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I'm obese, you're obese
The Fat Guy munches on doughnuts while figuring out whether he is fat or obese.

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By Steven A. Shaw

Nov. 10, 1999 | I'm obese, and according to the American Medical Association there's a one-in-four chance you are too. Let's find out.

Take your weight in kilograms and divide by the square of your height in meters. Just kidding -- the government maintains a Web site that will perform this computation for you. This is your body mass index, or BMI. If your BMI is between 25 and 30, you're overweight -- that's 42 percent of men and 28 percent of women. If it's 30 or more, you're obese (mine is 35.9; Pavarotti is 42; Princess Di on a good day was probably a 19; the average fashion model is probably an 18), along with 21 percent of men and 27 percent of women.

That's a grand total of 63 percent of men and 55 percent of women who are overweight or obese, according to Aviva Must, Ph.D., of Tufts University School of Medicine in Boston, lead author on the study published in the Oct. 27 Journal of the American Medical Association.

And thus it happened that on Oct. 27 Americans awoke to a barrage of sensationalist TV and newspaper stories triggered by an onslaught of AMA press releases delivering the same old news: Americans are getting fatter.

Rather than finding any joy in this achievement (try complaining to an African about the country where poor people are fat), the AMA struck a shrill, alarmist note. It proclaimed a public-health crisis and dispensed some bizarre, troublesome new recommendations (give fat people painful subcutaneous leptin hormone injections for life) and Dr. Strangelove-esque pleas for social engineering, including a call for "scientifically based interventions that address societal and individual attitudes and behaviors and their environmental context." There was, as well, the same old harmless-but-ineffective advice (eat less; exercise more) we've been hearing for years.

It doesn't take much imagination to predict the reaction to this latest public-health scare: Frightened citizens who still believe everything they read will crash-diet en masse, ultimately gaining more weight than they lose. Concerned mothers will sign up their kids at fat camp (there's a special place in hell reserved for members of the fat-camp industry). And more than a few seemingly normal people will put their dogs, cats, iguanas and flying lemurs on diets.

After reading the press releases, I was first and foremost suspicious of this body mass index thing, and not just because it has an evil ring to it and was invented by a Belgian named Quetlet. Forget those old weight vs. height tables, the BMI people tell us -- this new gender-blind index, based on correlation to mortality statistics, is the measure of the moment.

But how could the measure of ideal weight be the same for men and women? Aren't men supposed to weigh more than women? Puzzled, I sat down with a box of doughnuts and my calculator and set out to deconstruct this statistic.

I dug out the old weight tables that were in widespread use 10 years ago (the good old days, it turns out, for fat guys). The tables divide people into male and female, and into small, medium and large frames. This makes intuitive sense -- more so, to be sure, than dividing your weight by the square of your height. According to the old tables, a large-framed 5-foot 10-inch man can weigh 180 and still be "normal." Yet according to the BMI calculation (which gives us 25.8), he's overweight. For a woman of similar height and frame, the old tables say she's overweight at 174. Yet her BMI of 24.8 keeps her in the normal ballpark. Minor differences, to be sure, but ones that will send armies of neurotic individuals into a collective panic.

So we've been defining obesity down for men, and up for women. That's probably fair, since obesity is so much more upsetting to women than to men, but I wonder about the science. Indeed, when I pressed several scientists off the record, they did eventually come around to admitting that the statistical underpinnings of the BMI indicate differences for men and women.

The medical establishment decided, however, that the value of a uniform rule of thumb was more important than perfect accuracy.

. Next page | Perhaps most important, I hate people on diets


 
Illustration by Bob Watts/Salon.com


 

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