Fat Loss 105: Overfat, not Obesity, is the Real Concern

Overfat, not Obesity, is the Real Concern

Excess body fat is associated with a wide range of cardiometabolic disorders, as well as most non-infectious chronic diseases.

The traditional measure of body composition, Body Mass Index (obesity defined as BMI > 30), however, is notoriously unreliable, as 30% of individuals with “healthy” BMI’s are found to be metabolically unhealthy.

What’s wrong with BMI?

The Body Mass Index (BMI) does not accurately account for body composition, as it does not distinguish between bone, muscle, fat, etc.  BMI is a simple calculation of dividing one’s weight (kg) by the square of one’s height (m2).  There are many other limitations with the BMI:

  • BMI underestimates body fat content. In fact, high body fat values are actually associated with lower BMI categories.
  • There are different BMI standards for different ethnic backgrounds. For example, at the same BMI, Asians have more than double the risk as whites of developing type 2 diabetes.
  • An individual’s body weight is not likely to be the primary contributor to the negative effects of obesity; rather, body fat appears to be a more important factor.
  • Individuals with large muscle mass often have BMI’s above 30 and are inappropriately categorized as obese.

BMI can be a useful tool for epidemiologic studies when looking at large populations of data, but is not helpful when assessing individual risk.

Waist circumference is a much stronger predictor of metabolic health status than Body Mass Index.  In fact, there are several other factors that are also more useful than BMI, including blood pressure, triglyceride level, glucose, insulin resistance, and C-reactive protein.

Excess body fat = Overfat

The presence of excess body fat is more properly defined as “overfat”, which includes the presence of at least one additional risk factor of impaired cardiometabolic or physical health.  Excess body fat is measured by increased body fat percentage or waist circumference.

Downstream metabolic consequences of excess body fat are related to chronic inflammation and insulin resistance:

  • Abnormal blood glucose, including prediabetes and Type 2 diabetes
  • Abnormal lipids
  • Elevated blood pressure
  • Cardiovascular disease, including heart disease, stroke, and peripheral arterial disease
  • Cancer
  • Alzheimer’s Disease

Some of the negative effects on physical health include:

  • Low back pain
  • Osteoarthritis
  • Osteoporosis
  • Reduced productivity, including absenteeism and disability

On the other extreme, underfat is also a relevant problem.  In addition to starvation-related malnutrition, underfat is also prevalent in chronic illness and in eating disorders.

The majority of people are overfat

It was estimated in 2017 that 91% of American adults could be classified as overfat, along with 69% of children.  Consequences of excess body fat can appear early in life, and an estimated 55% of obese children have non-alcoholic fatty liver disease (NAFLD).

Excess body fat in childhood also is a significant risk for overfat status later in life and development of chronic disease.  Sadly, and largely due to this overfat pandemic, children now have a lower life expectancy than their parents.

Normal weight but overfat

It is estimated that 40% of normal-weight individuals metabolically unhealthy – referred to as Metabolically Obese Normal Weight (MONW).  Overall, it is estimated that 20% of the population meets this criteria.  There is no evidence that the “normal weight” status of these individuals provides meaning beyond their metabolic disease risk, but rather just draws attention away from the fact that they are in fact at increased risk of disease.  Thus, it’s important to focus not on the normal weight status, but on the metabolic health status.

References to “normal weight” really just obscure the reality of the situation, as well as possible solutions.  Terms like “overfat” and “underfat” are useful because they describe how much of your total body weight is comprised of fat.

Is “overfat” insensitive?

With the negative stigma in our culture over terminology about excess body fat, in recent years, the health care community has avoided using the term “obese” in favor of euphemisms such as “unhealthy weight”.  It turns out, however, that the term “obese” is only more upsetting for non-obese patients, whereas obese patients find the euphemism more upsetting.

Additionally, the term “obese” gave affected individuals the impression that the condition had more serious consequences and thus appeared to be more motivating.  Euphemistic terms, however, caused more anxiety and upset when used to describe the same condition.

When used properly, “overfat” is an objective term that describes the relevant issue at hand and provides clarity to the affected individual.

Focus on the real issue

Terminology such as “overweight” can be misleading due to the fact that it draws attention away from the real cause of disease, focusing on weight rather than fat.  Thus, people may believe that weight loss, rather than specifically fat loss, will improve their health.  Using terms that reference “weight” puts the emphasis on measurements such as scale weight that don’t have as much bearing on our health status as do measurements that focus on body composition.

In order to solve a problem, one must first understand what matters.  Weight is mostly irrelevant, whereas fat content is what’s driving chronic disease.

Bottom line: Measure what matters.

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