(This article appeared previously on Grandparents.com.)
You know that excess weight can be harmful to your health. You know that obesity — when you have a Body Mass Index (BMI) higher than 30 — affects more than one-third of American adults. And you know that it’s related to a range of health problems, including heart disease, diabetes, stroke, osteoarthritis and some cancers.
What you might not know is this: In certain medical situations, carrying around a few extra pounds might protect a patient. It’s called the obesity paradox, and it flies against most of what we know about the relationship between health and weight.
The obesity paradox begs us to take a look at more than just the numbers on a scale.
— Dr. Wendy Scinta, Medical Director of Medical Weight Loss of New York
What is the Obesity Paradox?
The obesity paradox idea is generally attributed to Katherine Flegal, an epidemiologist at the Centers for Disease Control (CDC). In 2013, her team published a meta-analysis in The Journal of the American Medical Association that found that Grade 1 obesity (meaning a BMI between 30 and 34.9) “was not associated with higher mortality” and being overweight (BMI between 25 and 29.9) “was associated with significantly lower all-cause mortality.”
This means, in terms of risk of dying, overweight people are often better off than normal-weight people, while those with Grade 1 obesity are about the same.
It should be noted that severely obese people (BMI of 35 and up), who make up about 14 percent of U.S. adults, do not benefit from the obesity paradox. In fact, it’s just the opposite for them; in these cases, extra weight greatly hurts chances of survival.
Still, those carrying some extra pounds can find themselves better off.
“Once you have a disease (such as heart disease or diabetes), having extra weight may be more protective for you than someone who is of normal weight or underweight — particularly when going through a major operation or procedure,” says Wendy Scinta, M.D., medical director of Medical Weight Loss of New York and the president-elect of the Obesity Medicine Association. “The extra weight can actually be used as an energy store in the healing process, especially if you are bedridden for a period of time.”
That’s not all. In addition to recuperative support, studies have found that added pounds can be beneficial to people with type 2 diabetes, osteoporosis, arthritis (men only) and those at risk for premenopausal breast cancer.
Sometimes, as in the case of type 2 diabetes, being overweight lowers the risk of death. Other times, as in premenopausal breast cancer, it reduces the risk of becoming ill. There have even been links detected between a little extra weight and the likelihood of avoiding dementia.
So what’s the paradox? Well, excess weight makes you more prone to disease in the first place. And therein lies the problem.
The Obesity Paradox Controversy
This idea — that what protects you later is, paradoxically, the same thing that made you sick in the first place — is part of what makes the obesity paradox so contentious. In fact, some high-profile researchers and medical experts don’t believe it exists. They cite problems with Flegal’s methodology and worry that her conclusions could prevent doctors from emphasizing the hazards of obesity, or be misinterpreted as an endorsement of excess weight gain.
“I would be very cautious about recommending someone become obese,” says June Stevens, a spokesperson for the Obesity Society and professor of nutrition and epidemiology at the University of North Carolina at Chapel Hill, who is skeptical of the obesity paradox. “I do not think obesity is good for you, in general.”
Scinta agrees. Though she believes that extra pounds might help someone fighting a disease, she maintains that obesity is, in itself, unhealthy.
“As an obesity medicine specialist, my goal is to help people reverse the chronic diseases … with weight loss,” she says. “Then, I would focus on preventing the return of those diseases through exercise, behavioral modification, a balanced diet and medical management.”
Downfalls of the Scale
Even if you’re not fully convinced, at the very least, the discussion on the obesity paradox encourages us to further examine the relationship between weight and reducing our mortality risk.
“The obesity paradox begs us to take a look at more than just the numbers on a scale,” says Scinta. “It supports our knowledge that the level of fitness, how much fat we carry and the location of that fat (hips versus stomach, for example) are more important than our BMI when it comes to long-term survival.”
This is where discussing your weight with a doctor comes in, along with exploring different tools to evaluate your health. Because, while BMI is helpful, it’s a pretty general tool.
“To me, a person’s ideal weight depends upon their height, weight, fat percentage and fat distribution,” says Scinta. “In my practice, I use a scale that measures body composition based upon impedance [electrical signals].”
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