tag:theconversation.com,2011:/africa/topics/obese-25617/articlesObese – The Conversation2024-02-08T04:07:59Ztag:theconversation.com,2011:article/2225982024-02-08T04:07:59Z2024-02-08T04:07:59ZCan kimchi really help you lose weight? Hold your pickle. The evidence isn’t looking great<figure><img src="https://images.theconversation.com/files/573992/original/file-20240207-18-9do2qy.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C998%2C682&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fermented-preserved-vegetables-food-concept-cabbage-624182348">casanisa/Shutterstock</a></span></figcaption></figure><p>Fermented foods have become popular in recent years, partly due to their <a href="https://pubmed.ncbi.nlm.nih.gov/28945458/#:%7E:text=As%20a%20result%2C%20fermented%20foods,diabetic%20and%20anti%2Datherosclerotic%20activity.">perceived health benefits</a>.</p>
<p>For instance, there is some evidence eating or drinking fermented foods can improve <a href="https://www.tandfonline.com/doi/full/10.1080/10408398.2022.2128032">blood glucose control</a> in people with diabetes. They can <a href="https://www.cambridge.org/core/journals/nutrition-research-reviews/article/impact-of-botanical-fermented-foods-on-metabolic-syndrome-and-type-2-diabetes-a-systematic-review-of-randomised-controlled-trials/27AE60CFFA7C937455C9DA50BD542F78">lower</a> blood lipid (fats) levels and blood pressure in people with diabetes or obesity. Fermented foods can also improve <a href="https://journals.sagepub.com/doi/full/10.1177/02601060221095678">diarrhoea</a> symptoms.</p>
<p>But can they help you lose weight, as a <a href="https://bmjopen.bmj.com/content/14/2/e076650">recent study</a> suggests? Let’s look at the evidence.</p>
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Read more:
<a href="https://theconversation.com/what-is-kombucha-and-how-do-the-health-claims-stack-up-87180">What is kombucha and how do the health claims stack up?</a>
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<h2>Remind me, what are fermented foods?</h2>
<p><a href="https://www.nature.com/articles/s41575-020-00390-5">Fermented foods</a> are ones prepared when microbes (bacteria and/or yeast) ferment (or digest) food components to form new foods. Examples include yoghurt, cheese, kefir, kombucha, wine, beer, sauerkraut and kimchi.</p>
<p>As a result of fermentation, the food becomes acidic, extending its shelf life (food-spoilage microbes are less likely to grow under these conditions). This makes fermentation one of the earliest forms of food processing.</p>
<p>Fermentation also leads to new nutrients being made. Beneficial microbes (probiotics) digest nutrients and components in the food to produce new bioactive components (postbiotics). These postbiotics are thought to contribute to the health benefits of the fermented foods, alongside the health benefits of the bacteria themselves.</p>
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Read more:
<a href="https://theconversation.com/space-travel-taxes-astronauts-brains-but-microbes-on-the-menu-could-help-in-unexpected-ways-216355">Space travel taxes astronauts' brains. But microbes on the menu could help in unexpected ways</a>
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<h2>What does the evidence say?</h2>
<p>A <a href="https://bmjopen.bmj.com/content/14/2/e076650">study</a> published last week has provided some preliminary evidence eating kimchi – the popular Korean fermented food – is associated with a lower risk of obesity in some instances. But there were mixed results.</p>
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<p>The South Korean study involved 115,726 men and women aged 40-69 who reported how much kimchi they’d eaten over the previous year. The study was funded by the World Institute of Kimchi, which specialises in researching the country’s national dish.</p>
<p>Eating one to three servings of any type of kimchi a day was associated with a lower risk of obesity in men.</p>
<p>Men who ate more than three serves a day of cabbage kimchi (baechu) were less likely to have obesity and abdominal obesity (excess fat deposits around their middle). And women who ate two to three serves a day of baechu were less likely to have obesity and abdominal obesity.</p>
<p>Eating more radish kimchi (kkakdugi) was associated with less abdominal obesity in both men and women.</p>
<p>However, people who ate five or more serves of any type of kimchi weighed more, had a larger waist sizes and were more likely to be obese.</p>
<p>The study had limitations. The authors acknowledged the questionnaire they used may make it difficult to say exactly how much kimchi people actually ate.</p>
<p>The study also relied on people to report past eating habits. This may make it hard for them to accurately recall what they ate.</p>
<p>This study design can also only tell us if something is linked (kimchi and obesity), not if one thing causes another (if kimchi causes weight loss). So it is important to look at experimental studies where researchers make changes to people’s diets then look at the results.</p>
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Read more:
<a href="https://theconversation.com/is-apple-cider-vinegar-really-a-wonder-food-86551">Is apple cider vinegar really a wonder food?</a>
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</em>
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<h2>How about evidence from experimental trials?</h2>
<p>There have been several experimental studies looking at how much weight people lose after eating various types of fermented foods. Other studies looked at markers or measures of appetite, but not weight loss.</p>
<p>One <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/different-effects-of-whole-milk-and-a-fermented-milk-with-the-same-fat-and-lactose-content-on-gastric-emptying-and-postprandial-lipaemia-but-not-on-glycaemic-response-and-appetite/79DEE4301B2C3190497E058E49ACA758">study</a> showed the stomach of men who drank 1.4 litres of fermented milk during a meal took longer to empty (compared to those who drank the same quantity of whole milk). This is related to feeling fuller for longer, potentially having less appetite for more food.</p>
<p>Another <a href="https://www.scielo.br/j/rn/a/FBWZ7CYwfJN7mxnxWZqvWsS/?lang=en#">study</a> showed drinking 200 millilitres of kefir (a small glass) reduced participants’ appetite after the meal, but only when the meal contained quickly-digested foods likely to make blood glucose levels rise rapidly. This study did not measure changes in weight.</p>
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<a href="https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Kefir in jar, with kefir grains on wood spoon" src="https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Kefir, a fermented milk drink, reduced people’s appetite.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/milk-kefir-grains-on-wooden-spoon-526635049">Ildi Papp/Shutterstock</a></span>
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<p>Another <a href="https://www.sciencedirect.com/science/article/pii/S1871403X21000910?via%3Dihub">study</a> looked at Indonesian young women with obesity. Eating tempeh (a fermented soybean product) led to changes in an appetite hormone. But this did not impact their appetite or whether they felt full. Weight was not measured in this study. </p>
<p>A <a href="https://www.nature.com/articles/ejcn201677">study</a> in South Korea asked people to eat about 70g a day of chungkookjang (fermented soybean). There were improvements in some measures of obesity, including percentage body fat, lean body mass, waist-to-hip ratio and waist circumference in women. However there were no changes in weight for men or women.</p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S0924224423000535">systematic review</a> of all studies that looked at the impact of fermented foods on satiety (feeling full) showed no effect. </p>
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Read more:
<a href="https://theconversation.com/how-much-weight-do-you-actually-need-to-lose-it-might-be-a-lot-less-than-you-think-217287">How much weight do you actually need to lose? It might be a lot less than you think</a>
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<h2>What should I do?</h2>
<p>The evidence so far is very weak to support or recommend fermented foods for weight loss. These experimental studies have been short in length, and many did not report weight changes. </p>
<p>To date, most of the studies have used different fermented foods, so it is difficult to generalise across them all. </p>
<p>Nevertheless, fermented foods are still useful as part of a healthy, varied and balanced <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">diet</a>, particularly if you enjoy them. They are rich in healthy <a href="https://pubmed.ncbi.nlm.nih.gov/28945458/#:%7E:text=As%20a%20result%2C%20fermented%20foods,diabetic%20and%20anti%2Datherosclerotic%20activity.">bacteria, and nutrients</a>.</p>
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Read more:
<a href="https://theconversation.com/im-trying-to-lose-weight-and-eat-healthily-why-do-i-feel-so-hungry-all-the-time-what-can-i-do-about-it-215808">I’m trying to lose weight and eat healthily. Why do I feel so hungry all the time? What can I do about it?</a>
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<h2>Are there downsides?</h2>
<p>Some fermented foods, such as kimchi and sauerkraut, have added salt. The latest kimchi study said the average amount of kimchi South Koreans eat provides about 490mg of salt a day. For an Australian, this would represent about <a href="https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/sodium">50%</a> of the suggested dietary target for optimal health. </p>
<p>Eating too much salt <a href="https://theconversation.com/remind-me-again-why-is-salt-bad-for-you-179768">increases your risk</a> of high blood pressure, heart disease and stroke. </p>
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Read more:
<a href="https://theconversation.com/remind-me-again-why-is-salt-bad-for-you-179768">Remind me again, why is salt bad for you?</a>
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<img src="https://counter.theconversation.com/content/222598/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Fermented foods, such as kimchi, have some health benefits. But helping you lose weight? I’m not convinced.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2092242023-07-30T20:08:36Z2023-07-30T20:08:36ZRenaming obesity won’t fix weight stigma overnight. Here’s what we really need to do<figure><img src="https://images.theconversation.com/files/536241/original/file-20230707-27-wk8k6h.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-curvy-woman-smiling-on-camera-1923802535">Shutterstock</a></span></figcaption></figure><p>The stigma that surrounds people living in larger bodies is pervasive and deeply affects the people it’s directed at. It’s been described as one of the last acceptable <a href="https://theconversation.com/how-australias-discrimination-laws-and-public-health-campaigns-perpetuate-fat-stigma-80471">forms of</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592337">discrimination</a>.</p>
<p>Some researchers think the term “obesity” itself is part of the problem, and are calling for a <a href="https://pubmed.ncbi.nlm.nih.gov/27967229/">name change</a> to reduce stigma. They’re <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">proposing</a> “adipose-based chronic disease” instead.</p>
<p>We study the stigma that surrounds obesity – around the time of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.13147">pregnancy</a>, among <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.23266">health professionals</a> and health <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00071-8/fulltext">students</a>, and in <a href="https://www.phrp.com.au/issues/october-2022-volume-32-issue-3/weight-stigma-in-australia/">public health</a> more widely. Here’s what’s really needed to reduce weight stigma.</p>
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Read more:
<a href="https://theconversation.com/lizzo-proudly-calls-herself-a-fat-woman-are-we-allowed-to-as-well-209682">Lizzo proudly calls herself a 'fat' woman. Are we allowed to as well?</a>
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<h2>Weight stigma is common</h2>
<p>Up to <a href="https://pubmed.ncbi.nlm.nih.gov/26596238/">42% of adults</a> living in larger bodies experience weight stigma. This is when others have negative beliefs, attitudes, assumptions and judgements towards them, unfairly viewing them as lazy, and lacking in willpower or self-discipline. </p>
<p>People in larger bodies experience <a href="https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2008.636">discrimination</a> in many areas, including in the workplace, intimate and family relationships, education, health care and the media.</p>
<p>Weight stigma is associated with <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5">harms</a> including increased cortisol levels (the main stress hormone in the body), negative body image, increased weight gain, and poor mental health. It leads to decreased uptake of, and quality of, health care.</p>
<p>Weight stigma may even pose a <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5">greater threat</a> to someone’s health than increasing body size.</p>
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Read more:
<a href="https://theconversation.com/should-gps-bring-up-a-patients-weight-in-consultations-about-other-matters-we-asked-5-experts-209681">Should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts</a>
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<h2>Should we rename obesity?</h2>
<p>Calls to remove or rename health conditions or identifications to reduce stigma are not new. For example, in the 1950s homosexuality was classed as a “<a href="https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2022.180103">sociopathic personality disturbance</a>”. Following many years of protests and activism, the term and condition <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/">were removed</a> from the globally recognised classification of mental health disorders.</p>
<p>In recent weeks, European researchers have renamed non-alcoholic fatty liver disease “metabolic dysfunction-associated steatotic liver disease”. This occurred after <a href="https://www.bmj.com/content/382/bmj.p1587">up to 66%</a> of health-care professionals surveyed felt the terms “non-alcoholic” and “fatty” to be stigmatising.</p>
<p>Perhaps it is finally time to follow suit and rename obesity. But is “adiposity-based chronic disease” the answer?</p>
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Read more:
<a href="https://theconversation.com/changing-the-terminology-to-people-with-obesity-wont-reduce-stigma-against-fat-people-124266">Changing the terminology to 'people with obesity' won't reduce stigma against fat people</a>
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<h2>A new name needs to go beyond BMI</h2>
<p>There are two common ways people view obesity. </p>
<p>First, most people use the term for people with a body-mass index (BMI) of 30kg/m² or above. Most, if not all, public health organisations also use BMI to categorise obesity and <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00138-9/fulltext">make assumptions</a> about health. </p>
<p>However, BMI alone is not enough to accurately summarise someone’s health. It does not account for muscle mass and <a href="https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf">does not provide</a> information about the distribution of body weight or adipose tissue (body fat). A high BMI can occur <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">without</a> biological indicators of poor health.</p>
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<p>Second, obesity is sometimes used to describe the condition of excess weight when mainly <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">accompanied by</a> metabolic abnormalities.</p>
<p>To simplify, this reflects how the body has adapted to the environment in a way that makes it more susceptible to health risks, with excess weight a by-product of this.</p>
<p>Renaming obesity “adiposity-based chronic disease” acknowledges the chronic metabolic dysfunction associated with what we currently term obesity. It also avoids labelling people purely on body size.</p>
