Weight vs. BMI: Which One Really Matters?

Adult obesity rates have gone up in 23 states in the past year. Are Americans dangerously unhealthy, or do these new findings need a grain of salt? Health Editor-at-Large Madelyn Fernstrom, Ph.D., CNS, explains why the BMI may not be a realistic way to gauge how healthy you are.

We all know what to do to lose weight, right? So, why, as a nation, do we continue to put on extra pounds year after year? A new report from the Center for Disease Control revealed that nearly two-thirds of states now have adult obesity rates of about 25%. That's 1 in 4 people. Plus weight is creeping up in all age groups, which is particularly troubling when it comes to children and adolescents.

Maybe an important area to revisit is just how we determine "obesity". For many years, it was the eyeballing approach: Do I "look" fat, or "feel" fat, or have health problems that seem to accompany extra weight? Multiple large scale studies have strongly linked increasing weight with increasing health risk. This has been based on body mass index or BMI (What's your BMI?), a term linking height and weight for a single number used as the marker comparing weight and likelihood of diseases (like high blood pressure, diabetes, and high cholesterol). Your BMI translates in number that classifies you as healthy, overweight, and obese. You don't have to look particularly "heavy" to be classified as medically obese. In fact, many "overweight" folks agree that they want to "lose a few pounds", but don't feel this is a health issue, since they have no medical illness related to their weight.

The big problem here is automatically translating population statistics to our own personal situation. While the BMI has been a major plus in helping to assess overweight and obesity in this country, we've gotten too caught up in the numbers, and not enough in the constellation of factors that also contribute to good health.

New research studies update national health recommendations. But what does that mean for excess weight? It's often forgotten that a number of years ago, a BMI of 27 or less was considered a "heathy" weight. Now, recent large-scale population studies showed that a BMI of less than 25 is now the healthy range. So overnight an entire segment of the population became overweight, without gaining a pound.

While weight is a major barometer of good health, I think it's time we took a broader look at what "counts". I think it's unrealistic for many people to get below a BMI of 25. When the bar is set too high, most of us give up and do nothing. It's just too defeating. We've got to get away from the "all or nothing approach", to the "something is better than nothing approach".

We need to return to a more realistic way of looking at the weight issue. It's the big picture that counts, including blood pressure, blood sugar, blood fats, and the lifestyle activities that support them (eating, activity, no smoking, stress control), with weight being one of the factors, but not the only focus.

Choosing a realistic weight as a healthy one should be the major focus, rather than an idealized weight. For many people, a BMI of less than 25 is not going to be a reality. We need to think more about a goal weight that we are able to maintain (not just achieve!) to support good health and avoid the endless round of self-defeating weight loss and regain episodes.

That's an important step in the right direction to combating this very real epidemic. Let's use the BMI as a guideline, but not the sole replacement to evaluation of good health.

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