“For every complex problem there is an answer that is clear, simple, and wrong”
- Find out your current weight and BMI
- Find out your waist circumference
- Find out your body fat
- Excess adipose tissue (fat), particularly the type found in the midsection, plays a major role in poor health
- Losing weight (fat) and maintaining this weight is very likely to significantly improve physical and mental health
- Use a combination of evidence-based strategies to be able to adjust lifestyle habits (eating, activity, sleep, etc)
Before explaining the many variables that affect your weight, we feel it is necessary to highlight some facts about bodyweight, body fat, and its connection to health. We did this because this topic should be understood by all people who are trying to change their weight and because much of this information is not typically dealt with in most weight loss books.
The Extent of the Weight Problem in the U.S.
It is likely that the main reason you are reading this book is to learn what to do to reduce your weight, or better yet, your body fat. In the U.S., at any given moment, approximately 40% of women and 25% of men are trying to lose weight.1 It is clear that the percentage of overweight and obese adults and children have been steadily rising since the 1970’s.2 As of 2002, the percentage of adults classified as overweight was 34.7% and obese was 30.4%, totaling 65.1% of the adult population.3 However, it is important to realize that some of the increase is due to a change in the reference ranges used to determine the categories.4 In fact, the term “obesity epidemic” seems to be an exaggeration of the true change in weight. The actual average change in bodyweight for the majority of people during this “epidemic” has been about 6 to 10 pounds.5 There have been greater changes in the heaviest people but the majority of people who are now in the overweight and obesity categories have not gained a huge amount of weight.5 According to Campos et al:
In the US, to take a much-cited example, the so-called ‘obesity epidemic’ is almost wholly a product of tens of millions of people with BMI’s [body mass index] formerly in the 23-25 [normal] range gaining a modest amount of weight and thus now being classified as ‘overweight’ and, similarly, tens of millions of people with BMI’s formerly in the high 20’s [overweight] now having BMI’s just > 30 [obese] (p.1).5
The Body Mass Index
The method typically used to determine healthy and unhealthy bodyweights is the body mass index, referred to as the BMI. The BMI is basically the relationship of your height and weight. Normal weight, overweight and obesity are based on the BMI ratings of 18.5 – 24.9, greater than 25 and 30, respectively.6 However, there are many potential shortcomings with the BMI:7-9
- BMI does not tell you if the weight is fat or muscle (body composition)
- BMI does not tell you where the weight is distributed, i.e., is it in the midsection or the hips
- BMI does not tell you if there is more visceral or subcutaneous fat
- BMI does not differentiate between genders, ethnicity, age, or health status which can all modify the healthy range of weight/BMI for an individual
Interestingly, a lower body fat percentage in older men, which will probably mean they have a low BMI, has been associated with increased mortality relative to older men with higher BMI’s.10 The bottom line about the BMI designation is not always a good indicator of what is a healthy weight. However, it is a simple and quick method, that often helps to understand if you are at a healthy weight or not, but often it should not be used by itself.
- Calculate your BMI – HERE
Bodyweight and Health
There is no doubt the amount of fat that individuals are carrying has increased. The question is: Does extra fat increase morbidity (sickness) and mortality (death)? It has been a common position that people who are overweight will suffer from higher rates of morbidity and mortality relative to those who are at a normal weight, i.e., BMI of 18.5 – 24.9. This position is often the driving force behind public health messages to lose weight and one of the reasons people want to lose weight.
There is evidence that having higher levels of fat, relative to normal weight individuals, may NOT be unhealthy. This is not a new view. As early as 1954,11 and many times since then,8,12 the connection between body fatness and heart disease has been one of correlation and not causation. In recent years, a number of researchers have highlighted the fact that fat is probably not the cause of many diseases and premature death.5,13,14,15,16 For instance, a recent study in the Journal of the American Medical Association concluded that people who were underweight had a shorter life expectancy than those who were at a normal weight, and those who were overweight but not obese had a longer life expectancy than normal-weight individuals.16 Obesity and underweight are both strongly associated with greater morbidity and mortality, but being overweight by itself may not be detrimental to one’s health.5,14,15,18 Interestingly, there are a small percentage of obese, even grossly obese (BMI > 40), individuals that are metabolically healthy, meaning they do not exhibit physiological signs of poor health.19
This does not mean that people should not be concerned with excess fat. There are good reasons to suspect a high level of body fat, particularly visceral fat, as a cause of poor health. But, a good deal of research concludes that certain behaviors, particularly poor eating, exercising, and sleep habits, are the real causes of poor health associated with higher bodyweights.5,16,20,21 Therefore, it may not be the weight per se that is causing health issues associated with higher bodyweights, such as cardiovascular disease, diabetes and cancer.