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Read more:
<a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">Using BMI to measure your health is nonsense. Here's why</a>
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<h2>Is obesity a disease anyway?</h2>
<p>“Adiposity-based chronic disease” is an acknowledgement of a disease state. Yet there is still no universal consensus on whether obesity is a disease. Nor is there clear agreement on the definition of “disease”. </p>
<p>People who take a biological-dysfunction approach to disease <a href="https://pubmed.ncbi.nlm.nih.gov/25336733/">argue</a> dysfunction occurs when physiological or psychological systems don’t do what they’re supposed to.</p>
<p>By this definition, obesity may <a href="https://pubmed.ncbi.nlm.nih.gov/37279872/">not be classified as a disease</a> until after harm from the additional weight occurs. That’s because the excess weight itself may not initially be harmful.</p>
<p>Even if we do categorise obesity as a disease, there may still be value in renaming it.</p>
<p>Renaming obesity may improve public understanding that while obesity is often associated with an increase in BMI, the increased BMI <em>itself</em> is not the disease. This change could move the focus from obesity and body size, to a more nuanced understanding and discussion of the biological, environmental, and lifestyle factors <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">associated</a> with it.</p>
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Read more:
<a href="https://theconversation.com/when-youre-sick-the-support-youll-get-may-depend-on-the-worth-of-your-disease-93955">When you're sick, the support you'll get may depend on the 'worth' of your disease</a>
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<h2>Workshopping alternatives</h2>
<p>Before deciding to rename obesity, we need discussions between obesity and stigma experts, health-care professionals, members of the public, and crucially, <a href="https://www.phrp.com.au/issues/october-2022-volume-32-issue-3/weight-stigma-in-australia/">people living with obesity</a>.</p>
<p>Such discussions can ensure robust evidence informs any future decisions, and proposed new terms are not also stigmatising. </p>
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<a href="https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Friends sitting around table drinking beer and smiling" src="https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People living with obesity need to have a say in any future terms for it.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/aCEg6DQEiDo">AllGo - An App For Plus Size People/Unsplash</a></span>
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Read more:
<a href="https://theconversation.com/todays-disease-names-are-less-catchy-but-also-less-likely-to-cause-stigma-131465">Today's disease names are less catchy, but also less likely to cause stigma</a>
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<h2>What else can we do?</h2>
<p>Even then, renaming obesity may not be enough to reduce the stigma.</p>
<p>Our constant exposure to the socially-defined and acceptable idealisation of smaller bodies (the “thin ideal”) and the pervasiveness of weight stigma means this stigma is deeply ingrained at a societal level.</p>
<p>Perhaps true reductions in obesity stigma may only come from a societal shift – away from the focus of the “thin ideal” to one that acknowledges health and wellbeing can occur at a range of body sizes.</p><img src="https://counter.theconversation.com/content/209224/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Blake Lawrence is a member of The Obesity Society and The Obesity Collective. </span></em></p><p class="fine-print"><em><span>Briony Hill receives funding from the Australian Research Council and The Australian Prevention Partnership Centre. She is affiliated with The Obesity Collective. </span></em></p><p class="fine-print"><em><span>Ravisha Jayawickrama does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Obesity is out and ‘adipose-based chronic disease’ is in, according to a recent paper. But a name change alone won’t fix entrenched stigma.Ravisha Jayawickrama, PhD candidate, School of Population Health, Curtin UniversityBlake Lawrence, Lecturer, Curtin School of Population Health, Curtin UniversityBriony Hill, Deputy Head, Health and Social Care Unit and Senior Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2081742023-06-26T12:21:51Z2023-06-26T12:21:51ZBMI alone will no longer be treated as the go-to measure for weight management – an obesity medicine physician explains the seismic shift taking place<figure><img src="https://images.theconversation.com/files/533803/original/file-20230623-5599-r64fub.jpg?ixlib=rb-1.1.0&rect=64%2C83%2C4214%2C3188&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Body mass index has been the standard measure to classify obesity and overweight for decades. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/text-on-digital-weighing-scale-persons-looking-down-royalty-free-image/1076583812?adppopup=true">kaipong/iStock via Getty Images</a></span></figcaption></figure><p>Amid the buzz around <a href="https://theconversation.com/drugs-that-melt-away-pounds-still-present-more-questions-than-answers-but-ozempic-wegovy-and-mounjaro-could-be-key-tools-in-reducing-the-obesity-epidemic-205549">weight loss drugs</a> and rising rates of <a href="https://www.who.int/activities/controlling-the-global-obesity-epidemic">obesity worldwide</a>, many health care professionals are questioning one of the key measures that has long been used to define obesity. </p>
<p>On June 14, 2023, the American Medical Association adopted a new policy, calling on doctors to <a href="https://www.ama-assn.org/delivering-care/public-health/ama-use-bmi-alone-imperfect-clinical-measure">deemphasize the role of body mass index</a>, or BMI, in clinical practice. </p>
<p>The statement by the AMA, the <a href="https://www.ama-assn.org/about#:">nation’s largest association</a> representing physicians, signals a significant shift in how clinicians regard BMI as a measure of general health. With <a href="https://www.cdc.gov/nchs/data/databriefs/db360-h.pdf#:">over 40% of Americans</a> having obesity as defined by BMI, a movement away from BMI could have broad implications for patient care.</p>
<p>As a board-certified <a href="https://www.ncbi.nlm.nih.gov/myncbi/scott.hagan.1/bibliography/public/">obesity medicine physician with a research interest</a> in patient-centered obesity care, I have written before about my concerns over use of <a href="https://doi.org/10.1007/s11606-022-07821-w">BMI as a measure of health</a>. The AMA’s policy statement creates an important opportunity to review the current use of BMI in health care settings and to consider what the future holds for the assessment of the health risks of elevated body weight.</p>
<h2>BMI basics</h2>
<p><a href="https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm">Body mass index is a measurement</a> taken by dividing body weight in kilograms by height in meters squared. The metric was developed to estimate a normal body weight <a href="https://doi.org/10.1016/0021-9681(72)90027-6">depending on an individual’s height</a>, given that taller people tend to weigh more. </p>
<p>It rose to prominence for clinicians in the 1990s following the World Health Organization’s adoption of the metric as the <a href="https://pubmed.ncbi.nlm.nih.gov/8594834/">official screening index for obesity</a>. </p>
<p>Research has consistently shown that BMI at a population level <a href="https://doi.org/10.1177/193229680800200623">correlates strongly with body fat percentage</a> and risk for <a href="https://www.cdc.gov/healthyweight/effects/index.html">serious health conditions</a>. The index is easy to measure and inexpensive to calculate, allowing its wide implementation in health care settings.</p>
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<h2>Major limitations</h2>
<p>Because of that ample body of evidence from previous decades, one of the long-standing assumptions in the use of BMI as a measure of general health is that it <a href="https://doi.org/10.1136/jech.25.1.42">accurately predicts an individual’s body fat percentage</a> and, therefore, the potential health risks of elevated weight. </p>
<p>However, while BMI may have strong correlations with the amount of body weight composed of body fat in studies of averages of large groups of people, it does not directly measure body fat for an individual. Therefore, people with the same BMI may have substantially different body fat percentage based on a variety of factors such as <a href="https://doi.org/10.1046/j.1467-789x.2001.00031.x">age, muscle mass, sex and race</a>. In an example from <a href="https://doi.org/10.1038/ijo.2008.11">one large study</a>, adults with a BMI of 25 had a body fat percentage ranging from 14% to 35% for men, and 26% to 42% for women.</p>
<p>Ultimately, BMI cannot provide doctors with precise information about the portion of body weight composed of body fat, nor can it tell us how that fat is distributed in the body. But this distribution is important because research has shown that fat stored around the internal organs has <a href="https://doi.org/10.1136/bmj.m3324">significantly higher health risks</a> than that distributed in the extremities.</p>
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<figcaption><span class="caption">You can’t tell if someone is healthy just by looking at their body weight, and using BMI alone to determine if someone is healthy can be misleading.</span></figcaption>
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<p>Further, just as a variety of health factors may affect the accuracy of BMI to predict how much body fat someone has, health outcomes <a href="https://doi.org/10.1016/s2213-8587(21)00088-7">such as developing diabetes</a> at a specific BMI can vary substantially based on factors such as a person’s race, sex, age and <a href="https://doi.org/10.1001/jama.282.16.1547">physical fitness level</a>.</p>
<p>Finally, a significant number of adults <a href="https://doi.org/10.1001/archinte.168.15.1617">may have metabolically healthy obesity</a>, defined as having a BMI above 30 without having high blood pressure, blood sugar or cholesterol. Adults with metabolically healthy obesity <a href="https://doi.org/10.7326/0003-4819-159-11-201312030-00008">have significantly lower health risks</a> associated with a high BMI and therefore may not benefit from weight loss.</p>
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<figcaption><span class="caption">The American Medical Association says the data determining body mass index does not include considerations for genetics, muscle mass or racial differences.</span></figcaption>
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<p>Although research in the 1970s suggested that any BMI above a normal (18.5-24.9) range <a href="https://doi.org/10.1056/nejm199509143331101">shortened life expectancy</a>, <a href="https://doi.org/10.1001/jama.2012.113905">some modern studies</a> suggest that BMI in the overweight (25-29.9) to class 1 obesity (30-34.9) range <a href="https://doi.org/10.1001/jama.2016.4666">does not raise risk for early death</a>.</p>
<p>The potentially lower risk of death in modern studies for people with higher body weight might be explained by <a href="https://doi.org/10.1001/jama.293.15.1868">improved treatment of conditions</a> such as high cholesterol and blood pressure, common contributors to shortened life expectancy for people with a BMI over 30.</p>
<h2>Using BMI to guide recommendations for weight loss</h2>
<p>Clinicians commonly use BMI as the metric to decide whether to recommend weight loss, drawing from recommendations such as those released by the United States Preventive Services Task Force, an independent, national panel of health care experts that writes <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations">guidelines on preventive health</a>. The task force recommends <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/obesity-in-adults-interventions">lifestyle-based weight loss programs</a> such as diet and exercise for adults with a BMI above 30, or above 25 if they have other obesity-associated health conditions such as high blood pressure or high blood sugar. Its members cite the potential for lifestyle-based weight loss interventions to reduce obesity-related health risks as justification for the recommendation.</p>
<p>However, in their 2018 evidence review for these guidelines, task force researchers found <a href="https://doi.org/10.1001/jama.2018.7777">no significant improvements in cardiovascular events</a>, mortality or health-related quality of life in studies comparing those who received a lifestyle-based or medication-based weight loss intervention, or both, versus those who did not. </p>
<p>The only specific health outcome that was prevented was developing diabetes. Whether newer, more effective weight loss medications, <a href="https://theconversation.com/ozempic-helps-people-lose-weight-but-who-should-be-able-to-use-it-196794">such as Ozempic</a>, will lead to long-term health benefits <a href="https://classic.clinicaltrials.gov/ct2/show/NCT03574597">remains to be seen</a>.</p>
<p>Part of the reason that the evidence for health benefits of weight loss interventions is so poor is that <a href="https://doi.org/10.1210/er.2017-00111">body weight is regulated by a complicated hormonal system</a>. An adult trying to lose weight with diet and exercise <a href="https://doi.org/10.1056/nejmoa1105816">will face indefinite increases in hunger</a> and <a href="https://doi.org/10.1056/nejm199503093321001">reductions in daily calories burned</a> as the body attempts to correct weight back to baseline. As a result, even in the optimal setting of clinical trials, the task force found that only 1 in 8 adults would sustain clinically meaningful weight loss of at least 5% of their prior body weight.</p>
<h2>Alternatives for assessing weight and health</h2>
<p>With the shift away from BMI, the AMA recommends alternative measures that clinicians can use for the assessment of the health risks of an elevated body weight. A variety of measures are suggested, including <a href="https://www.omnicalculator.com/health/bai">body adiposity index</a>, <a href="https://www.omnicalculator.com/health/relative-fat-mass">relative fat mass</a>, <a href="https://www.omnicalculator.com/health/waist-hip-ratio#:">waist-to-hip ratio</a> and waist circumference. </p>
<p>These measures attempt to better characterize fat distribution in the body, given the increased health risks of fat stored around the internal organs. They require additional measurements in a clinic visit. Given the prevalence of <a href="https://doi.org/10.1038/s41574-022-00686-3">anti-fat bias in health care settings</a>, patients may find such measurements to be stigmatizing. Further, while these measurements may <a href="https://doi.org/10.1016/s0140-6736(05)67663-5">better predict health risks</a> of elevated weight, evidence for using these measurements to improve health outcomes is lacking.</p>
<p>In acknowledging the limitations in using BMI as a general measure of health or as a tool to assess the need for obesity treatment, the AMA has taken an important step toward diminishing the role of BMI in clinical practice. Further research is needed to identify the best ways to assess the health risks of elevated body weight.</p><img src="https://counter.theconversation.com/content/208174/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Scott Hagan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Overreliance on BMI as a measure of weight and health has deepened inequities and led to inaccuracies and overgeneralizations.Scott Hagan, Assistant Professor of Medicine, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1892362022-09-28T14:37:10Z2022-09-28T14:37:10ZObesity is on the rise among South African women – a risk to maternal and child health<figure><img src="https://images.theconversation.com/files/484034/original/file-20220912-12-v49dqu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Obesity in adults has <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">nearly tripled</a> between 1975 and 2016 across the world. The World Health Organization <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">estimated</a> that by 2016, about 1.9 billion adults worldwide were overweight. More than 650 million of these adults were obese. These represent about 39% and 13% of the world’s adult population, respectively. </p>
