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The amount of excess fat is important, but where individuals carry that fat also plays a role in the risk level for health issues. (Photo by Luis Louro)

A Weighty Subject

By Shannon Burgert

Since 1960, the prevalence of obesity has risen steadily. Three years ago, the American Medical Association classified it as a disease. Though the trend is slowing, more than a third of American adults are now classified as obese, and another third are overweight. Obesity raises the risk for more than 30 chronic health problems. It is among America’s greatest public-health challenges. But what’s the tipping point on the scale? When should excess weight become a concern?

Chart by Alexandr III
Chart by Alexandr III

It depends on the person, says Pierre Brunschwig, M.D., a family and holistic practitioner at Helios Integrated Medicine in Boulder. For some people, he says, “there are combinations of things that mix badly with any extra weight.” Essentially, some factors make weight more toxic, and high among them is type II diabetes. Other concerns include back and lower-extremity joint pain, sleep apnea, respiratory conditions, hypertension and cardiovascular disease. “For almost any of the cardiac issues that we can think of, adding weight makes it worse,” Brunschwig says.

According to the American Association for Cancer Research, excess weight is also associated with nearly 25 percent of cancer cases, ranking second only to tobacco use as a factor contributing to cancer. The impact of obesity rises when lack of exercise and poor diet are also present. Obesity is tied to postmenopausal breast cancer and colorectal cancer, as well as cancers of the esophagus, pancreas, kidney, thyroid, gallbladder and endometrium. The link to other cancers is not yet as clear.

How Is ‘Excess’ Weight Determined?

The question of when to worry is complicated by the methods we use to quantify excess weight. The most common tool is the body mass index, or BMI, which measures body fat based on a person’s height and weight. BMI categorizes people as underweight (below 18.5), normal (18.5-24.5), overweight (25-29.9), obese (30-39.9) or extremely obese (40 and above).* While BMI is standard, it doesn’t take into account a person’s frame size or body composition—that is, the percentage of muscle or fat a person has. Consider a football player who is bulky but extremely muscular. His BMI may suggest that he is obese, when in fact his percentage of body fat may be quite low. On the flip side, BMI may underestimate body fat in elderly individuals, who lose muscle mass over time. (It takes more calories to maintain muscle mass than fat tissue, so as people age and lose muscle mass, they should curtail their caloric intake.) Other methods of measurement, including waist circumference, waist-to-hip ratio and scales that analyze body composition, can provide additional information on body fat.

Numerous online tools can calculate your body mass index; just search “Calculate BMI.” Some, including cdc.gov/healthy weight/assessing, will register half-inches of height instead of making you round up or down.

The amount of excess fat is important, but where individuals carry that fat also plays a role in the risk level for health issues, notes registered dietician and personal trainer Lindsay Lawes of Boulder Nutrition and Exercise. Lawes explains that a person who is apple-shaped, carrying weight around the midsection, is generally at a higher risk than someone who is pear-shaped, carrying the same amount of weight, but lower, in the hips and thighs. A general guideline for concern, she says, is when a woman’s waist measurement exceeds 35 inches in circumference, or when a man’s exceeds 40 inches.

The problem with belly fat is not only the subcutaneous fat that you can grab, but the visceral fat that builds up deeper inside, surrounding your internal organs. Visceral fat is linked with more health risks. It produces toxins such as cytokines, which cause inflammation and can contribute to cancer. They lessen the body’s sensitivity to insulin, which can lead to type II diabetes.

Cytokines also boost chances of heart disease. And this is noteworthy: Studies have linked increased risk of cardiovascular disease to a large waistline, even on women who fall within a normal BMI range.

When it comes to belly fat, crunches aren’t the answer. Lawes says the idea that you can “spot reduce” fat—commonly suggested in recent years in regard to belly fat—is a myth. To lose weight in one area, such as the belly or arms, a person really needs to lose weight overall.

Ready for some good news? According to the National Institutes of Health, even a small amount of weight loss, by 5 to 10 percent, can reduce risk for disease.

A Complex Picture

For some people, weight gain and loss may simply be an issue of lifestyle—particularly diet and exercise—but for many people that’s a gross oversimplification, Brunschwig says. Obesity is complex and may be affected by genetics, metabolism, behavior, economics, culture and social influences.