Clearly the subject of bodyweight and health is not as simple as it is typically portrayed. These facts are highlighted because there may be many people who are trying to lose ten, twenty or even thirty pounds because they think they will be healthier if they do. That may not be the case. There is more to this story.
Body Fat Location
First, the most important aspect about body fat, regarding your health, is where it is stored. Body fat that is stored just under the skin is technically referred to as subcutaneous fat. Subcutaneous fat seems to have little effect on numerous risk factors for cardiovascular disease.20 In fact, larger hip and thigh measurements, commonly due to subcutaneous fat, are negatively associated with increased health risks.22 This means your risk goes down. On the other hand, fat that is located deep in the midsection, around the organs, technically referred to as visceral fat (VAT), seems to have a negative impact on health.22,23,24 In older adults this can be a greater risk factor than poor fitness levels.25 In general, the greater the amount of visceral fat a person has, the greater their risk of disease.22,23,24 One of the better, and relatively easy, measures of visceral fat is your waist circumference, which is measured at the level of the navel.23,24,26 When this number is 35” to 38” for males and 32” to 35” for females your health risk goes up some. If your waist is equal to or greater than 39” for males and 36” for females the risks of disease goes up considerably. Therefore, using these reference ranges and measuring your waist is a very good way to gauge your level of risk.22,23,24,26
Body composition assessments determine the relative amounts of fat and lean tissue (muscle, bone, and organs) that make up your total bodyweight. This is useful because a higher bodyweight due to an increase of muscle mass may not be unhealthy and can be health promoting.27 Body composition can be measured by many methods, such as skinfolds, bio-impedance, hydrostatic weighing and ultrasound. Each method has its own advantages and disadvantages. For consistency purposes, it is important to continue to use the same method. The results of a body composition assessment are given as the percentage of your bodyweight that is fat. It seems that men’s body composition should be under 28% to reduce their risk and probably closer to 22% to substantially reduce the risk of degenerative disease.28 Women should be under 37% to reduce their risk and probably be 30% or lower to substantially reduce the risk of degenerative diseases.28 A waist measurement should be included in the risk assessment to get a more accurate picture of the situation.
Fat: Just a Storage of Calories?
The focus has been on fat, in particular excess fat, and the potential for it to cause an increase in sickness and premature death compared to someone who has a normal or “healthy” amount of fat. The reason that fat has the potential to affect health is because it actually has many biological functions. In fact, fat (adipose tissue) has now been classified as an endocrine gland and not just a depository of energy.30 The new endocrine gland classification is due to the fact that fat cells secrete numerous substances which play many roles in the body.30,31 It is clear that fat cells are not just a depository of energy, but are collectively, a complicated tissue that serves many functions in the body.
Before recommending some guidelines for determining a healthy weight range, one additional variable must be discussed; genetics. Research conducted over the past two decades has led to the conclusion that weight is strongly affected by genetics.32-35 For example, Freidman states;
…compelling scientific evidence indicating that the propensity to obesity is, to a significant extent, genetically determined. The heritability of obesity is equivalent to that of height and greater than that for almost every other condition that has been studied – greater than for schizophrenia, greater than for breast cancer, greater than for heart disease and so on. Although environmental factors contribute to changes overtime, individual differences in weight are largely attributable to genetic factors (p.563).34
However, the relatively recent changes in bodyweight are not likely due to changes in genes but to a change in how the genes express themselves.35,37 This means that the major causes of weight and health problems are due to environmental changes, i.e., exercise, diet, sleep, and other factors.
There are real differences between individuals’ metabolic processes. These differences can have a significant impact on eating and activity habits. This can affect the likelihood of having a higher bodyweight and difficulty losing weight and keeping it off.38 An inability to attain or maintain a specific weight should not be automatically viewed as having a lack of commitment or will power. This does not give people a free pass to follow unhealthy lifestyle habits just because they may not be able, within realistic parameters, to change their weight.
Regarding the genetic component of bodyweight, many people will feel that it is unfair or harder for them to achieve their desired weight. Dwelling on this is a waste of mental energy and is unproductive. We all have differing genetic attributes such as I.Q, hand-eye coordination, visual acuity, artistic ability, physical attractiveness, and so on. Some people will have to work harder than others to accomplish similar results.