<p>Women bear a disproportionately higher burden of obesity. In 2016, it was <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">estimated</a> that 15% of the world’s women and 11% of men were obese. </p>
<p>Overweight and obesity are burgeoning health issues in sub-Saharan Africa – particularly South Africa, with a significantly high burden of overweight and obesity.</p>
<p>In our <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12601-6">recent research</a> we looked at the prevalence of overweight and obesity among women of childbearing age in South Africa. Earlier studies published in <a href="https://hsrc.ac.za/uploads/pageNews/72/SANHANES-launch%20edition%20(online%20version).pdf">2013</a>, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0107471">2014</a> and <a href="https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf">2019</a> (including a government report) show the prevalence of overweight and obesity at one single point in time. But there is a dearth of studies looking at trend data on overweight and obesity prevalence among women of childbearing age, including socioeconomic determinants.</p>
<p>Obesity leads to a number of <a href="https://www.ajol.info/index.php/ijmbr/article/view/133171">maternal and child health problems</a>. These include infertility, miscarriage, babies having congenital abnormalities and other adverse obstetric outcomes. Women who are super-obese experience <a href="https://www.ajol.info/index.php/sajog/article/view/108616/98414">more pregnancy complications</a> (hypertension, pre-eclampsia and surgical complications) than those who are morbidly obese. Noncommunicable diseases associated with obesity are among the <a href="http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000500013">top causes of death</a> in the country. </p>
<h2>Overweight and obesity</h2>
<p><a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12601-6">Our study</a> looked at nationally representative data on the prevalence and determinants of overweight and obesity in South African women aged 15 to 49 who were not pregnant. It covered the period 1998 to 2017.</p>
<p>The study found a rise in the prevalence of overweight (from 51.3% to 60%) and obesity (from 24.7% to 35.2%) between 1998 and 2017.</p>
<p>There are a number of factors behind the rising trend of overweight and obesity in women of childbearing age in South Africa. These include rapid economic development since the new democracy in 1994, urbanisation, and the increased number of women in the labour force. </p>
<p>Working women tend to have low-energy expending jobs. And mobility is less energy-intensive because of shorter commutes and the use of motorised transport. Long working hours make it difficult for many women to prepare healthy meals. In addition, processed food is more widely accessible. Also, the wider living environment may act as a barrier to physical activity. High crime levels in communities can lead to safety concerns that prevent women from being physically active.</p>
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Read more:
<a href="https://theconversation.com/young-women-in-soweto-say-healthy-living-is-hard-heres-why-118198">Young women in Soweto say healthy living is hard. Here's why</a>
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<p>Factors associated with being overweight and obese were: increased age; self-identifying with the black African population group; higher educational attainment; residing in an urban area; and belonging to wealthier socioeconomic quintiles. Current smokers had decreased odds of being overweight and obese.</p>
<p>The prevalence of obesity in South Africa is high relative to that documented in other countries (except for urban Egypt). Rates of overweight and obesity documented in the <a href="https://link.springer.com/content/pdf/10.1007%2Fs10995-008-0340-6.pdf">US</a>, <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/84DE7B5E812AA66BB028039B058C6E69/S1368980004000618a.pdf/div-class-title-anthropometry-of-women-of-childbearing-age-in-morocco-body-composition-and-prevalence-of-overweight-and-obesity-div.pdf">Morocco</a> and <a href="https://bmjopen.bmj.com/content/7/10/e017344">urban sub-Saharan Africa</a> vary between 10% and 32%. </p>
<p>Our findings show that South Africa is off-track with meeting targets it set in 2013 for reducing overweight and obesity levels. The initial goal was to get levels down <a href="https://extranet.who.int/ncdccs/Data/ZAF_B3_NCDs_STRAT_PLAN_1_29_1_3%5B2%5D.pdf">10 percentage points by 2020</a>.</p>
<p>Given that by <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12601-6">2017</a> the levels of overweight and obesity were still at 60% and 35.2%, respectively, it is clear from this research that more needs to be done. </p>
<h2>Recommendations</h2>
<p>The current tax on sugar-sweetened beverages is an example of the government’s commitment to fighting obesity in South Africa. However, the rising prevalence of overweight and obesity among women of childbearing age reported in this research means the government needs to complement this tax with other interventions. </p>
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<a href="https://theconversation.com/new-research-shows-south-africas-levy-on-sugar-sweetened-drinks-is-having-an-impact-158320">New research shows South Africa's levy on sugar-sweetened drinks is having an impact</a>
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<p>The government should run sensitisation and awareness-raising campaigns and programmes targeting certain groups of women. There is a need to focus on women who are older, who self-identify as black African, with higher educational attainment, who live in urban areas, and who are relatively wealthy. </p>
<p>In addition, the interests of the food industry that contribute to the rise in overweight and obesity need to be regulated. And investments must be made by the government to promote healthy lifestyles and safety in urban communities. At an individual level, women need to have healthy lifestyles and be physically active. This will help to reverse or restrain the rise in overweight and obesity.</p><img src="https://counter.theconversation.com/content/189236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mweete D. Nglazi received funding from the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the National Health Scholarship Programme from funding received from the Public Health Enhancement Fund/South African National Department of Health. The content hereof is the author’s sole responsibility and does not necessarily represent the official views of the SAMRC. The funder had no role in writing the article.</span></em></p><p class="fine-print"><em><span>John Ele-Ojo Ataguba does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Obesity leads to a number of maternal and child health problems.Mweete D. Nglazi, PhD graduate, University of Cape TownJohn Ele-Ojo Ataguba, Senior Lecturer in the Health Economics Unit, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1711162021-11-18T02:18:15Z2021-11-18T02:18:15ZIt might be uncomfortable to talk about. But obesity puts children at risk of severe COVID<figure><img src="https://images.theconversation.com/files/432317/original/file-20211117-23-1svtrta.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://s3-eu-west-1.amazonaws.com/wof-image-bank/Misys_SP2016041855.jpg">World Obesity Federation</a></span></figcaption></figure><p>Vaccinating children against COVID-19 is on parents’ minds, now Australia’s rollout is open to those aged 12 and over, and regulators are actively considering vaccination for five to 11 year olds. Many parents will be thinking about the pros and cons of their children being vaccinated. </p>
<p>Excess weight seems to be an important factor that increases the chance of COVID-19 progressing to severe disease, including in children. </p>
<p>Yet the benefits of vaccines for children with excess weight or obesity hasn’t received much attention. </p>
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Read more:
<a href="https://theconversation.com/these-3-factors-predict-a-childs-chance-of-obesity-in-adolescence-and-no-its-not-just-their-weight-124994">These 3 factors predict a child's chance of obesity in adolescence (and no, it's not just their weight)</a>
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<h2>What does the evidence say?</h2>
<p>Defining excess weight and obesity in a child is based on their weight and height (their <a href="http://pro.healthykids.nsw.gov.au/assess/">body mass index</a> or BMI). Like most aspects of health in children, that is expected to change as they grow and develop. </p>
<p>Many studies have shown children and young people with excess weight and obesity are more likely to go to hospital or become severely unwell with COVID-19.</p>
<p><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780706">A large study</a> of more than 43,000 hospital presentations of children under 18 years in the United States showed the main background health conditions that increased the chance a child would need admission to hospital with COVID were diabetes and obesity. </p>
<p>If admitted to hospital with COVID, having diabetes, obesity or heart disease increased the risk of severe disease requiring intensive care.</p>
<p><a href="https://www.medrxiv.org/content/10.1101/2021.10.28.21265616v2.full.pdf">A recent study</a> of more than 400 COVID admissions in children from Canada, Iran and Costa Rica showed obesity was associated with severe COVID-19, particularly among those aged over 12. Obesity was the only background health condition that increased the risk (three-fold) of severe COVID-19 in this age group.</p>
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<img alt="Doctor listens to a child's back with a stethoscope." src="https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">One study showed obesity was the only existing health condition that increased the risk of severe COVID in adolescents.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-doctor-listening-patient-lung-heartbeat-1690933801">Shutterstock</a></span>
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<p>In Australia, <a href="https://www.paeds.org.au">two-thirds of children</a> who needed ICU-level care for COVID have excess weight (weight above the 95th percentile for their age), which is <a href="https://www.aihw.gov.au/reports/overweight-obesity/overweight-obesity-australian-children-adolescents/summary">at least twice the proportion</a> of children with excess weight in the general population.</p>
<h2>Why does weight seem to matter so much?</h2>
<p>It is not absolutely clear, but it seems excess weight and obesity particularly affect <a href="https://academic.oup.com/ooim/article/2/1/iqab001/6105076?login=true">how well our immune system can control the virus</a> early on in the infection.</p>
<p>It also seems to predispose us to a poorly regulated immune response later in the infection, leading to too much inflammation. </p>
<p>This so-called hyper-inflammation is a key cause of severe COVID-19. </p>
<p>How <a href="https://www.sciencedirect.com/science/article/pii/S1550413121000164">blood vessels respond to stress and inflammation</a> may also be compromised in people with excess weight and obesity, leading to complications such as kidney injury, blood clotting, stroke and heart attacks.</p>
<p>In adults, obesity is <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247461#pone.0247461.ref010">a major risk factor for severe COVID-19</a>too. It frequently occurs alongside diabetes, high blood pressure and other diseases in the so-called metabolic syndrome. All of these diseases have been associated with more severe COVID and similarly are linked to poorly regulated immune responses. </p>
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Read more:
<a href="https://theconversation.com/multisystem-inflammatory-syndrome-after-covid-in-children-is-rare-but-makes-the-body-fight-itself-166822">Multisystem inflammatory syndrome after COVID in children is rare but makes the body fight itself</a>
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<p>There may also be a <a href="https://www.science.org/content/article/why-covid-19-more-deadly-people-obesity-even-if-theyre-young">mechanical effect</a>, with obesity restricting chest wall movement reducing lung volumes and airway size under stress.</p>
<p>Obesity is also a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523028/">leading risk factor for severe influenza</a>, potentially through some similar mechanisms. </p>
<h2>What can we do about it?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=310&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=310&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=310&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=390&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=390&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=390&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccines offer the best protection from COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccination-little-girl-doctors-office-funny-1817977970">Shutterstock</a></span>
</figcaption>
</figure>
<p>Parents need to be aware their child’s weight can affect their risk of severe COVID. <a href="http://pro.healthykids.nsw.gov.au">These resources</a> can help determine where your child sits in terms of their weight.</p>
<p>Parents should also factor their and their children’s weight into their family decisions about COVID prevention, including vaccination. If you or they are overweight, vaccines offer the best protection from COVID.</p>
<p>If you think your child might have excess weight, talk to your GP and consider making some changes to the family’s physical activity, screen time, sleep and eating behaviours. The <a href="https://pro.healthykids.nsw.gov.au/wp-content/uploads/2017/04/HNSW_223347_Healthy-weight-and-habits-fact-sheet_Web_FA.pdf">Eight Health Habits fact sheet</a> provides some starting points for families. </p>
<p>Obesity also needs to be factored into national decision-making around vaccination priorities. When vaccines were first made available for children aged 12-15 years, a number of health conditions were listed as “conditions associated with increased risk of severe COVID-19”. Severe obesity was on this list, but the list wasn’t ranked, so weight received very little focus. </p>
<p>Among all the recommended groups that should be vaccinated, people with obesity should be a top priority given it’s one of the <a href="https://www.fda.gov/media/153508/download">highest risk</a> factors for severe COVID. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-kids-get-long-covid-and-how-often-a-paediatrician-looks-at-the-data-166277">Do kids get long COVID? And how often? A paediatrician looks at the data</a>
</strong>
</em>
</p>
<hr>
<p>Parents need to be aware of their and their children’s weight as an important issue in making decisions about vaccination. </p>
<p>Health practitioners and policymakers should prioritise excess weight and obesity as health conditions in current and future vaccine programs.</p>
<p>It might be uncomfortable to talk about, but weight is a key factor that makes COVID worse, even in children. We need to talk about it so parents can make informed decisions about their child’s risk and the benefits of vaccination.</p><img src="https://counter.theconversation.com/content/171116/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Britton receives funding from the National Health and Medical Research Council and the Commonwealth Department and NSW Ministry of Health</span></em></p><p class="fine-print"><em><span>Louise Baur is Director of the NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood. She has an NHMRC Leadership Fellowship (2022-2026) which supports research in the prevention and treatment of paediatric obesity. In 2020 and 2022 she received honoraria from Novo Nordisk for educational sessions on the management of adolescent obesity (funding to her institutional research cost centre).
