

"The whole issue of weight and mortality is fairly complex. There's no simple, one-size-fits-all way to talk about this," she said.

Flegal advises people to see their doctor for the best assessment of their personal health risk at any weight.

More broadly, the CDC now recommends that at all weights, people should exercise regularly and eat nutritiously to optimize health. Yet the CDC also promotes a weight range that is coming under increasing fire, from its own researchers and others.

At the crux of the debate is who is "overweight" and what the term really says about health.

In 1998, in a controversial move that some argued played into the hands of the diet drug industry, the federal government toughened its guidelines, adding roughly 25 million Americans to the ranks of the dangerously hefty.

Since then, the standard adopted by the National Institutes of Health says that those with a body mass index, or BMI, of 18.5 to 24.9 are "normal," with "overweight" ranging from 25 to 29.9 and "obese" starting at 30.

BMI is a ratio of weight to height, and for a woman who is 5 feet 4 inches tall, the standard says that anything between 108 and 145 pounds is normal, 146 to 174 pounds is overweight and 175-plus is obese.

Yet doctors and researchers have argued about whether the data really support that description of "overweight."

"Ultimately, we're going to have to do better than BMI," said Dr. Robert Lustig, who runs the pediatric obesity program at the University of California, San Francisco.

A BMI between 25 and 30 actually can reflect three factors linked to improved health -- muscle mass, bone density and subcutaneous fat, Lustig said. It also can capture one thing linked to bad health: visceral fat, which gathers at the abdomen and is metabolically active in dangerous ways.

Dr. Tom Hopkins, a Sacramento weight-loss specialist, shares the view that no well-documented dangers apply universally to everyone lumped into the "overweight" category.

Hopkins doesn't worry about the faint hint of jowls at his jaw line, or the 205 pounds he carries on a 5-foot-11-inch frame, giving him a BMI of 28.6

"Fitness counts. Fatness doesn't," said Hopkins, who eats right and works out regularly.

The heavier people get, though, the more the ambiguities fade. By the time BMI tops 40 -- for a 5-foot-4 woman that would be 233 pounds or more -- much firmer links emerge with health problems.

In 2005, the same research team that conducted the newest study took a broad look at the issue, based on a large public health database. That study found unexpectedly low deaths among people who were overweight but not obese.

This time, Flegal and three other researchers with the CDC and the National Cancer Institute delved deeper, seeking links between specific weight ranges and causes of death.

Their conclusions:

--A little bit of pudge -- BMIs of 25 to 29.9 -- is correlated with lower death rates from respiratory disease, injury and a host of other ills when compared with people of normal weight.

--Merely overweight people appear to have no increased risk of death from cancer or heart disease, the two leading causes of death in America.

--A link between heart disease deaths and weight emerges only at BMIs above 30 and has been steadily weakening, possibly because of better treatments for cardiovascular disease.

--There is no link between weight and overall cancer death rates, but obese people do die more frequently from seven cancers considered weight-related, including colon, breast and pancreatic.

--The overweight and the obese, combined, have a higher risk of dying from kidney disease and diabetes.

Flegal stressed that no one really knows what is behind the statistical links between certain weights and certain fates. More study is needed.

Researchers speculated that overweight people may be better equipped to withstand infections, injuries and medical procedures because they have greater nutritional reserves and often more lean body mass.

For now, as the science unfolds, we're left with a broad consensus on basic health advice: Get plenty of exercise, eat your vegetables, and make sure your blood pressure, cholesterol and blood sugar levels are monitored and treated as needed.

And maybe one day, the now quaint notion of pleasingly plump will give way to a trendy new concept: protectively plump.

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