Medical World Debates Risk of Being Pudgy
"There is no basis in the medical literature to draw the conclusion that having a BMI between 25 and 29 an is an independent health risk," he says. "It is quite preposterous to make that claim."
Such out-of-step pronouncements are fighting words in the field of nutrition and health, where many consider the evils of fat to be beyond question.
Former New England Journal of Medicine Editor Jerome Kassirer remembers the indignation six years ago when he wrote a skeptical editorial calling the data linking weight and ill health "limited, fragmentary and often ambiguous."
"We got flack from just about everybody except the fatties," he remembers, although he hasn't seen anything since to change his mind.
One of the most persistent doubters is Steven Blair of the Cooper Aerobics Center in Dallas. His research buttresses the idea that fitness is more important than fatness.
Following 25,000 Cooper patients for eight years, he found that it is better to be fit and fat than skinny and sedentary. In fact, overweight people who have good stamina on a treadmill test live just as long as equally fit people who are not overweight.
"If you look at people in the overweight category, many have none of the conventional risk factors, like elevated blood pressure and cholesterol," says Blair. "Should they be stigmatized and treated? For what?"
Many obesity experts concede Blair has a point: People who are overweight but fit probably do escape many of the consequences of their size. But they often add: So what?
"It may be true, but the fact is, overweight people are not fit," says Dr. Xavier Pi-Sunyer, head of obesity research at St. Luke's-Roosevelt Hospital Center in New York City. "The average American is incredibly sedentary."
Not always, says Blair. About half of the oversize people who get physical exams at Cooper in fact are physically fit, based on their treadmill tests. While hardly a random sample - these people are overwhelmingly white, educated and well off - Blair contends plenty of overweight Americans are just like him.
"I'm a short fat guy," says Blair, whose BMI is about 32. "Would I rather be a short thin guy? Sure. But I'm not. I run everyday and eat a healthy diet and do what I can."
Until a few years ago, government agencies generally agreed that concern about weight begins when a man's BMI hits 28 and a woman's 27. That's 152 pounds for a 5-foot-3 female. But in 1997, the World Health Organization adopted a new standard. BMIs between 25 and 29.9 were now "preobese."
The next year, an expert committee of the U.S. National Institutes of Health came to the same conclusion and called the new category "overweight." Suddenly an extra 35 million Americans were judged to have weight problems.
"We felt it makes sense that if someone's BMI is between 25 and 30, they should not gain more weight," says Pi-Sunyer, who headed the U.S. committee. "We don't feel those millions of people should be trying desperately to lose weight. At a BMI of 30, the risk for both disease and early mortality is so great that people should begin to lose weight."
© 2004 The Associated Press