</span></em></p><p class="fine-print"><em><span>Nicholas Wood receives funding from the National Health and Medical Research Council for a Career Development Fellowship. He holds a Churchill Fellowship. </span></em></p>Obesity and excess weight increase the risk of COVID progressing to severe disease, including in children. Vaccination is key to reducing this risk.Philip Britton, Senior lecturer, Child and Adolescent Health, University of SydneyLouise Baur, Professor, Discipline of Child and Adolescent Health, University of SydneyNicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1527822021-02-08T13:42:02Z2021-02-08T13:42:02ZWill the COVID-19 vaccine work as well in patients with obesity?<figure><img src="https://images.theconversation.com/files/378933/original/file-20210114-14-wbf2ek.jpg?ixlib=rb-1.1.0&rect=16%2C16%2C5317%2C3275&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Patients with overweight or obesity issues make up more than 70% of the U.S. population.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/overweight-man-standing-on-bathroom-scales-royalty-free-image/1169212311?adppopup=true">Peter Dazeley via Getty Images</a></span></figcaption></figure><p>When researchers began to develop what they hoped would be an effective COVID-19 vaccine, they already knew that H1N1 influenza – a novel virus, like COVID-19 – <a href="https://doi.org/10.1093/cid/ciq152">more severely affected patients with overweight or obesity</a>. Patients with a body mass index of 30 or above had a higher risk of hospitalization and death from H1N1. </p>
<p>This is not the first time such a link has been found. A 2017 study from the University of North Carolina at Chapel Hill <a href="https://doi.org/10.1513/AnnalsATS.201706-447AW">discovered the flu shot</a> was less effective in patients who had excess weight or obesity. This study included only 1,022 participants, but <a href="https://doi.org/10.1038/ijo.2011.208">other small</a> studies show similar results. </p>
<p>Flash forward to today, when the COVID-19 vaccine has been created, tested on more than 40,000 patients and is now being distributed across the nation. The data is promising; the two authorized vaccines offer more than <a href="https://www.fda.gov/media/144246/download">90% protection</a> from the virus.</p>
<p>But doctors and researchers are mindful of the H1N1 and UNC findings. As <a href="https://uvahealth.com/findadoctor/profile/catherine-w-varney">a physician</a> who specializes in obesity medicine, I’m one of them. Now all of us want to know this: Will the COVID-19 vaccines be equally effective in patients who have excess weight or obesity? Initial data shows this to be the case, but additional data will need to be collected after many more patients are vaccinated. </p>
<figure class="align-center ">
<img alt="A woman receives a COVID-19 shot." src="https://images.theconversation.com/files/378109/original/file-20210111-13-1utp484.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378109/original/file-20210111-13-1utp484.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378109/original/file-20210111-13-1utp484.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378109/original/file-20210111-13-1utp484.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378109/original/file-20210111-13-1utp484.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378109/original/file-20210111-13-1utp484.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378109/original/file-20210111-13-1utp484.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some studies suggest people who are overweight or obese may be more at risk for influenza.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-doctor-makes-vaccination-to-woman-they-are-royalty-free-image/1264726623?adppopup=true">kevajefimija via Getty Images</a></span>
</figcaption>
</figure>
<h2>What the research says</h2>
<p>The answer to this question is crucial. Adult patients who have excess weight or obesity are among the <a href="https://doi.org/10.1002/oby.22913">most impacted</a> by COVID-19, and they make up more than <a href="https://www.cdc.gov/obesity/data/adult.html">70% of the U.S. population</a>. Indeed, as I read through the <a href="https://www.fda.gov/media/144246/download">Pfizer vaccine trial data</a>, I saw that very familiar group: 70% of the Pfizer COVID-19 trial participants, like the U.S. demographic, had overweight or obesity. A collective cheer from <a href="https://www.abom.org/">obesity specialists</a> could be heard around the world for creating a group that best represented our current U.S. population. </p>
<p>COVID-19 has been devastating here in the U.S. for those with overweight and obesity, <a href="https://doi.org/10.1093/cid/ciaa415">particularly younger patients</a>. Initially, doctors thought younger patients as a whole had less risk of severe complications due to their age. But for people younger than 50 who have obesity, the obesity negated the protective effect of age.</p>
<p>The COVID-19 vaccine is promising because it activates <a href="https://theconversation.com/coronavirus-b-cells-and-t-cells-explained-141888">B and T immune cells</a>, critical for long-term protection against viruses. B cell activity and levels have been shown to be <a href="https://doi.org/10.4049/jimmunol.1601031">lower in both mice and human subjects that have obesity</a> following infections. </p>
<p>These immune cells can quickly produce new antibodies even if antibody levels fall over time and there are few left from previous vaccinations. Antibodies block the virus from getting into a cell and infecting it, but B and T cells destroy the virus-infected cells and prevent further replication of the virus and spread to other cells. But this may not be true for people with obesity. Researchers believe that <a href="https://doi.org/10.1017/S0029665112000158">obesity negatively impacts the function of the immune system</a>. </p>
<p>Although patients with obesity can produce adequate antibodies, <a href="https://doi.org/10.1513/AnnalsATS.201706-447AW">multiple studies show</a> they have a <a href="https://pubmed.ncbi.nlm.nih.gov/23512822/">lower level</a> of those B and T cells following an infection with the H1N1 influenza. This can alter the typical immune response, leaving the body one step behind after the virus invades. An important question is whether this altered immune response is also present after a COVID-19 infection. And because of this, we want to know whether the vaccine will be as effective in patients with obesity for as long as other patients who do not suffer from this disease. </p>
<h2>Vaccine still a must</h2>
<p>Even with this concern, patients with overweight or obesity should still get the COVID-19 vaccine. Even for those patients with obesity who receive the flu vaccine but still get the flu, there’s almost a <a href="https://www.cdc.gov/flu/spotlights/2017-2018/vaccine-reduces-risk-severe-illness.htm">40% reduction</a> in hospitalization and 82% reduction in ICU admissions.</p>
<p>In short, the data released from Pfizer and the FDA show the vaccine is not only effective in participants as a whole, but in particular, patients with obesity. </p>
<p>It is encouraging that Pfizer <a href="https://www.fda.gov/media/144246/download">wanted to show</a> the vaccine was just as effective in those who have excess weight or obesity. Researchers are recognizing these patients are more at risk and now design studies to reflect that. </p>
<figure class="align-center ">
<img alt="A woman exercising outdoors." src="https://images.theconversation.com/files/378136/original/file-20210111-17-dktkbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378136/original/file-20210111-17-dktkbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378136/original/file-20210111-17-dktkbd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378136/original/file-20210111-17-dktkbd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378136/original/file-20210111-17-dktkbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378136/original/file-20210111-17-dktkbd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378136/original/file-20210111-17-dktkbd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People who exercise regularly may have a better response to the COVID-19 vaccine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-overweight-woman-on-her-way-to-training-royalty-free-image/1257216517?adppopup=true">urbazon via Getty Images</a></span>
</figcaption>
</figure>
<h2>Behaviors that will help</h2>
<p>Two things might encourage people with excess weight or obesity to exercise and improve their dietary habits: Previous studies <a href="https://doi.org/10.4161/hv.23365">show a positive association</a> between regular exercise before receiving a vaccine and your response to the vaccine, producing up to <a href="https://doi.org/10.1152/japplphysiol.00790.2006b">four times as more antibodies</a> after being exposed to a virus or bacteria. This means that antibodies are higher in those who exercised prior to vaccine administration versus those who did not engage in exercise.