Lindsay Lawes, a registered dietician and personal trainer, says that for healthy weight management, exercise simply can’t be left out. (photo courtesy Boulder Nutrition and Exercise)
Lindsay Lawes, a registered dietician
and personal trainer, says that for healthy weight management, exercise simply can’t be left out. (photo courtesy Boulder Nutrition and Exercise)

“We can’t assume any sort of health implications without looking at the overall picture,” cautions Lawes. For those who have tried and failed to lose weight by lessening caloric intake and increasing exercise, it’s important to gain the assistance of a physician to check for conditions that might be hampering progress, such as poor thyroid or adrenal function. Food allergies and sensitivities can play a role in weight, as can the microbial makeup of our guts, though we still know very little about how microbes influence weight or what we can do about it.

The value of sleep doesn’t get nearly enough attention, says Brunschwig, who explains that sufficient sleep is among the most essential components of weight loss. So sleep apnea is another complication he checks for. He adds that sleep is the variable that correlates most closely with childhood obesity: Kids are getting an hour less of sleep on average than they did 20 years ago.

Regardless of other factors, a healthy diet is key. “But the ‘right’ diet—what the heck does that mean?” asks Brunschwig.

The two main pitfalls Lawes sees with her clients are a difficulty with portion control and lack of balance among carbohydrates, protein and fat throughout the day. She shudders at the recent trend toward starting the day off with juicing. “It’s throwing your body into a roller-coaster ride with your blood sugar through the day,” she explains. Getting adequate protein early in the day helps to prevent blood-sugar spikes, which lead to oversnacking or the craving for a soda as a pick-me-up.

For patients who are struggling with weight loss but are highly motivated, Brunschwig recommends The Plan, a book that outlines an elimination diet. The idea is that particular foods—many of which are staples, like eggs and tomatoes—react with a person’s body chemistry, causing weight gain. Which foods are problematic depends on the individual.

But Brunschwig is quick to note that there is no one-size-fits-all diet. He sees too many people frustrated after buying book upon book on weight loss, grappling with too many opinions on how to shed pounds. He cautions people to remember that they are the experts on their own bodies. Sometimes you need a little help, Brunschwig says, but you need to make a plan that resonates for you.

He adds, “Your body is trying to tell you something. What is it trying to tell you?”

Weight-Loss Tips

Get some sleep. Try for a solid seven or eight hours a night.
Use digital tools. There are a slew of devices that can help you track
calories and activity. They include smartphone apps, wearable devices like the Fitbit, and scales that not only measure body composition, but send data to smartphones. Some offer a social component, which can help with motivation. There are also apps targeted toward kids, with games, music and age-appropriate content.
Write it down. Write down everything you eat, even if temporarily. It improves awareness of what you’re taking in.
Forgo fruit juice. “Juice should not be allowed on shelves,” declares dietician Lindsay Lawes. The fat-reducing fiber has been removed, and the pure fruit sugars are really not much healthier than a sugary soda. A smoothie is fine, but limit the fruit to not much more than a cup, and throw in a protein source such as protein powder, Greek yogurt or peanut butter.
Cut back on booze. The beer belly is notorious, but drinking too much of any type of alcohol adds up.
Add exercise to your calendar. Put it in there just like you would a doctor’s appointment, which you wouldn’t miss, Lawes says. For healthy weight management, exercise simply can’t be left out.
Walk while you’re on the phone. All those minutes on the phone with your family and friends add up to a lot of steps.
Take advantage of those 5 minutes. Lawes emphasizes that exercise doesn’t have to happen in one chunk. Fit in a few flights of stairs or a walk to the mailbox, whenever you have time throughout the day.
Find exercise you enjoy. Water aerobics? Tennis? Dancing? Lawes suggests linking exercise with pleasant pastimes, if you can. If you ski, for instance, take a ski-conditioning class.
Take baby steps. If you have a lot to drop, says Lawes, don’t aim for 50 pounds; go for 5 to start with.


Shannon Burgert, Ph.D., teaches fifth grade in Louisville.