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Battle of bulge is life or death

New medical studies say that being overweight, but less than obese, can affect your lifespan.

By LISA GREENE
Published August 22, 2006


Baby boomers grappling with middle-age spread take note: Two new major studies show your risk of death increases if you are overweight, even if you don’t qualify as obese.

The studies, which together tracked 1.5-million people, did show that health risks were worst for the fattest people. But they warned the risks start to mount with every extra pound.

“The phenomenon of 'global fattening’ will contribute to a pandemic of chronic diseases for many years to come,’’ says an essay about the two studies, all published in Thursday’s  issue of the New England Journal of Medicine.

Scientists agree that being extremely overweight is unhealthy, but conflicting studies have sparked debate in recent years about how much pudge is permissible. Some have argued that the risks of extra fat are overstated, and paint those warning of a global obesity epidemic as alarmist.

But the new studies are among the largest to show a significant increase — 20 to 40 percent — in the risk of death for people with a body mass index between 25 and 29, which is considered overweight, but not obese. Somebody 5 foot 9 and 169 pounds has a BMI of 25.

Scientists who study obesity said Tuesday it’s time to stop fighting about the level of risk and focus on helping people lose weight.

“It’s time to realize it’s a health risk and take it seriously,’’ said Dr. Tim Byers, professor of preventive medicine at the University of Colorado School of Medicine.

Byers is making his own contribution. In the Journal essay he wrote, he confessed that his body mass index, or BMI, is 27.3 — too high to be healthy.

“I’m outing my love handles,’’ said Byers, 57, in a phone interview.

Over the past two years, Byers has lost 10 pounds by cutting out powdered doughnuts and walking more.

“The key has to be small steps,’’ said Dr. Michael Leitzmann, senior author of one study and investigator with the National Cancer Institute. “We have to encourage people to make small changes in everyday living habits. It can be a mild workout. Replace the elevator with the stairs. Take bike rides. Don’t overeat.’’

Yet Leitzmann and others acknowledge such changes are easier preached than practiced.

“We need to change the way people eat, and change the way people move,’’ said Donna J. Petersen, dean of the University of South Florida College of Public Health.

Individuals must make changes, but broader action is needed as well, she said: more sidewalks, healthier school lunches, better ways to make healthy food convenient and cheap.

“Probably a whole societal shift needs to occur,’’ she said.

In the first study, federal researchers surveyed more than 527,000 U.S. residents ages 50 to 71 and followed them for 10 years, during which time more than 61,000 died. Researchers found higher rates of death among those who were overweight.

Among 50-year-old nonsmokers, the study found a 20 to 40 percent increase in risk of death among overweight people. The risk was doubled or tripled among the obese.

This study is “one of the best ever done,’’ said Dr. Louis Aronne, past president of the Obesity Society and clinical professor of medicine at Weill Medical College of Cornell University.

Weight and health risks are hard to measure, Aronne said. The connection can be obscured by smokers, who may be thin but unhealthy, or by people who have normal BMIs but unhealthy levels of abdominal fat. But this study controlled for smokers and for chronic diseases.

“The bottom line is that the evidence is increasing that obesity is a serious health burden in the U.S., and it’s getting worse with time,’’ he said.

The second study followed more than 1.2-million Koreans between ages 30 and 95. It found those of normal weight had the lowest risk of death. Those who were underweight or overweight were more likely to die.

Tarpon Springs resident Russell Kelly said the study matches his own experience. After he retired as a Navy diver in 1991, the pounds crept on.

“The day I retired, the eating did not stop, but the physical exercise did,’’ he said Tuesday.

As the pounds piled up, so did the maladies. Diabetes, high cholesterol, sleep apnea. Kelly tried diets without success, until in 2003, at age 52 and weighing 370 pounds, he made a drastic decision. He went to Morton Plant Hospital for gastric bypass surgery.

“The weight was going to win,’’ Kelly said. “It definitely was going to end my life earlier.’’

Since then, Kelly has lost 150 pounds and no longer needs any medicines. He said the study shows that extra weight has an effect even for people lighter than he was.

“Every pound doesn’t help,’’ he said.

For Dr. James Hill, director of the Center for Human Nutrition at the University of Colorado, people like Kelly are the real problem. Hill believes the new studies are right about the increased risk of death, but said that debate misses the point.

“The effect of obesity on dying is not the big thing,’’ he said. “It’s on diseases that affect your quality of life. … You’re taking drugs so you don’t die from them, but you have people who are debilitated from diabetes and heart disease and amputations.’’

Hill is the co-founder of the National Weight Control Registry, which tracks people who lose weight and keep it off.
Like other experts, he suggests people smart small. First, he said, stop gaining weight. Then work on losing. Think of weight control as “a lifelong challenge.’’

“People want to take on their weight all at once,’’ Hill said. “They want to go lose it in six weeks and go back to how they were eating before. It doesn’t work that way.’’