A trying-to-be-brief discussion of weight

A brief discussion of weight.

One thing that set me off on my current quest to understand health better was that I wanted to get back to my pre-pregnancy weight, even though my doctor thought that my weight was just fine. I don't consider myself to be particularly obsessed with weight, but I do think about it. Over the course of my lifetime, people have gotten fatter. Here's a chart (from https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity)

Interestingly, the percentage who are classed as overweight has stayed about the same (the so-called "overweight" bracket seems to be associated with similar health outcomes to the "Normal" bracket). The general increase comes from people who are in the part of the charts where weight seems to have a real negative impact on their health.

Enter the diet industry. Thinking about weight loss is so easy; picking a number, setting a goal, the idea that you can fix all your problems with a simple calories-in vs. calories-out calculation. I’ve always had a bathroom scale in the house, and I think most people do.¹ That makes weigh-ins convenient. On top of that, you have the cultural and commercial pressure to diet – the dieting industry is enormous (over $70 billion spent in the US in 2018²) and it wants your money. With all that advertising and obsession about appearance, a lot of weight loss ambition is driven by anxiety over appearance more than a desire to be healthier.

So let’s get this straightened out (a little). In general there are two dominant, polarizing narratives about excess weight. One is that it’s a result of poor self-control and weak-mindedness. The other is that it’s all about a person’s genes, so there’s nothing they can do about it.³ Neither of those stories is very helpful. I actually find it more helpful to blame the world in general: in recent decades (and centuries) our environment has changed to make us more sedentary (driving cars and working desk jobs), while simultaneously there has been a rise in consumption of junk food, sugar, and empty calories in general (also driven by food companies pursuing profits).

You’d be hard-pressed to find an obese hunter-gatherer or an obese subsistence farmer. A pattern of moving throughout the day, eating natural whole foods at mealtimes, where meals take a lot of labor to prepare, does not lead to obesity. Sitting in front of a glowing screen while eating highly processed snack foods all day and half the night does, and even if you’re still skinny after all that, it doesn’t mean you’re healthy.

There are small things that you can do to change your own environment, short of banning all cars and cell phones, but I’ll get into that later. First, I am going to go out on a limb and say that yes, there is such thing as a healthy weight. I know that for myself, I feel better when I’m under 150 pounds (at which point my back starts to hurt) and over about 135 pounds, at which point I start to feel run down and wrung out, so 135-150 is an okay range for me, personally. Establishing an ideal weight guideline for people in general is more of a problem, because you can do broad epidemiological studies and find a decent general guideline but there will always be some exceptions (though maybe not as many as some people would like to think).

So what is a healthy weight, anyway? BMI is the most popular tool used to determine this. It’s not a perfect gauge of health but it’s pretty good, especially in conjunction with other measures (blood pressure, cholesterol, VO2Max, etc.). You can calculate it easily using your weight and height. Here’s a link to one of dozens of calculators: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm. I would steer you away from “ideal weight” calculators because they set narrow targets that probably aren’t the healthiest for most people.

I’ve encountered the whole “Healthy at Any Weight” line of thought and I’m not sold it. Excess weight, especially if it’s in the form of fat, is a strain on the body. Every heavy person I know seems to have more joint pain than the skinny people I know. Excess weight – or excess fat – also increases risk of the following:

• diabetes
• arthritis
• liver disease
• several types of cancer (such as those of the breast, colon, and prostate)
• high blood pressure (hypertension)
• high cholesterol
• sleep apnea

(see https://www.health.harvard.edu/blog/how-useful-is-the-body-mass-index-bmi-201603309339)

Meanwhile, low BMI goes along with a different set of increased health risks:

• malnutrition, vitamin deficiencies, or anemia
• osteoporosis from too little vitamin D and calcium
• decreased immune function
• increased risk for complications from surgery
• fertility issues caused by irregular menstrual cycles
• growth and development issues, especially in children and teenagers

           (from https://www.healthline.com/health/underweight-health-risks)