What is a Healthy Weight?
So what is a healthy weight? There are a number of variables that will determine this for a specific individual. From the current research the three variables that should be focused on are BMI, waist circumference and body composition, with waist circumference being the most important. A helpful chart to determine your healthy weight range is located in Appendix B.
It must be stressed that bodyweight itself is not the only determinant of health even when the above parameters are considered. Moreover, those people who are underweight or who fall within a healthy weight range, who do not maintain a healthy lifestyle can still have a high risk profile. Weight, along with eating, exercising, sleeping, and other lifestyle habits must be considered in a collective or synergistic manner when determining your overall health status and risk for disease.
One final bodyweight topic needs to be discussed before concluding this chapter. The topic is about weight cycling, often referred to as “yo-yo” dieting, and its association to increased disease and death.5 Unfortunately, there is no clear definition of weight cycling. It can be generally referred to as repeated bouts of weight loss and regain, usually more than 5% of body weight since reaching adulthood, due to intentional changes in behavior.39 Additional confusion surrounds the topic of whether weight cycling causes more disease and death than maintaining a stable weight, even if the stable weight is considered too high.
Cycling of body weight is probably not much of a health hazard.39,40,41 There are four key points about this conclusion. First, maintaining a stable healthy weight seems to be the best scenario for your health.42 Second, whether the weight lost or gained is fat or muscle is also important. The goal for health is to maintain muscle mass and lose fat mass, particularly visceral fat.42,43,44 Unfortunately, there is typically a loss of muscle and fat during a weight loss phase which is likely due to the use of inappropriate diet and exercise regimens. Thankfully, specific types of diets and exercise, such as a very low-carbohydrate, ketogenic type diet and a strength training program can often preserve muscle mass and preferentially target fat and visceral fat.23,45,46,47 Third, the diets that are typically used for weight loss are often nutrient (vitamins, minerals, essential fats, protein) deficient which can have negative effects on health.48,49 Fourth, many researchers feel that there are other variables, besides the three mentioned above, that are likely the cause of the poor health and greater mortality associated with weight cycling.42
Another negative associated with trying to lose weight is that it could actually contribute to gaining more weight over the long term.50 It seems that this is probably due to negative metabolic changes associated with improper weight loss techniques rather than to the weight loss itself.50 As long as you are following proper weight loss techniques, such as those described here, do not be dissuaded from doing the things that can facilitate weight loss because you think it will eventually lead to more of a weight problem.
Regulation of Body Fat
The regulation of fat tissue and the resulting amounts that people have are influenced, directly or indirectly, by biological, psychological, and sociological factors. There is ample research to support this idea. For example, according to Williams et al “Substantial research has confirmed that people’s weight is a complex function of genetic, behavioral, psychological, and environmental factors” (p.115).51 Also, according to Reeve;
Hunger and eating are further affected, and substantially so, by cognitive, social, and environmental influences, so much so, in fact, that an understanding of hunger and eating requires (1) short-term physiological models, (2) long-term physiological models, and (3) cognitive-social-environmental models (p.82).52
Because of these facts, our recommendations incorporate strategies that address each area.
Why Mention This?
You may be asking why we are highlighting this information in a weight loss book. We want to give you an honest and complete view, based on the preponderance of high quality evidence, of how bodyweight and body fat affects health. As we mentioned in the introduction, there is often an over simplification of weight regulation. Hopefully by having a better understanding about fat and weight regulation you will realize that success in modifying the amount of fat/weight that you have will take a comprehensive plan.
The fact that losing weight may not be as strongly correlated with improved health should not discourage you from wanting to have a lower amount of fat. This just means that having “six pack abs” has NOT been shown to confer any health benefits. However, having a lower body fat level will change your appearance and if this is something that you are striving for, go for it.
In conclusion, having a high level of visceral fat, for most people, can have a significantly negative impact on their health. Therefore, it’s in your best interest to maintain your weight (BMI, waist circumference, and body fat%) within a healthy range. With a comprehensive program it is highly likely that you will be able to attain and maintain a healthy weight. Regardless of your weight loss success, do not lose sight of the fact that it’s not just your weight, but also your everyday habits that largely determine your health. You should strive to attain a healthy weight for your body, through healthy habits, in as few attempts as possible and then maintain that weight for the rest of your life.
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