BMI

proling: bad medicine

Untreated

Normal weight

Overweight
Treated
Obese
1 False negaOve
2 False posiOve

Abnormal
cardiometabolic
Prole

Normal
cardiometabolic
prole

TOTAL

23.5%
(16.3 million people) 1

76.5%
(53.0 million people)

100%
(69.3 million
people)

48.7%
(34.1 million people)

51.3%
(35.9 million people)

100%
(70.0 million
people)

68.3%
(42.0 million people)

31.7%
(19.5 million people)

100%
(61.5 million
people)

Bacon and Aphramor, Nutr J., 2011, 10:9

Using BMI, 51% of healthy people

are deemed unhealthy

Wildman, et al., Arch Intern Med, 2008, 168:1617-1624

Slide courtesy of Dr. Deb Burgard

Myth: BMI is meaningful

Body Mass Index
Not evidence-based
Pathologizes certain bodies
Overweight? There is no weight over which one is
necessarily unhealthy
Many overweight and obese people live long,
disease-free lives

All other weight/adiposity-based measures (e.g.

waist circumference, % body fat) similarly awed
Bacon and Aphramor. Nutr J 2011: 10(9)

Myth: Fat Causes Disease

Several diseases are associated with obesity, but
this doesnt mean that fat causes disease.
Confounding factors play a larger role in disease
incidence. Examples of confounders:
tness
discriminaOon
dieOng/weight cycling
socio-economic status (+ many more)
Bacon and Aphramor. Nutr J 2011: 10(9)

Fitness vs Fatness: RelaKve Risk of All-

Cause Mortality
Normal Weight

Overweight

Obese

1.1

1.1

2.2
Fit

2.5

Unt
3.1

0
0.5
1
1.5
2
2.5
3
3.5
Wei et al. RelaOonship Between Low Cardiorespiratory Fitness and Mortality in
Normal-Weight, Overweight, and Obese Men. JAMA, 282:1547-1553, 1999.

Socioeconomic Status (SES)

Consider type 2 diabetes (T2D)
Poverty is much more strongly associated with
T2D than weight.
Also, much evidence suggests that the insulin
resistance that underlies T2D causes weight gain.

McDermof, Soc. Sci. Med. 1998;47(9):1189

Wamala, et al., Diabetes Care. 1999;22(12):1999

Fat/Health Risk: Summary

Fat is exaggerated as a health risk.
Overweight and moderate obesity are NOT
associated with decreased longevity.
Although many disorders are more common among
larger persons, issues other than weight play a larger
role.

Weight sKgma carries larger health risk than

weight itself.
Bacon and Aphramor. Nutr J 2011: 10(9)

Myth: Weight Loss is Proven to

Improve Health and Longevity

Short-term studies

cant control for habits that induce weight loss

Example: if parOcipants lose weight on an exercise program,

health improvement may be afributable to the exercise

dont monitor adverse eects

Examples of known adverse eects: toxin release from fat Ossue;

inammaOon; most parOcipants will regain the weight (many
contraindicaOons from repeated weight cycling including
decreased self-esteem, increased cardiovascular disease, etc.)

Long-term (epidemiologic) studies nd weight loss

is associated with increased mortality
Bacon and Aphramor. Nutr J 2011: 10(9)

Myth: Diet, exercise or surgery are

eecKve for sustained weight loss
No exercise, diet, or surgery study has
ever demonstrated long term
maintenance of weight loss for any but a
small minority.
Well-studied for diet and exercise programs
The limited long term research for surgical studies
show eventual weight regain

Mann, American Psychologist, 2007, 62(3): 220-233.

Bacon and Aphramor. Nutr J 2011: 10(9)

Why dont exercise/diet work?

There are many contributors to energy balance
Fat Kssue is homeostaKcally regulated
RegulaOon is long-term (slow)
Lax resistance to weight gain
Strong resistance to weight loss
Vulnerable to up-regulaOon

Regulatory mechanisms can cause

compensaKon; result: weight is regained
despite conKnued diet/exercise behavior
Strohacker, et al., Front. Biosci. 2010;E2:98

Health at Every Size (HAES)

Weight neutral
Supports body acceptance
Encourages nourishing lifestyle habits. Examples:

IntuiOve eaOng (as opposed to dieOng)

Joyful movement
Meaningful work
SupporOve relaOonships/community
Stress management

Supports development of stereotype management skills

Commifed to social jusOce, insOtuOonal and cultural
change
(Not limited to individual intervenOon)

Bacon, Health at Every Size, Benbella Books, 2010

Thank you
AddiKonal informaKon can be found at
www.LindaBacon.Org