34% of the adult population in America (32% of men and 35% of women) is obese. While the rate of obesity (body mass index ≥ 30, or 30 lbs overweight for someone who is 5’4″) has remained constant over the past few years. The rate of obesity has more than doubled since 1985, when less than 15% of the population was obese. Now 68% of the population is either overweight (BMI of ≥ 25-29) or obese (JAMA, 2010).
We can argue about BMI being an imperfect tool, and it is. BMI only accounts for weight, not muscle versus fat, so a very healthy person with a lot of muscle mass could have a BMI of ≥ 25 and technically be a healthy weight. Likewise, a person can have a normal BMI (≥19-25) and actually be unhealthy if they have no lean muscle mass (that is why BMI is less accurate for elderly people as most people lose muscle mass with age). However, keep in mind if your BMI is over 30 it’s a pretty accurate reflection of obesity. And while my observations are clearly not evidence based medicine, I remember very few instances where I was surprised to find out a patient who I thought was a healthy weight actually had a BMI of 25 or more.
Being overweight is a health risk. It increases the odds of diabetes, heart disease, breast cancer, and arthritis just to name a few of the negative health repercussions. This is not a judgement, it is simply fact. If you are overweight you are more likely to die earlier than someone with a BMI of 19 – 25. Of course, not everyone who is overweight will die of a heart attack and not every smoker will get lung cancer. My grandfather smoked until he died, at the age of 99, but just because he beat the odds doesn’t mean it is a safe habit.
Seeing the color changes by decade on the CDC chart is heart breaking. That we are eating ourselves to death (never mind the economic burden due to the increased costs of health care). While there are many factors involved, such as poverty, education, and difficult access to better food choices, I wonder how much the normalization of overweight comes into play. Is there a tipping point where so many people around are overweight that it ceases to register as a health concern?
I’m not sure I know the answer, but I live in a county with the lowest obesity rate in California: 16%. And seeing healthy looking people out and about helps. It certainly helped trigger me into thinking that I wasn’t as healthy as I had previous thought. When I lived in areas where decidedly more people were obese, well, it just seemed more normal.
It’s a hard conversation for many to hear. So much body image and self-worth bound and wound together with each pound. But when we talk about healthy weight, about striving for a BMI of 19-25, we are not ascribing blame or wrong doing. We are not saying bad or good. We are talking about health. About reducing diabetes risk. About reducing the risk for cancer. About preventing a knee replacement.
Normalization of what is common happens to all of us. It doesn’t mean we are bad people it’s just human nature. But it’s also one more reason why we need to keep talking about healthy weight. No matter how difficult the conversation.