Dear Dr. ROACH: I was confused by your column the other day and your response to weight loss writers who are losing height due to aging and osteoporosis.
Is it possible to get more information as to why someone shouldn’t need to lose weight unless they are in the morbidly obese range? You also said that you are within the overweight (BMI) range and that you are fine with staying healthy. What about the BMI obese range?
Many people, myself included, have oscillated between being overweight and obese for quite some years now, not feeling healthy and wanting to lose weight. To do. It is therefore unclear why this is considered sustainable unless it reaches the morbid obesity spectrum.
I’m sick and tired of people’s fatphobia. Perhaps your column was an attempt to normalize overweight and obesity in order to avoid the lipophobia that is rampant in society. But I’m still curious as to the actual health implications of not losing weight, or why you said it wasn’t necessary.
Answer: We try to make evidence-based recommendations wherever possible, but the evidence that being overweight does not increase a person’s overall risk of death is fairly strong. Data show that BMI (the body mass index, which is flawed but is widely used as a method of adjusting weight for a person’s height) in the overweight range does not cause significant harm, with some studies have shown improved mortality compared to people in the ‘normal’ range.
However, obese individuals have a significantly worse risk of death, which is highly dependent on a person’s waist size. It will be improved. This reflects the fact that abdominal obesity (sometimes called an “apple”) is very different and much worse than obesity around the waist and thighs. (“Pear”). At very high levels of obesity, called morbid obesity, mortality increases and worsens with increasing BMI.
The reason I do not emphasize weight loss in overweight patients, and in people who are obese but not in the morbidly obese range, is that the evidence that weight loss improves outcomes is scant. Obese patients have heard many times that they need to lose weight. After a careful review of my diet, I feel it is more important to emphasize specific behavioral changes, such as moderately increased physical activity and certain dietary changes. It may improve a person’s health more than just “lose weight” advice.
Obese and morbidly obese people with weight-related diseases, such as diabetes, benefit from weight loss. However, the best evidence for this comes from trials of weight loss surgery that is not suitable for most people. New diabetes drugs becoming available could dramatically change our understanding of the potential health benefits of weight loss, but we’ve witnessed some epic disasters with weight loss drugs, so these new We are awaiting more long-term data before making stronger recommendations for the class. Use of drugs, especially when used for weight loss (as opposed to use for diabetes).
Dr. Roach regrets not being able to respond to individual letters, but incorporates them into his columns whenever possible. You can email Virginia Dr., Orlando, FL 32803.
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