Also, it seems the type and <a href="https://doi.org/10.1016/j.cell.2019.08.010">amount of your gut bacteria</a> may impact the vaccine response. Foods containing <a href="https://blog.uvahealth.com/2019/06/05/probiotics-good-gut-health/">prebiotics and probiotics</a> may assist with this and other disease prevention and treatment. Prebiotics can be found in barley and garlic, while yogurt, sauerkraut and some cheeses contain probiotics. </p>
<p>More data is needed before we know precisely how patients with excess weight and obesity respond to vaccines when compared to the rest of the population. But that data is coming quickly. Even just one year from now, we will look back and be amazed at all we have learned about COVID-19. From that research will come the knowledge we need to create a better way to deliver health care to all of us.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/152782/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cate Varney does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Americans with excess weight and obesity have been hit hard by COVID-19. Now there is reason to believe they may not get the same protection from the vaccines.Cate Varney, Clinical Physician, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1450172020-09-08T12:17:22Z2020-09-08T12:17:22ZA doctor’s open apology to those fighting overweight and obesity<figure><img src="https://images.theconversation.com/files/356603/original/file-20200904-24-3gd05a.jpg?ixlib=rb-1.1.0&rect=3%2C3%2C791%2C480&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors have told people who are overweight to exercise more and eat less, when in fact their overweight may be due to genetic or other factors that exercise won't change. </span> <span class="attribution"><a class="source" href="http://www.uconnruddcenter.org/image-library?#">UConn Rudd Center for Food Policy & Obesity</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Obesity has emerged as a significant risk factor <a href="https://news.yahoo.com/obesity-increases-risk-covid-19-230500610.html">for poor outcomes</a> in patients infected with COVID-19. Based on how doctors and others in health care have previously treated patients with obesity or overweight conditions, my guess is that many will respond by declaring: “Well, it’s their own fault for being overweight!” </p>
<p>In the spirit of recognizing that people who struggle with weight loss include our family and friends, let me propose a different sentiment. </p>
<p>To those who we have shamed for having excess body weight and/or failing diets: “You were right, and we are sorry. After giving you undoable tasks, we ridiculed you. When you tried to tell us, we labeled you as weak and crazy. Because we didn’t understand what you were experiencing, we looked down on you. We had never felt it ourselves. We did not know. And for that, we apologize.” </p>
<figure class="align-center ">
<img alt="A woman and a nutritionist." src="https://images.theconversation.com/files/356607/original/file-20200904-14-87q46a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/356607/original/file-20200904-14-87q46a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/356607/original/file-20200904-14-87q46a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/356607/original/file-20200904-14-87q46a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/356607/original/file-20200904-14-87q46a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/356607/original/file-20200904-14-87q46a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/356607/original/file-20200904-14-87q46a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A nutritionist talks with a patient at an obesity clinic in Mulhouse, France.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/reportage-in-the-obesity-clinic-in-mulhouse-france-news-photo/481681619?adppopup=true">BSIP/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<h2>‘Fat shaming’ doesn’t work</h2>
<p>This is just one version of the apology we owe our fellow human beings whom we told to lose weight using diet and exercise. Then, when it didn’t work, we blamed them for our treatment plan failures and smothered their feedback with prejudice and persecution. </p>
<p>As a <a href="https://www.linkedin.com/in/j-david-prologo-md-fsir-abom-d-40071861/">physician and researcher</a>, I have worked in this space for many years. I have witnessed firsthand the life-altering power of preexisting ideas, judgments and stereotypes. I have seen how unfounded, negative ideas are woven through virtually every interaction that those struggling with weight loss endure when seeking help. </p>
<p>And there are tens of millions of them. The Centers for Disease Control and Prevention classifies more than 70% of U.S. adults <a href="https://www.cdc.gov/obesity/data/adult.html">as overweight</a>, and more than 40% as obese. Those numbers continue to climb, and even when some manage to lose weight, <a href="https://www.apa.org/science/about/psa/2018/05/calorie-deprivation">they almost always gain it back</a> over time. </p>
<h2>Rash judgments</h2>
<p>To illustrate, imagine that I am your doctor. You have a body rash (which represents the condition of being overweight or obese), and you make an appointment with me to discuss a treatment plan. </p>
<p>During your visit, my office staff uses stigmatizing language and nonverbal signals that make it clear we are annoyed at the idea of dealing with another rash person. We invoke a set of assumptions that dictate the tone of our relationship, including the notions that you are lazy or ignorant or both. You will sense my disgust, which will make you uncomfortable. </p>
<p>Unfortunately, health care providers commonly treat patients who struggle with weight loss by assigning stereotypes, snap judgments and ingrained negative attributes – including <a href="https://4617c1smqldcqsat27z78x17-wpengine.netdna-ssl.com/wp-content/uploads/Weight-Bias-in-Healthcare.pdf">laziness, noncompliance, weakness and dishonesty.</a> </p>
<p>After this uncomfortable exchange, I will prescribe a treatment program for your rash and explain that it’s quite straightforward and easy to use. I will point you to several resources with pictures of smiling people with beautiful skin who never had a rash to emphasize how wonderful your outcome will be. “It’s just a matter of sticking to it,” I will say.</p>
<p>Back at home, you are excited to start treatment. However, you quickly realize that putting on the cream is unbearable. It burns; your arms and legs feel like they’re on fire shortly after you apply the treatment. You shower and wash off the cream. </p>
<h2>A dismal conversation</h2>
<p>After a few days, you try again. Same result. Your body will not accept the cream without intolerable burning and itching. You return to my office, and we have the following conversation:</p>
<p><strong>You</strong>: Doctor, I cannot stick to this plan. My body cannot tolerate the cream. </p>
<p><strong>Me</strong>: This is exactly why doctors do not want to deal with rash people. I’m giving you the treatment and you won’t stick to it. I put the cream on myself every morning without an issue.</p>
<p><strong>You</strong>: But you don’t have a rash! Putting this cream on when you have a rash is different than putting it on clear skin. I do want to get rid of my rash, but I cannot tolerate this cream. </p>
<p><strong>Me</strong>: If you don’t want to follow the treatment, that’s up to you. But it’s not the cream that needs changing. It is your attitude toward sticking with it.</p>
<p>This exchange illustrates prejudical behavior, bias and a disconnect between a provider’s perceptions and a patient’s experience. </p>
<figure class="align-center ">
<img alt="For people trying to lose weight, new approaches are needed." src="https://images.theconversation.com/files/356452/original/file-20200903-24-1p8ih1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/356452/original/file-20200903-24-1p8ih1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/356452/original/file-20200903-24-1p8ih1t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/356452/original/file-20200903-24-1p8ih1t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/356452/original/file-20200903-24-1p8ih1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/356452/original/file-20200903-24-1p8ih1t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/356452/original/file-20200903-24-1p8ih1t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">New approaches are needed for those trying to lose weight.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cape-verdean-woman-weighing-herself-royalty-free-image/155771035?adppopup=true">Jamie Grill/JGI via Getty Images</a></span>
</figcaption>
</figure>
<h2>Prejudice and bias</h2>
<p>For someone who wants to lose weight, the experience of a diet and exercise prescription is not the same as for a lean person on the same program. Perceiving another person’s experience as the same as one’s own when circumstances are different <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1559-1816.2000.tb02464.x">fuels prejudice and bias</a>.</p>
<p>That night, though, you can’t help but wonder: “Is something wrong with me? Maybe my genes or thyroid or something? The cream seems so fun and easy for everyone else.” </p>
<p>At this point, the blame unconscionably lands on the patient. Despite an undeniable explosion of this rash, and abysmal treatment adherence rates while <a href="https://www.cdc.gov/nchs/products/databriefs/db313.htm">we have been touting the cream</a>, we stubbornly maintain it works. If the rash is expanding, and hundreds of millions of people are failing treatment or relapsing every day, well – it’s their own fault! </p>
<p>As time goes on, you feel increasingly discouraged and depressed because of this untenable situation. Frustration wears on your sense of optimism and chips away at your happy moments. You have this rash and you can’t tolerate the treatment plan, but no one believes you. They judge you, and say you choose not to use the cream because you lack willpower and resolve. You overhear their conversations: “It’s her own fault,” they say. “If that were me, I would just use the d#$% cream.” </p>
<p>This is the very definition of prejudice: an opinion, often negative, directed toward someone and related to something that the individual does not control. Although it has been extensively demonstrated that the causes for overweight and obesity are multifactorial, the myth that it’s the patient’s fault <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1559-1816.2000.tb02477.x">is still widely accepted</a>. This perception of controllability leads to the <a href="https://www.nature.com/articles/nrn3800.pdf?origin=ppub">assignment of derogatory stigma</a>.</p>
<h2>A setup for failure</h2>
<p>That evening you sit alone. You think there’s not a single person on the planet who believes your body won’t tolerate this treatment. Society believes you brought this on yourself to begin with; there doesn’t seem to be a way out. </p>
<p>We have driven those with overweight and obesity conditions to this place far too many times. We have set them up to take the fall for our failed treatment approaches. When they came to us with the truth about tolerability, we loudly discredited them and said they were mentally weak, noncompliant or lazy. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>So where do we go from here? If we agree to stop stigmatizing, stereotyping and blaming patients for our treatment failures, and we accept that our current nonsurgical paradigm is ineffective – what takes its place? </p>
<p>For starters, we need a new approach, founded on respect and dignity for patients. A fresh lens of acceptance and suspended judgment will allow us to shift our focus toward treatments for the body, rather than “mind over matter,” which is a concept we use for no other medical condition. A perspective based in objectivity and equality will allow caregivers to escape the antiquated blaming approach and perceive those with overweight or obese conditions in the same light as those with other diseases. Only then will we finally shift the paradigm.</p><img src="https://counter.theconversation.com/content/145017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. David Prologo does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>All too often the medical community ‘fat-shames’ patients trying to lose weight, when in fact obesity and overweight are complicated medical issues.J. David Prologo, Associate Professor, Emory University School of Medicine, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1373422020-05-06T12:11:09Z2020-05-06T12:11:09ZCoronavirus linked to greater risk of life-threatening infection in people with obesity<figure><img src="https://images.theconversation.com/files/333110/original/file-20200506-49579-peb5sr.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3858%2C2577&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A report found that 90% of morbidly obese patients admitted to intensive care needed a ventilator.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/svitavy-czech-republic-september-20-2012-1682201872">Patrik Slezak/ Shutterstock</a></span></figcaption></figure><p>As worldwide coronavirus-related deaths tip a <a href="https://www.worldometers.info/coronavirus/">quarter of a million</a>, a concerning trend is surfacing in the medical literature: high rates of obesity in groups of patients with severe or life-threatening COVID-19.</p>
<p>A <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2010419">recent report from New York</a> shows more than two in every five people requiring a breathing tube were obese. A report from one intensive care unit in France found almost <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.2283">90% of morbidly obese patients</a> admitted required mechanical ventilation compared to less than half of those with lower body weight.</p>
<p>There are several reason why patients with obesity admitted to intensive care with COVID-19 may require invasive ventilation.</p>
<p>Higher levels of fat in the chest and belly put pressure on the lungs, making it difficult for people with obesity to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311385/">fill them to capacity</a> under normal circumstances. This reduced breathing capacity may add to respiratory distress in patients with COVID-19.</p>
<p>Carrying extra weight also means there is higher oxygen demand. Some patients with obesity might breathe too shallowly or too slowly to <a href="https://www.nhlbi.nih.gov/health-topics/obesity-hypoventilation-syndrome">provide enough oxygen</a> to the body, and some may intermittently cease breathing altogether.</p>
<p>Both of these factors already put strain on the heart and lungs, and may worsen COVID-19 symptoms. But they don’t seem to entirely explain the unexpectedly high rates of obesity in very sick coronavirus infected patients. This suggests that there may be other factors at play which are unique to this virus. </p>
<p>In a <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.22843">recent review paper</a>, we looked at why patients with obesity are at higher risk of severe or life-threatening COVID-19 infections. Based on our findings, we believe fat tissue is a potential source of unchecked inflammation which could cause damage to organs, including the lungs, as a result of COVID-19.</p>
<p>People with obesity are commonly shown to have an unbalanced or <a href="https://jamanetwork.com/journals/jama/article-abstract/1030726">inflamed immune system</a>. Their blood often has higher levels of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929211/">several inflammatory signals</a> which are similar to COVID-19 responses in the body. This may mean their immune systems are more likely to overreact to a coronavirus infection.</p>
<p>Fat tissue also <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2019.01173/full">acts as a vast reservoir</a> for a range of immune cells, including <a href="https://www.immunology.org/public-information/bitesized-immunology/cells/macrophages">macrophages</a> and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/t-cell">T cells</a>. Macrophages devour infectious agents (such as bacteria and viruses) and present the leftovers to T cells, who alert the body of infection. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/333047/original/file-20200506-49558-1sj1j6w.jpg?ixlib=rb-1.1.0&rect=51%2C0%2C5760%2C3837&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333047/original/file-20200506-49558-1sj1j6w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333047/original/file-20200506-49558-1sj1j6w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333047/original/file-20200506-49558-1sj1j6w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333047/original/file-20200506-49558-1sj1j6w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333047/original/file-20200506-49558-1sj1j6w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333047/original/file-20200506-49558-1sj1j6w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fat tissue can act as a reservoir for immune cells.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-examining-patient-obesity-on-light-187742627">Africa Studio/ Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.cdc.gov/coronavirus/2019-ncov/downloads/Huang-2019-nCoV-clinical-features-Lancet-1-24-2020.pdf">Data from Wuhan, China</a> indicates that the body’s immune signal response is higher in people with severe forms of COVID-19. This reaction is referred to as a “<a href="https://theconversation.com/coronavirus-cytokine-storm-this-over-active-immune-response-could-be-behind-some-fatal-cases-of-covid-19-136878">cytokine storm</a>”. </p>
