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It Wouldn't Kill You to Lose a Few Pounds. Or Would It?

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Tuesday, July 7, 2009

These days it seems our entire way of life is predicated on the belief that being overweight is terrible for you. We're waging war against the obesity epidemic, which public health experts call one of the great threats to our society. Countless diet books and programs promise to help us get thin because our lives depend on it.

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The government joins in, too. Just two weeks ago, the Centers for Disease Control and Prevention launched a Web site designed to help small and medium-sized employers devise strategies for helping workers manage their weight. At the end of this month, the CDC will convene its first "Weight of the Nation" conference in Washington to discuss obesity prevention and control.

But what if it turns out being fat's not so bad after all?

Late last month, the journal Obesity published two studies that showed overweight and obese people can expect to live at least as long as people of "normal" weight, while underweight folks are at increased risk of premature death.

In one, a survey over 11 years of nearly 27,000 Japanese men and women ages 61 to 79, underweight people and those at the low end of the normal weight range had a greater risk of death than those squarely in the normal range, while neither overweight nor obesity was found to elevate risk of death.

In the other, a Canadian study involving more than 11,000 people ages 25 and older that aimed to pin down the relationship between overweight and mortality, underweight people were at far greater risk of dying during the 12-year study period than those of normal weight, while those who were overweight and obese were at far less risk of dying. Only the very most obese were at increased risk of death.

Though these findings might sound surprising, they are in keeping with those of earlier research, including studies published in the Journal of the American Medical Association in 2005 and 2007.

So why is it so hard to believe, even in the face of such evidence, that being fat's not exactly a death sentence?

Morgan Downey, policy director for the Stop Obesity Alliance, a nonprofit headquartered at George Washington University, also notes that obesity research is complicated by an array of confounding circumstances such as age, ethnicity, sex and lifestyle, which make it hard to establish clear cause-and-effect relationships between poundage and health. Researchers are even scrutinizing the body-mass index, or BMI, the commonly accepted base for defining weight categories, from underweight to morbidly obese.

The BMI, developed in 19th-century Europe and based on a mostly Caucasian population, may not be a reliable indicator of body-fat levels for blacks and Hispanics, for one thing. For another, scientists analyzing data don't always agree as to the exact point at which weight becomes tied to mortality.

Downey points out that, paradoxically, obesity/mortality study results might be skewed by the medical community's focus on treating conditions associated with overweight: For example, he'd be interested in seeing a study in which no participants were on statins (cholesterol-reducing drugs).

And he, like other experts, is certain that obesity contributes to poor health, even if it doesn't kill you.


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