However, the range for healthy weight is pretty broad, and doesn’t correspond neatly to the “normal” BMI window of 18.5 to 24.9 (as defined by the World Health Organization and the CDC). Overall disease risk is lowest in a slightly higher range. “… many epidemiological studies show an inverse relationship between mortality and BMI inside the normal BMI range. Other studies show that the lowest mortality in the entire range of BMI is obtained in the overweight range,” (from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115619/). This study shows lowest overall mortality at a BMI of 23.4, but no significant difference from 20.8 to 27.7, meaning that the lower end of the “overweight” range had better health outcomes, on average, than the lower end of the “normal” range. Using this range, my healthy weight could be anywhere between about 125 and 165 pounds. That’s a wide range. It would probably take me from a pants size of 2 to a pants size of 18. On the other hand, if I use one of those “ideal weight” calculators it gives me a weight range of 122-130, which is lower, narrower, and not going to happen any time soon (I hope).

Another measure of health is the waist-to-hip or waist-to-height ratio, which is probably a better measure of “fatness” and thereby a better predictor of cardiovascular disease risk. You’ll need a nice flexible tape measure to check this, like the kind you would use for sewing, or a non-stretchy piece of thread and a measuring stick. If your waist is nearly as big as your hips, or bigger, that’s indicative of a problem, or at least increased risk. Your waist-to-height ratio should be definitely less than .5, meaning that your waist circumference should be less than half your height (see https://health.clevelandclinic.org/beyond-bmi-a-better-tool-to-measure-your-health/). The trouble with waist measurement is that you’re supposed to measure it with your breath exhaled, but not sucking your gut in, and of course I’m going to suck in my gut. For comparison’s sake I tried it without sucking my gut in, then with my gut sucked in, and lo and behold there was a 2-inch difference. Anyway, this is said to be a better and more accurate way of looking at weight health than BMI is. (See https://www.theatlantic.com/health/archive/2017/01/against-body-weight/513428/)

It seems to me that if you’re officially obese, or underweight, it’s probably worth some effort to get into a healthier weight range. I have friends who’ve had success with calorie counting, low carb diets (temporarily), fasting, and even bariatric surgery (stomach stapling), but many of these approaches are not sustainable in the long term and are not necessarily healthy. (I do also know a couple of underweight people, and they haven’t had an easy time gaining weight, either.) If you want to lose weight, there are many options, but for most people, most of the time, it’s better to adopt permanent lifestyle changes than to try to lose a lot of pounds quickly.⁴

So, figure out an acceptable weight range for yourself, based on your own health indicators, but don't make it the be-all and end-all.

Tomorrow, I’m going to get more into the thing about our food and physical environment. It affects a lot more than just our waistlines.

1 I don’t know, though, and Google failed me. The closest I got was this report, https://www.statista.com/statistics/807251/us-retail-sales-of-bath-scales/, which puts average annual sales of bathroom scales in the 270 million dollar range. At $20 per scale (about the average price for the top results on Amazon.com) that would be about 13.5 million scales sold per year. There are about 127 million households in the United States, so if the average bathroom scale lasts 10 years, that’s about one per household. So yes, most people have them.

2 https://blog.marketresearch.com/u.s.-weight-loss-industry-grows-to-72-billion

3 Genes do contribute to body weight, but not as much as people would like to think. “When these 32 ‘top’ genetic hits are combined into a genetic risk of obesity score, those with the highest genetic risk (i.e., carriers of over 38 risk alleles), have just a 2.7 kg/m2 higher BMI on average than those with a low genetic risk. This translates into about a 15-lb (7-kg) weight difference between two 5’3” (160 cm) individuals with high versus low genetic risk (24).” from “The Epidemiology of Obesity” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859313/

4 For the traditional approach, you can check out US News & World Reports diet ranking, here, https://health.usnews.com/best-diet/best-weight-loss-diets. Weight Watchers, Volumetrics, and Flexitarian diets take the first three slots. Crash dieting is generally regarded as bad for people.