<p>Cytokines act as “messengers” that tell other immune cells about potential threats and trigger inflammation (often in the form of a fever or swelling) in order to destroy the pathogen. But sometimes the immune system overreacts, releasing too many cytokines (a “cytokine storm”).</p>
<p>After becoming infected with coronavirus, an obese person’s body may activate the large fat-dwelling reservoir of immune cells, which can cause excessive swelling and inflammation. This disproportionate activation of the immune system can cause damage in organs, including the lungs.</p>
<p>At day seven to ten of COVID-19, the patient often either begins to improve or can take a turn for the worse. This delayed deterioration suggests that the true harm caused by COVID-19 may be caused by the cytokine storm, rather than the infection itself.</p>
<p>Because fat tissue stores a large reservoir of immune cells, people with obesity may be more likely to suffer a cytokine storm reaction from COVID-19. This would result in damage to the lungs, severe respiratory distress or even death.</p>
<p>There is currently no approved treatment or cure for COVID-19. Doctors are primarily focusing on keeping patients oxygenated and hydrated.</p>
<p>Targeted immunosuppressive drugs (which reduce the strength of the body’s immune system) may be particularly beneficial for patients with severe infections and <a href="https://www.straitstimes.com/world/europe/arthritis-drug-tocilizumab-shows-significant-promise-in-severe-covid-19-cases-study">trials are currently underway</a>.</p>
<p>However, researchers have also seen deficiencies of specific <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa248/5803306">subpopulations of T cells</a> in severe disease. Therefore, non-targeted immunosuppressive medicines could potentially worsen symptoms by further dampening the immune response. </p>
<p>Several additional inflammatory messengers, such as <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30858-8/fulltext">TNFa</a>, may be worth targeting at different stages of the disease. Testing is ongoing for a number of drugs, with more than <a href="https://covid-nma.com/">600 clinical trials</a> currently underway. But it may be months before any immune therapies are approved and none of these drugs will be a cure. </p>
<p>People with obesity should take extra measures to protect themselves from getting COVID-19, including following social distancing measures. Public health attention should also be drawn to <a href="https://jamanetwork.com/journals/jama/fullarticle/2765524">underpriviledged, overcrowded neighbourhoods</a> where poor diet and obesity often coexist. The threshold for escalating intensive treatment should be lowered for subjects with obesity to prevent severe infection.</p><img src="https://counter.theconversation.com/content/137342/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:n.caplice@ucc.ie">n.caplice@ucc.ie</a> receives funding from Science Foundation Ireland. </span></em></p><p class="fine-print"><em><span>Paul MacDaragh Ryan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Over-active immune response might be behind higher rates of life-threatening COVID-19 infections in patients with obesity.Paul MacDaragh Ryan, Junior Doctor (Academic Track Intern), University College CorkNoel Caplice, University College CorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/969852018-07-02T20:10:02Z2018-07-02T20:10:02ZIs BMI a good way to tell if my weight is healthy? We asked five experts<figure><img src="https://images.theconversation.com/files/219881/original/file-20180522-51105-dj1quu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">BMI takes into account your height and your weight, and that's it. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Staying a healthy weight can be a challenge, and knowing what weight is healthy for you can be too. Most people rely on the body mass index, or BMI, which is a measure of our weight in relation to our height. </p>
<p><a href="https://theconversation.com/does-my-bmi-look-big-in-this-and-does-it-really-matter-35156">Many experts</a> have <a href="https://theconversation.com/bmi-is-underestimating-obesity-in-australia-waist-circumference-needs-to-be-measured-too-89156">criticised</a> this fairly limited measure of the health of our weight, yet it still remains the most popular way for most people to judge a healthy weight. </p>
<p>We asked five experts if the BMI is a good indicator of a healthy weight.</p>
<h2>Five out of five experts said no</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/219885/original/file-20180522-51091-1qezyur.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219885/original/file-20180522-51091-1qezyur.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=99&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219885/original/file-20180522-51091-1qezyur.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=99&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219885/original/file-20180522-51091-1qezyur.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=99&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219885/original/file-20180522-51091-1qezyur.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=125&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219885/original/file-20180522-51091-1qezyur.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=125&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219885/original/file-20180522-51091-1qezyur.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=125&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>Here are their detailed responses:</em></strong></p>
<p><iframe id="tc-infographic-274" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/274/b8093fc9b60eedc7c3a36feca9e1ee0a8d581308/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<p><em>If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au</em></p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Disclosures: Emma Gearon has received an Australian Government Research Training Program Scholarship.</em></p><img src="https://counter.theconversation.com/content/96985/count.gif" alt="The Conversation" width="1" height="1" />
All five experts said BMI is not ideal for determining the health of your weight.Alexandra Hansen, Deputy Editor and Chief of Staff, The Conversation AUNZLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/930892018-03-23T09:41:17Z2018-03-23T09:41:17ZHow stigma in the healthcare system is undermining efforts to reduce obesity<figure><img src="https://images.theconversation.com/files/210396/original/file-20180314-113479-1e3yqr0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows healthcare providers may offer weight loss advice in place of medical treatment.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/144769815@N06/with/32897001576/">Canadian Obesity Network</a></span></figcaption></figure><p>Obesity is a <a href="http://www.who.int/nutrition/topics/obesity/en/">global public health concern</a> due to its associations with an increased risk of poor mental and physical health. This is why attempts to prevent and treat obesity – especially in children – have become a focus of public health policy.</p>
<p>But these good intentions are being undermined by persistent and widespread negative stigma against obesity. <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2001.108/full">People with obesity are stigmatised </a> as lazy, gluttonous, unintelligent, unattractive, and lacking in social skills. None of these stereotypes are supported by research. So if not based on evidence, why are these beliefs so widespread? </p>
<p>Obesity is a complex condition and is influenced by a number of <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/287937/07-1184x-tackling-obesities-future-choices-report.pdf">controllable and uncontrollable factors</a>. But despite this, the media, public, and “shock and shame” campaigns focus overwhelmingly on the contribution of [<a href="http://psycnet.apa.org/doiLanding?doi=10.1037%2Fsah0000013">individual choice and responsibility</a>]. </p>
<p>The assumption is that if someone has obesity, it is because they don’t know better, don’t want to be healthier, and don’t have the ability to self regulate. These assumptions are inherently linked to stereotypes and are likely to exacerbate stigmatising attitudes towards people with obesity. </p>
<p>Stigma that perpetuates blame can harm people with obesity in a number of ways. It can lead to self-loathing, a reduction in confidence, <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.234/full">avoidance of exercise</a>, and an increased risk of engaging in self-harm. Both directly and indirectly, <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2006.208/abstract">stigma reduces the health</a> of those who experience it. </p>
<h2>Implications of weight stigma</h2>
<p>Healthcare settings should be the ideal place to advise and support people to make informed choices about their health. With respect to obesity, this might include helping a patient assess contributory factors to their weight. Or might mean going beyond lifestyle factors to consider broader underlying health problems. </p>
<p>While in principle this should be the patient’s experience, the reality for people with obesity is far more challenging. People with obesity are often exposed to stigmatising attitudes and discriminatory behaviours from <a href="http://onlinelibrary.wiley.com/doi/10.1111/obr.12266/full">healthcare professionals</a>. These include receiving less clinician time, being less likely to receive appropriate treatment, and in some instances not being offered certain treatments. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/210392/original/file-20180314-113449-1vox94o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210392/original/file-20180314-113449-1vox94o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210392/original/file-20180314-113449-1vox94o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210392/original/file-20180314-113449-1vox94o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210392/original/file-20180314-113449-1vox94o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210392/original/file-20180314-113449-1vox94o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210392/original/file-20180314-113449-1vox94o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Non-stigmatising image of a couple walking in the woods.</span>
<span class="attribution"><a class="source" href="http://www.imagebank.worldobesity.org/browse">World Obesity Federation</a></span>
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<p>This can <a href="https://www.tandfonline.com/doi/full/10.1080/19406940.2016.1182048">impact patient engagement</a>, and in turn reduce funding for services specifically to support weight management. As such, people with obesity are being excluded from, or are less likely than non-obese people, to receive care and treatment that is likely to help improve health. These effects are compounded by the wider stigmatising beliefs held by the public that reduce the likelihood of individuals with obesity seeking help in the first place. </p>
<h2>Breaking the stigma</h2>
<p>For this to change, everyone needs to recognise and reflect on their own weight stigmatising attitudes and beliefs – because we all have a role to play in the perpetuation of stigma in society. We need to notice and care about stigma – how it is being conveyed, how we can challenge it, and how we can work to develop non-stigmatising environments. </p>
<p>This might involve choosing to support products and companies that are non-stigmatising in their advertising, and being <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30041-X/fulltext">critical of media discourse</a> that focuses on single-factor causes of obesity. </p>
<p>On top of this, those involved in public health promotion or health service delivery can explicitly challenge stigma in their communications and campaigns. Collectively, the sector can develop approaches that view health holistically, support patients’ dignity, as well as their right to make informed choices about whether or not to engage in treatments. </p>
<p>This is important, because it is vital weight stigma is tackled as it is causes psychological harm, and results in unfair and discriminatory treatment that negatively influences patient and public health. And inadvertently, this stigma is undermining efforts to reduce obesity and more generally support people’s health.</p><img src="https://counter.theconversation.com/content/93089/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stuart W. Flint has previously received funding from Middlesborough Borough Council, Sandwell Metropolitan Borough Council and the National Centre of Sport and Exercise Medicine in Sheffield. </span></em></p><p class="fine-print"><em><span><a href="mailto:emily.oliver@durham.ac.uk">emily.oliver@durham.ac.uk</a> has received funding for research from Health and Care Research Wales, the Wolfson Research Institute for Health and Wellbeing, and the NIHR School of Public Health Research. . </span></em></p>Weight stigma at the doctors can be mentally and physically harmful.Stuart W. Flint, Senior Research Fellow in Public Health and Obesity, Leeds Beckett UniversityEmily Oliver, Associate Professor of Sport, Exercise and Physical Activity, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/856162017-10-23T09:41:29Z2017-10-23T09:41:29ZOverweight kids: tackling childhood obesity is about more than just diet and exercise<figure><img src="https://images.theconversation.com/files/191031/original/file-20171019-1086-cesxsx.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>A recent <a href="http://www.who.int/mediacentre/news/releases/2017/increase-childhood-obesity/en/">World Health Organisation report</a> revealed that the number of obese children and adolescents – aged five to 19 years – worldwide has risen tenfold in the past four decades. </p>
<p>Worryingly, it also predicts that “obese” is likely to become the new norm. The report stated that:</p>
<blockquote>
<p>If current trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022.</p>
</blockquote>
<p>The number of overweight or obese infants and young children increased from 32m globally in 1990 to <a href="http://www.who.int/end-childhood-obesity/facts/en/">41m in 2016</a>. The vast majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30% higher than that of developed countries.</p>
<p>And in the UK, <a href="http://content.digital.nhs.uk/ncmp">recent research</a> shows that 9% of four and five year-olds are now classed as obese – with the proportion rising to 20% for 10 to 11-year-olds. </p>
<p>Efforts to reverse this growing trend have mainly focused on two aspects of a child’s life: diet and physical activity. The aim has been to try and regulate a child’s dietary habits by decreasing calorific intake. This is most commonly through the reduction in sugar, while at the same time boosting the amount of exercise children get. </p>
<p>But what is often ignored is a child’s ability to move effectively. It is one thing to say that a child should be more physically active, but quite another for a child to develop the competence and confidence required to engage in physical activity. </p>
<h2>Changing lifestyles</h2>
<p>Most adults tend to think this is something that will happen naturally as part of child’s development – through play and sports participation. But because of the way the world has changed over recent decades – think less time for running around outside and more time inside looking at screens – opportunities for children to move are in decline. </p>
<p>In this way, a child’s “play radius” – the distance a child travels from their home to play – <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-8-15">has shrunk by 90% in a single generation</a>. </p>
<p>A decrease in walking and an increase in transport by car, train or bus also limits children’s opportunities to play. Combine this with the <a href="http://www.tandfonline.com/doi/abs/10.1080/17408989.2011.582489">lack of specialist physical education teachers in primary schools</a> and the result is children’s movement development can no longer be left to chance. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The way children play has changed.</span>
<span class="attribution"><span class="source">Pexels</span></span>
</figcaption>
</figure>
