by Teresa Corbett
This week, a paper published in JAMA Internal Medicine revealed some very stark statistics about the obesity epidemic in the United States. The researchers estimated that that 67.6 million Americans over the age of 25 were obese as of 2012, and another 65.2 million were overweight.
Their data was collected between 2007 and 2012 as part of the National Health and Nutrition Examination Survey, an ongoing study conducted by the Centers for Disease Control and Prevention. Height and weight were used to establish the BMI of particpants. For those who are not familiar with BMI guidelines: A BMI between 18.5 and 24.9 is considered normal. Someone with a BMI in the 25-to-29.9 range is considered overweight, and a BMI over 30 qualifies a person as obese. (You can calculate your BMI here )
Studies like these are becoming more and more common. In turn, the more we read… they become somewhat less shocking. We know its not good. We know it’s a crisis. We know that being overweight and obese are associated with various chronic conditions. We know that these conditions are considerable health care and societal burdens. We know that these are preventable conditions caused largely by health behaviours.
Yet, the one thing that struck me about all of this was whether or not we actually understand what being obese looks like.
There are have been many criticisms of BMI in recent years, with media outlets highlighting flaws in the measurement. Muscle-heavy sports stars have been cited as examples of healthy people with a BMI greater than 25. In fact, one study found that the players on the Irish rugby team have an average Body Mass Index of 29.1 – which would be deemed overweight, veering on obese. Report co-author Dr Paul Cotter noted that with them it’s down to high muscle mass rather than fat.
So maybe BMI isn’t the way to go? In that study, the waist-hip ratios of the 40 rugby players was OK and this was deemed to be a better measure of health for these exceptional individuals than BMI. Waist-to-hip ratio has been found to be a better indicator of poor cardiac status than BMI. It has also been found to be a better predictor for Noninsulin Dependent Diabetes Mellitus. You can measure your waist circumference here.
And yet none of this is the point of this post. Because my main gripe with this study isn’t the use of BMI. My main problem was the pictures that accompanied the story when the study (and many other obesity studies that went before) was reported in the media. Each article seems accompanied with a picture of a severely obese individual. This portrayal of the extreme allows people to sit on their laurels and think “Oh I’m not THAT bad.”
Where are the pictures of the everyday obese? The people who go to movies and sit in normal seats? The people who sometimes fit into size medium clothes? The everyday obese, the ones you see on the street and meet in the office. These people are often unaware of the damage being caused to their health. Because the image of obesity that they are presented with in the media is not congruent with the true representation of obesity. We are presented with the extreme. And it annoys me.
I don’t mean to write this blog to fat shame. It’s more a recognition of a personal experience. And something I’ve noticed more and more in recent years. A few years ago, I moved to Galway as a bright young girl in her early twenties. I went to the doctor on campus to get a prescription and she told me that I would have to get my BMI checked while I was there. Now like many 20-somethings I was body conscious. I’d just eaten breakfast. I knew I was overweight. This was gonna be embarrassing. And so I stepped on the scales.
My BMI was 31. Obese. A 23 year old who walked everywhere. I wasn’t “Fat, Sick and nearly Dead.” I was normal, on diets, fitting into normal clothes. I was shocked. Obese people were the ones who had to pay for an extra Ryanair seat. They were the ones who had to buy their clothes in special plus-size shops. I couldn’t be obese. But I was. And I hadn’t even realised.
The doctor only agreed to prescribe me the medication if I promised to lose weight. My blood pressure was high and there was a risk of blood clotting while on the medication if I was obese. I couldn’t get over it. I wasn’t what the pictures of obesity looked like. I was fiiiinneee...
I guess I was lucky that I studied Health Psychology. Because it gave me the kick I needed. I sat in lectures listening to stats on obesity. Every chronic illness you can imagine was made worse by being overweight or obese. Pregnancy was tougher and riskier. I heard about breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects… the list goes on.
I also learned that in the NHS having a BMI of 35 or above is counted as “potentially life-threatening” obesity (I was only 4 off that!). And in some cases you may even be eligible for weight loss surgery, also called bariatric surgery. That terrified me. I thought I was grand.
But… armed with an awareness of my BMI, I set about changing it. I ate better, drank less and began to do more exercise. It wasn’t a diet, it was a change in how I saw myself. I wasn’t comparing myself to pictures anymore. I realised that the pictures of obese people in the media weren’t the same as the obese person I saw in the mirror. I started thinking about my health and the person I wanted to be. It took a while but slowly I worked my way out of the obesity category and now I am within the normal range (even with ALL my newfound muscle).
We read these stories in the newspapers or online. Obese this, overweight that. Diabetes here, heart attack there. It never feels applicable to us. We tell ourselves it’s the pint of water we drank before stepping on the scales. We tell ourselves that the shopping was heavy and we probably gained muscle on the way home the day before. Muscle weighs more than fat. And sure everyone says BMI is nonsense anyway. And it might be…
But it’s a good “weigh” (Badum-tish! ♬♬) to start. It’s an indicator or a proxy. So check it out… and while you’re at it you can check your waist circumference too. The only person who can be motivated to make a difference is you. For me, the trigger was fear, panic and a desire to be a Health Psychologist who practiced what she preached. Get to know your body before you decide that the stats aren’t relevant to you.. Or before you roll your eyes at another study about those silly fat people ruining their lives. Or better still, go to the doctor and let her scare the bejaysus out of ya!