Forget the Scale? Up to a Point

Recent studies have suggested that a few extra pounds may not be harmful, and may even be protective in some individuals especially the elderly. Now a study in the journal Obesity provides additional evidence that being “overweight”, somewhere between recommended weight and what we now consider obesity (Body Mass Index >30 kg/m2) may be beneficial. But let’s not get this message out of kilter, obesity is a significant risk factor for many disease processes and once you get beyond those few extra pounds survival turns South. Indeed, I was discussing a related phenomenon with a colleague just the other day. That being the extreme rarity with which we see morbidly obese patients over the age of 70. Obese people just don’t live very long.

I suspect that the actual target for ideal weight is not effectively captured by BMI. Rather, it is just as important to consider where the weight is carried (i.e. intra-abdomen vs. subcutaneous), and whether patients are being treated for weight related complications such as high blood pressure and high cholesterol. But even more importantly is cardiorespiratory fitness, or the ability to crank off several minutes of very brisk walking or running. The work of Dr. Steve Blair and colleagues has been very revealing regarding the notion that fit fat people can do very well.