<p>Effective movement for children in the early stages of development, (roughly four to seven years of age) can be assessed by their ability to perform fundamental movement skills. This includes how they run, catch, throw and balance. These skills are often viewed as the building blocks for participation in sport and physical activity. And there is growing evidence that supports the positive relationship between “movement competence” and physical activity in <a href="http://www.tandfonline.com/doi/abs/10.1080/00336297.2008.10483582">early childhood</a> – showing the importance of appropriate movement skills for children.</p>
<p>Evidence suggests that the “movement competence” of four to seven year-olds, in the UK, is average or below average in relation to their peers <a href="http://www.sciencedirect.com/science/article/pii/S0167945715300312">in most other countries</a>, which, alongside childhood obesity levels, clearly indicates the UK’s poor standing in children’s health.</p>
<h2>Getting children moving</h2>
<p>But one glimmer of hope comes from a new movement assessment app called <a href="https://itunes.apple.com/gb/app/movement-assessment-tool/id1253503754?mt=8">Start to Move</a>. The app is based on an assessment tool that enables primary school teachers – who are well placed to spot these skills – to measure, record and track the fundamental movement skills of children aged four to seven years old. And this data can then be used to help policymakers and practitioners alike recognise what support is needed to ensure all children have appropriate movement skills.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=414&fit=crop&dpr=1 600w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=414&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=414&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=520&fit=crop&dpr=1 754w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=520&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=520&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Let’s get kids moving again.</span>
<span class="attribution"><span class="source">Pexels</span></span>
</figcaption>
</figure>
<p>This is important because although findings from previous research studies are useful in providing a snapshot of children’s “movement competence” only a <a href="http://backup.ons.gov.uk/wp-content/uploads/sites/3/2015/11/Overview-of-the-UK-Population-November-2015.pdf">very small number of children</a> have been <a href="http://journals.sagepub.com/doi/abs/10.2466/10.25.pms.121c14x0">measured</a>. So a more widespread understanding of children’s movement is a positive next step – particularly as we stand, globally, on the brink of a situation where “obese” will be more common than “underweight”.</p>
<p>It is crucial then that every solution available is looked into to reverse this worrying trend, because it is clear that current methods are falling short in many places. But ultimately this is about more than just the figures and obesity rates, this is about making sure the next generation of adults are suitably prepared for a sustainable active lifestyle.</p><img src="https://counter.theconversation.com/content/85616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Morley receives funding from the Youth Sport Trust. </span></em></p>One in five children are now obese by the time they turn 11.David Morley, Professor of Youth Sport and physical activity, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/832492017-09-04T12:16:34Z2017-09-04T12:16:34ZJust like humans, more cats and dogs are living with chronic health conditions<figure><img src="https://images.theconversation.com/files/184366/original/file-20170901-27307-mboa19.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As sick as a dog.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>About <a href="https://www.kingsfund.org.uk/projects/time-think-differently/trends-disease-and-disability-long-term-conditions-multi-morbidity">15m people</a> in England have a long-term health condition, such as diabetes, persistent pain or arthritis. </p>
<p>Living with this type of a health problem can have a huge impact on a person’s life. And for a lot of these people, the situation is complicated by the fact their condition is often “<a href="https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/">invisible</a>” – so it isn’t initially obvious to others there is anything wrong. A lot of these conditions also don’t have a cure, but are managed with a range of treatments such as drugs or physiotherapy along with psychological interventions. Some people also turn to alternative therapies such as acupuncture.</p>
<p>According to the <a href="https://www.gov.uk/government/publications/long-term-conditions-compendium-of-information-third-edition">Department of Health</a> not only are the numbers of people living with these types of long term health conditions increasing, but there has also been a rise in the number of people living with more than one. </p>
<p>And now it seems the same can be said for our household pets. The UK based <a href="http://www.cats.org.uk/uploads/documents/cat-care-leaflets-2013/EG16_Elderly_cats.pdf">Cats Protection</a> outlines in their leaflet the age associated disorders that your elderly cat may develop and they include arthritis, diabetes, hyperthyroidism or renal impairment. </p>
<h2>Why the increase?</h2>
<p>One of the main reasons for the <a href="http://www.annualreviews.org/doi/pdf/10.1146/annurev-psych-010416-044014">rise of chronic conditions</a> in both humans and domestic animals is that we are all living longer. According to the writer <a href="http://www.sacbee.com/entertainment/living/pets/article49611725.html">Cynthia Hubert</a> our dogs and cats are living longer than ever before – 16-20 years is not uncommon these days. For both humans and pets, this longevity is largely down to increased access to vaccines, healthcare, and good nutrition. </p>
<p>But while life expectancy for humans and domestic pets has increased, it is still of course the case that in the wild, animals that are not in peak condition will die early or be picked off by predators. For most humans though, gone are the days of starving to death because of a broken leg or swollen ankle.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/184369/original/file-20170901-27291-1xahfjj.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184369/original/file-20170901-27291-1xahfjj.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184369/original/file-20170901-27291-1xahfjj.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184369/original/file-20170901-27291-1xahfjj.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184369/original/file-20170901-27291-1xahfjj.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184369/original/file-20170901-27291-1xahfjj.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184369/original/file-20170901-27291-1xahfjj.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s a dog’s life.</span>
<span class="attribution"><span class="source">Pexels</span></span>
</figcaption>
</figure>
<p>The <a href="http://www.who.int/chp/chronic_disease_report/full_report.pdf">most common causes of death</a> these days are conditions that are associated with what’s known as “<a href="https://www.phpc.cam.ac.uk/pcu/wp-content/files/2012/01/Ch-04.pdf">health impairing behaviours</a>”. We drink too much alcohol, we eat too much of the wrong foods, we don’t take enough exercise, we smoke. And all these behaviours can lead to an <a href="http://www.who.int/chp/about/integrated_cd/en/">increased likelihood</a> of developing a chronic condition.</p>
<p>That is not to say that all chronic diseases are avoidable and that anyone with a chronic disease has brought it upon themselves – some chronic illnesses are of course completely unavoidable. But if you think about most people’s typical working day it might look something like this: walk to the car and drive to work. Walk from the car to the desk. Sit. Eat at the desk. Finish work. Walk to the car. Drive home. Walk to the house. Sit. Eat. Go to bed. And start all over again the next day. </p>
<p>It is clear then that few of us are taking the recommended minimum amount of exercise – which is <a href="http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx">at least 150 minutes of moderate aerobic activity</a> or 75 minutes of vigorous aerobic activity a week. Even just ten minutes brisk walking each day can help to <a href="https://www.gov.uk/government/news/6-million-adults-do-not-do-a-monthly-brisk-10-minute-walk">reduce the risk of developing chronic disease</a>. </p>
<p>So it is not only the fact that we are living longer, but it’s also the way we are living which is making humans more susceptible to chronic disease. The same can be said for our pets. A <a href="http://www.dailymail.co.uk/news/article-1300658/Walkies-Fat-chance-One-dog-owners-lazy-pets-day.html">survey from the Kennel Club</a> has shown that not enough dogs are getting their <a href="http://www.telegraph.co.uk/technology/news/11411467/Is-your-dog-getting-enough-exercise.html">daily exercise</a>, with one in five dog owners too lazy to take their pets out every day.</p>
<p>Recent estimates also show that almost <a href="http://www.telegraph.co.uk/lifestyle/pets/10747181/Nearly-half-of-dogs-are-now-obese-say-vets.html">half of all cats and dogs are now obese</a>. And that these numbers are <a href="https://www.theguardian.com/uk-news/2015/mar/26/pet-obesity-a-growing-problem-in-the-uk">expected to rise</a> in coming years – as more pets (like humans) live sedentary lifestyles and eat too much food. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/184372/original/file-20170901-27315-1be2z47.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184372/original/file-20170901-27315-1be2z47.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184372/original/file-20170901-27315-1be2z47.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184372/original/file-20170901-27315-1be2z47.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184372/original/file-20170901-27315-1be2z47.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184372/original/file-20170901-27315-1be2z47.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184372/original/file-20170901-27315-1be2z47.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not enough walkies.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But if we could change our behaviour (and that of our pets), just a little bit, we could do much to reduce the likelihood that we develop a chronic illness in the first place. </p>
<p>These don’t have to be massive changes either. Small changes to our behaviour and our habits can have a big payoff. These could include making healthy eating choices, moderating drinking, and stopping smoking. You should also try to take more exercise – do it for yourself, do it for the dog, just make sure you do it together.</p><img src="https://counter.theconversation.com/content/83249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Rodham does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A longer life for humans and pets means more challenges for doctors and vets.Karen Rodham, Professor of Health Psychology, Staffordshire UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/815082017-07-26T10:05:51Z2017-07-26T10:05:51ZAre you ‘overfat’? Here are the best ways to tell<figure><img src="https://images.theconversation.com/files/179663/original/file-20170725-30157-1x880fn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/210882508?src=ZrJrA0CN7vPwm2Lb9P3U_A-1-47&size=medium_jpg">Marko Poplasen/Shutterstock</a></span></figcaption></figure><p>About 90% of men and 50% of children in developed countries are “overfat”, according to a new study published in <a href="http://journal.frontiersin.org/article/10.3389/fpubh.2017.00190/full">Frontiers in Public Health</a>. Most people will be alarmed by these figures … and the fact that a new term (“overfat”) seems to have emerged overnight. What happened to “overweight” and “obese”? Are there different ways of measuring body fat?</p>
<p>Being overweight or obese is normally classified using the body mass index (BMI) system. But BMI is controversial because it doesn’t actually take the amount of a person’s body fat into account, just their total body weight and their height. This means that short, heavily muscled people can be classified as obese. If body <em>fat</em> is measured instead of body <em>mass</em>, then it is thought that around 70% of people are “overfat”, or carrying enough excess body fat that it could impair their health. </p>
<p>Although body fat is essential for normal health, in excess it is a risk factor for a number of diseases, including type 2 diabetes, heart disease and some cancers. This means that measuring body fat is very important because it allows us to predict a person’s risk of developing one of these diseases. </p>
<p>It has been shown that BMI fails to identify <a href="https://www.ncbi.nlm.nih.gov/pubmed/20125098">around half of people with excess body fat</a>, making its use questionable. This means that many normal weight (BMI of 20-24.9) but overfat people may be unaware of the risks that their body fat poses to their health. </p>
<p>When measuring body fat, there are a number of factors that have to be taken into account, and these factors influence which method is used. These include accuracy, invasiveness, cost, availability and ease of use. </p>
<p>The reason BMI is still universally used by healthcare professionals is that it is cheap, non-invasive, and easy to understand and explain. This can also be said, however, of other methods that can better discriminate between body weight and body fat. Other methods also exist that are significantly more accurate at estimating body-fat levels, but these are often impractical or expensive to use. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179657/original/file-20170725-30125-1dmmlm5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179657/original/file-20170725-30125-1dmmlm5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=502&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179657/original/file-20170725-30125-1dmmlm5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=502&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179657/original/file-20170725-30125-1dmmlm5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=502&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179657/original/file-20170725-30125-1dmmlm5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=630&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179657/original/file-20170725-30125-1dmmlm5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=630&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179657/original/file-20170725-30125-1dmmlm5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=630&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The relationship between overfat and disease.</span>
<span class="attribution"><span class="source">Maffetone, Rivera-Dominguez and Laursen</span></span>
</figcaption>
</figure>
<h2>The high-tech approach</h2>
<p>The best way to accurately assess the amount of body fat a person has is to use <a href="http://www.birpublications.org/doi/full/10.1259/bjr/80083156">imaging technology</a> to scan inside the body. These scans include well-known imaging techniques such as MRI or CT scans, but also lesser known techniques, such as <a href="http://www.nhs.uk/conditions/dexa-scan/pages/introduction.aspx">dual-energy X-ray absorptiometry or DEXA scans</a>. </p>
<p>The DEXA scan uses X-rays to give highly accurate measurements of the total weights of fat, lean tissue and bone minerals. This level of information and accuracy makes DEXA stand out among methods of estimating body fat. Importantly, though, there are relatively few DEXA scanners available worldwide and their cost is prohibitive – both to buy and to run. </p>
<p>Other sophisticated technologies exist which are much cheaper and more readily available than imaging, but at a cost to their accuracy. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2543039/">Bioelectrical impedance analysis (BIA)</a> is a non-invasive, low-cost and increasingly common approach for measuring the composition of the body, including body-fat percentage. </p>
<p>This method uses the natural property of electrical resistance that body fat exhibits. Usually, a multi-frequency electrical impulse will be passed through the body between electrodes and an algorithm estimates the level of resistance the percentage of body fat presents. Unfortunately, this method underestimates body fat and is easily biased by eating, drinking or exercise. Although BIA is cheap and available, it is not a gold standard measurement due to its accuracy issues. </p>
<h2>… and the low-tech</h2>
<p>Beyond high-tech methods, there are simple, non-invasive and cheap ways to estimate body fat that have been shown to be very good at <a href="https://www.ncbi.nlm.nih.gov/pubmed/21913536">predicting cardiovascular disease risk</a>. These methods are based on measuring the circumference of the waist with a tape measure and comparing it either to the circumference of the hips (waist-to-hip ratio) or height (waist-to-height ratio). </p>
