Reassessing the Fear of Fat
By Abigail Trafford
This good news comes from the New England Journal of Medicine, in which the editors rail against the nation's obsession with dieting "in an attempt to look like our semi-starved celebrities."
It turns out that the hazards of being overweight and the benefits of weight loss have been exaggerated, the doctors note. It's all a matter of degree. For most people who dwell in the gray zone of modest flesh creep, the message is simple: stop worrying and start living.
"Countless numbers of our daughters and increasingly many of our sons are suffering immeasurable torment in fruitless weight-loss schemes and scams, and some are losing their lives," conclude physicians Jerome P. Kassirer and Marcia Angell in an editorial in last week's issue of the medical journal. "Doctors can help the public regain a sense of proportion."
Welcome back, Rubens! The old masters understood the beauty of soft rolling flesh, the allure of a solid arm or thigh, the sensuousness of a full cheek. How drab and haunted and drugged out so many fashion models look beside a ripe Rubens portrait.
Medical science wants to spread the word: It's time for Americans to go from silhouette to substance. Goodbye to X-ray chic. Hello to a new ideal of flesh and blood!
In moderation, of course.
Obesity -- severe overweight -- is linked with major health problems including heart disease, high blood pressure and diabetes. But for those who are just somewhat overweight, the risks are less clear.
According to a 12-year study of more than 62,000 men and 262,000 women, the dangers of being overweight are greatest for younger people. To be sure, weight gain is associated with an increased risk of death, largely from heart disease, but the additional amount of risk appears to be modest and declines with age. By the time people reach 75, the fat effect virtually disappears.
What's more, the hazards of too much solid flesh seem to be limited to people who are significantly overweight -- not to the legions of chronic dieters who just wish they were a few pounds thinner.
Scientists calculate what weight category you're in by a complicated formula called the body-mass index, or BMI. (Divide your weight in kilograms by the square of your height in meters.) To put this in layspeak, the "ideal" weight, or baseline, for a 5-foot-4 generic woman is about 123 pounds -- or a BMI of 21. Every additional six pounds translates into another point on her BMI.
Yet a healthy BMI can range up to 25. That gives a woman at least a 20-pound margin of grace. To see an effect on health, the BMI has to get up to at least 27 or 28, Kassirer and Angell point out. That means our generic woman would have to weigh almost 165 pounds to be in obesity trouble. The archetypal 5-foot-10 man would have to hit about 196 pounds. For a woman between the ages of 65 and 74, a major increase in mortality risk only comes with a BMI of nearly 41. That means she would have to weigh 238 pounds, a weight gain of more than 100 pounds from the baseline. A generic man, 75 years and older, would have to weigh 294 pounds.
In this analysis drawn from participants in the American Cancer Society's Cancer Prevention Study, there may even be a flesh advantage. The lowest death rates, for example, among women 55 and older were found in those with BMIs between 23 and 25 -- which is definitely more fleshy than the baseline measure of 21.
For all those Americans slouching toward middle age, this year's resolution should be to lighten up in the head. Accept a certain robustness as time goes by. Instead of reducing poundage, why not shed our cultural bondage to thinness?
No one is minimizing the danger of obesity, especially in younger men and women. They have a medical problem and need to be treated. "In our view, doctors should provide advice if an overweight patient asks for help in planning a weight-loss program and recommend weight loss if a patient is suffering from . . . hypertension, diabetes, or osteoarthritis, of if a patient is so obese that he or she is clearly in jeopardy," conclude Kassirer and Angell.
But for many people who are mildly overweight -- those who pledge on New Year's to lose 10 or 20 pounds -- a dose of common sense is maybe what the doctor should order. As Kassirer and Angell put it: "Until we have better data about the risks of being overweight and the benefits and risks of trying to lose weight, we should remember that the cure for obesity may be worse than the condition."
That advice leaves us free to make more meaningful -- and realistic -- resolutions for body and soul. Perhaps a resolution to take a daily walk down a tree-lined street before work. To send a weekly message to far-flung friends. To listen to music in a quiet room. To clean out the attic. To take a child to see a waterfall. To love a little more.
Those are the kinds of resolutions that make for a healthier new year.
© Copyright 1998 The Washington Post Company