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Millions Healthier Than BMI Indicates, Study Says

Obesity Rates in North Central Florida
Obesity Rates in North Central Florida

A study published in February in the International Journal of Obesity, UCLA researchers concluded that about 54 million Americans considered overweight or obese – based on their body mass index – are actually healthy when other health factors, such as blood pressure, cholesterol, glucose and fatty acid levels, are factored.

Many people see obesity as a death sentence,”  A. Janet Tomiyama, the study’s lead author, told UCLA Newsroom. “But the data show there are tens of millions of people who are overweight and obese and are perfectly healthy.”

Obesity is classified as having a BMI greater than 30.

In Florida, about 26 percent of adults in 2013 were obese, according to the Florida Department of Health's Behavioral Risk Factor Surveillance System survey. Across Florida, obesity rates have steadily risen from 2002 to 2013, according to the survey.

The research also found that about 30 percent of those with a normal weight were unhealthier than their BMI suggested when the same factors were considered.

The study, funded by the Hellman Fellows Fund, examined data from the latest National Health and Nutrition Examination Survey, which included a wide range of individuals 18 and older.

The issue of weight and true healthiness varies along a spectrum, according to health professionals.

Dr. Heather Vincent, who works orthopedics and rehabilitation at UF's College of Medicine, has been researching obesity and health for 17 years.

For a while, Vincent said she was convinced orthopedic issues were correlated with BMI. But she has found that the body can withstand a certain amount of excess weight.

"I think we’re finding that it isn’t a one-to-one relationship,” she said.

For example, she said, someone with a BMI of 18, which is considered healthy, may also be a heavy smoker who eats unhealthy food regularly and doesn't exercise, putting them at risk for serious heart and lung conditions.

Conversely, Vincent described a person with a BMI considered to be overweight, like 27, but who is actively pursuing healthier habits.

“I would much rather have that person carry a little bit more weight but be making those appropriate lifestyle choices,” she said.

Vincent said she agreed with the research's findings and doesn't think it's fair to judge someone's health by their BMI only. Others, such as Dr. Michelle Cardel, who works in health outcomes and policy at UF's College of Medicine, chose not to comment on whether the EEOC's proposed policy is right or wrong, but generally agreed that BMI is an unreliable measure of people's health.

Cardel also said that penalization programs aren’t effective at making people healthier, and that incentivizing programs are better. She also pointed to football players as a  classic example of a disproportionate health-to-BMI ratio. A lot of large athletes have high BMIs because of their size and muscle mass, but are still considered healthy.

“One of the issues with BMI is that it can’t distinguish between muscle mass, fat mass or bone mass,” she said.

Even though BMI has its issues, a person's weight should not be thrown out altogether when examining health, Cardel said.

“Ultimately, it's high body fat that is associated with poor health outcomes," she said.

In obese patients, there have been cases of higher risk for depression, muscular disorders, kidney disease, knee and joint issues, Cardel said. An obese BMI – 30 or greater – can still be dangerous.

“It’s not just about the weight," she said. "It’s about how much body fat you have and where that body fat is stored."

Experts from the Annals of Internal Medicine agree.

The research journal examined risk of chronic kidney disease in obese patients who were considered metabolically healthy – healthy in terms of their blood pressure, cholesterol, etc.

The investigators found that obesity is associated with an increased risk kidney disease in metabolically healthy, young and middle-aged patients.

The study concluded that metabolically healthy obesity is not harmless condition, but instead can have serious health implications.

It is these risks that Dr. Cardel is most concerned about.

“I think it extremely important people strive to maintain a healthy weight and active lifestyle to prevent obesity related disease,” Cardel said. “I don’t think the number on the scale should be the only determinant of health.”

Aaron is a reporter for WUFT News. Reach him by calling 352-392-6397 or emailing news@wuft.org.