<p>For waist-to-hip ratio, a diagnostic point of 0.9 for males or 0.85 for females for obesity has been <a href="http://apps.who.int/iris/bitstream/10665/44583/1/9789241501491_eng.pdf">suggested by the World Health Organisation</a>. For example, a woman with a 34 inch (86.4cm) waist and 40 inch (101.6 cm) hips has a waist–to-hip ratio of 0.85. Waist-to-hip ratio has been shown to be <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2011.00879.x/full">better than BMI at predicting cardiovascular disease</a>. This method is simple and cheap and, as long as the tape measure is placed at the correct locations, provides good data.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/jyL8UfGZMJE?wmode=transparent&start=99" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Measuring in the right places is important for an accurate result.</span></figcaption>
</figure>
<p>When considering all the factors listed above, possibly the best method for estimating body fat is waist-to-height ratio, the method that was used in the study mentioned earlier that determined that up to 90% of men in the developed world are overfat. The standard way to measure waist-to-height ratio is similar to waist-to-hip, only this time you substitute your height for your hip circumference. A healthy ratio should be 0.5, so your waist circumference should be half your height. For example, a six foot tall man (183cm) with a 36 inch (91.5cm) waist has a waist-to-height ratio of 0.5.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/179661/original/file-20170725-30120-1das8sk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/179661/original/file-20170725-30120-1das8sk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1313&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179661/original/file-20170725-30120-1das8sk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1313&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179661/original/file-20170725-30120-1das8sk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1313&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179661/original/file-20170725-30120-1das8sk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1650&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179661/original/file-20170725-30120-1das8sk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1650&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179661/original/file-20170725-30120-1das8sk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1650&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Frontiers in Public Health</span></span>
</figcaption>
</figure>
<p>Although this method has existed for some time, a newer way of measuring waist-to-height has evolved. This method divides waist size by the square root of height and has been suggested to be the <a href="http://wlv.openrepository.com/wlv/handle/2436/620277">best measure of fat-derived disease risk of all</a> because it gives a reading that works for pretty much everyone, independent of how tall or short they might be. </p>
<p>Waist-to-height ratio has also recently been suggested as being <a href="https://www.sciencedaily.com/releases/2017/06/170606090942.htm">better than BMI at predicting heart disease</a>, while a meta-analysis of studies suggested that waist-to-height ratio is a <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2011.00952.x/full">better screening tool for cardiometabolic disease</a> (diabetes, heart disease and stroke) than waist circumference or BMI.</p>
<p>Getting the message across that BMI isn’t the be-all and end-all of metabolic health is important, and for this a clear message is needed. Unless significant steps are made to improve the accuracy of BIA or reduce the cost of DEXA, measurements like waist-to-height ratio are likely to be the best hope of accurately estimating just how overfat we really are in the coming years. </p>
<p>These measurement based tests are incredibly cheap and easy to perform and are backed by a wealth of published data that shows that they outperform BMI. The time for them to be universally adopted by healthcare professionals is long overdue.</p><img src="https://counter.theconversation.com/content/81508/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Brown has previously received funding from the Society for Endocrinology and Diabetes UK. </span></em></p>A new study finds that 90% of men are overfat. But by what measure?James Brown, Lecturer in Biology and Biomedical Science, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/727182017-02-14T16:30:12Z2017-02-14T16:30:12ZObese does not necessarily mean unhealthy<figure><img src="https://images.theconversation.com/files/156797/original/image-20170214-25995-1uploib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Regularly physically activity is more important than weight.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-beautiful-overweight-woman-blonde-hair-551549179?src=GVcdBMFuWMZTJty5DxoaPQ-1-0">Creativa Images/www.shutterstock.com</a></span></figcaption></figure><p>Self-proclaimed “<a href="http://www.yourweightlossmaster.co.uk/about-steve-miller/">weight loss hypnosis master</a>” Steve Miller has announced a campaign to see all overweight NHS staff wearing badges that read “<a href="http://www.dailymail.co.uk/news/article-4199970/All-obese-NHS-staff-wear-m-fat-badges.html">I’m fat, but I’m losing it</a>”. He also wants all restaurant menus to carry the warning that “if you’re fat, think before ordering”. </p>
<p>It would be easy to discount Miller’s campaign as a publicity stunt, but doing so would ignore the damaging consequences it is likely to have. <a href="http://ac.els-cdn.com/S0277953614005206/1-s2.0-S0277953614005206-main.pdf?_tid=ce62c4fe-f140-11e6-827b-00000aab0f02&acdnat=1486917312_bd5cb5af40aef3a029571b6c6764e274">Scientific evidence</a> overwhelmingly demonstrates that this sort of obesity stigma is an ineffective way to reduce the incidence of obesity, and in fact perpetuates it. If this strategy supported losing weight, the obesity “epidemic” would already be over, because obese people are frequently framed as <a href="http://nypost.com/2015/01/16/i-gained-43-pounds-to-prove-obese-people-are-lazy/">lazy, gluttonous</a> and <a href="http://www.bbc.co.uk/news/uk-england-derbyshire-35954439">targets for ridicule</a> as it is.</p>
<h2>Body shaming</h2>
<p>Obesity stigma, guilt, and shame reinforce high body weights and can even <a href="http://www.gatherthepeople.org/Downloads/OBESITY_STIGMA.pdf">promote weight gain</a>. Experiencing obesity stigma often leads people to adopt coping strategies that undermine physical health – such as <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2007.521/epdf">comfort eating</a>, or avoiding exercise in case they are made to feel embarrassed about <a href="http://journals.sagepub.com/doi/pdf/10.1177/1359105307084318">their bodies</a>. Obesity stigma has also been strongly linked with depression and <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2008.636/epdf">compromised mental health</a> . </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/156823/original/image-20170214-25987-9wtqjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/156823/original/image-20170214-25987-9wtqjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=709&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156823/original/image-20170214-25987-9wtqjs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=709&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156823/original/image-20170214-25987-9wtqjs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=709&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156823/original/image-20170214-25987-9wtqjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=890&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156823/original/image-20170214-25987-9wtqjs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=890&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156823/original/image-20170214-25987-9wtqjs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=890&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>Simplistic promotion of individual weight loss also fails to consider <a href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/endo/147/1/10.1210_en.2005-0972/2/endo0003.pdf?Expires=1487334141&Signature=NsmeH9i6xsXJuTi4SOa07ytfHLjeh4J3yoPISsS8UOep5dVasblYtgsBcl2SB95nC9RTcbUnjKpx8qsgq6KAa12OtGkDLE9Q30j1eRNKz8FcWtuw3hWAAikc4Gq87xnRMyJxjROFmVVKW6HnjPIHUBti1sfI%7E-XgJsVUaFRRxjveOw4fJc6V374IjME%7Eh%7Eu8aAKBzRkwkh%7E1e3k9JY-SzJ2TcJdOKt-XRF85SAktaxUStgvWG1ZeeU7vpcRvVyuY6z6QJDqvzYKgAN%7Esy1Boy-VqM4f4iRiv1uCoWlEyTCLOw-XQHeDEuNHynUaB0MZt5oempv24v-LplLzYWeCCVw__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q">scientific evidence</a> which shows that hunger is elevated in obese populations, and that it takes more effort for an obese person to exercise, as they have a greater amount of body weight than a lighter person doing the same activity. In many cases weight loss is not simple or easy.</p>
<p>The way obesity is currently addressed – though it may be with the best of intentions – does not generally support overweight/obese people to lose weight, or indeed promote the health of those who are most in need. <a href="https://academic.oup.com/nutritionreviews/article-abstract/67/suppl_1/S36/1872742/Obesity-diets-and-social-inequalities?redirectedFrom=fulltext">Obesity</a> and associated <a href="http://www.haringey.gov.uk/sites/haringeygovuk/files/clustering-of-unhealthy-behaviours-over-time-aug-2013.pdf">health behaviours</a> – for example eating fruit and vegetables, and being physically active – are linked with social inequality. So even where someone may want to lose weight, their <a href="https://theconversation.com/obesity-stop-accusing-the-poor-of-making-bad-choices-55801">circumstances may make it difficult for them</a> to do so.</p>
<p>At present obesity campaigns tend to focus on this idea of individual “choice”, but the evidence suggests that making it easier for everyone to access healthy food and to be physically active would do far more.</p>
<h2>Fat but fit</h2>
<p>Focusing on obesity and individual weight loss also ignores another key issue: that a person may be obese and yet healthy at the same time. Indeed, there is growing research that questions whether being overweight/obese is always detrimental to a person’s health. </p>
<p>Many people use BMI to measure their own weight and health, but this indicator <a href="http://www.medicalnewstoday.com/articles/265215.php">is inaccurate</a>, and cannot portray a true picture of physical health. For instance, someone with a “healthy” BMI, or who looks slim, may not actually be in good health (think about regular smokers, for example). Likewise more muscular people, like rugby players, are often categorised as having an “obese” BMI but are in good health. </p>
<p>It has been scientifically proven that some obese people with high levels of fat <a href="https://www.sciencedaily.com/releases/2012/09/120904193052.htm">can also be in good physical health</a>. In 2012, a US <a href="http://www.deporteparatodos.es/imagenes/documentacion/ficheros/018A6EBD.pdf">study</a> with over 40,000 participants found that the difference between healthy and unhealthy obese people was fitness levels: the people who were metabolically healthy but obese were fitter. What’s more, this “fat but fit” group had no higher risk of death or illness than their “normal-fat” fit peers. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/156800/original/image-20170214-25992-hz0y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/156800/original/image-20170214-25992-hz0y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156800/original/image-20170214-25992-hz0y2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156800/original/image-20170214-25992-hz0y2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156800/original/image-20170214-25992-hz0y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156800/original/image-20170214-25992-hz0y2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156800/original/image-20170214-25992-hz0y2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">BMI has confused the public over what healthy can mean.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/big-belly-man-jogging-exercising-doing-533453260?src=GVcdBMFuWMZTJty5DxoaPQ-1-6">Giuseppe Elio Cammarata</a></span>
</figcaption>
</figure>
<p>Similarly, a British <a href="http://ac.els-cdn.com/S0091743516303450/1-s2.0-S0091743516303450-main.pdf?_tid=e8c00dd0-f15d-11e6-b09e-00000aab0f01&acdnat=1486929812_2eefac4338982546b8a2973cd709b2a7">study</a> found that an overweight or obese person is more likely to be “metabolically healthy” when they lead an active lifestyle and have moderate-to-high levels of fitness. This remains the case irrespective of age, smoking status, alcohol consumption and waist measurement. Furthermore, despite 78% of the men studied being classified as either overweight or obese according to BMI, the vast majority – around 84% – of them were actually metabolically healthy. In fact, only 3.7% were classified “metabolically unhealthy obese”, which was comparable to the prevalence of metabolically unhealthy people within the “normal weight” group (3.4%). </p>
<h2>Support not stigma</h2>
<p>What these findings reveal is that whether or not someone is regularly physically active is more important than if they are overweight or obese. In terms of promoting health, the cultural obsession with weight loss is unnecessary and ineffective. Additionally, the continued focus on individual willpower and responsibility disguises the impact of social inequality and to this extent blames the victim. </p>
<p>Miller’s idea latches onto the trend of treating obesity as an individual health issue, but it would be far more constructive to deal with the social factors that stop people being physically active, and also to recognise that being overweight/obese does not necessarily mean that someone is unhealthy or indeed lazy. </p>
<p>It is those who continue to ignore scientific evidence and the long established link between inequality and health who should be obliged to wear badges proclaiming that they are “losing it”. Continuing to stigmatise obesity and to treat it as an individual issue is unhelpful and ineffective. The focus needs to be on creating social conditions that make healthy living the easy choice for all.</p><img src="https://counter.theconversation.com/content/72718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Oli Williams does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.</span></em></p><p class="fine-print"><em><span>Kevin Deighton has received funding from the Physiological Society, Ministry of Defence and Nutricia Research Foundation. He is a member of the Labour Party. </span></em></p><p class="fine-print"><em><span>Michelle Swainson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scientifically you can be overweight and healthy - and yet there is still an obesity stigma.Oli Williams, Postdoctoral Research Fellow, University of BathKevin Deighton, Senior Lecturer, Leeds Beckett UniversityMichelle Swainson, Senior Lecturer in Exercise Physiology, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/546712016-03-09T09:55:22Z2016-03-09T09:55:22ZWhy life is tougher for short men and overweight women<figure><img src="https://images.theconversation.com/files/114113/original/image-20160307-31287-1qew7gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Body weight plays a role in women's job prospects.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=x2h7Yyj-Gb0vnh_tZV3k5Q&searchterm=obese%20woman%20&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=263824958">www.shutterstock.com</a></span></figcaption></figure><p>Are you a short man or an overweight woman? If so, you may have a slight disadvantage in life compared with taller men and thinner women. </p>
<p>Our <a href="http://www.bmj.com/cgi/doi/10.1136/bmj.i582">latest study</a> has found evidence that men who are shorter due to their genes have lower incomes, lower levels of education, and lowlier occupations than their taller counterparts. The effect of height on socioeconomic status was much weaker in women. In contrast, women who have a higher body mass index (BMI) due to their genes have lower standards of living and household incomes. Having a higher BMI didn’t seem to have the same negative effect on men.</p>
<h2>Don’t we know this already?</h2>
<p>Why did we want to do this study? After all, didn’t we know that height and BMI are associated with socioeconomic status? And you can’t change your genes, so why is this study interesting? </p>
<p>It’s true that we have known for a long time that being short is associated with poverty, almost certainly because poor nutrition in childhood stunts growth. But the relationship between fatness and poverty is more nuanced. </p>
<p>In the not too distant past being thin was associated with poverty, and being overweight with wealth because people with more money were able to eat more. However, in the past few generations, in developed countries, that association has reversed. As we have moved to a world where calorie-dense food is readily and cheaply available, and life has become more sedentary, lower standards of living are associated with higher BMIs. But in this study we wanted to answer questions about causality rather than associations, which is why we turned to genetics. </p>
<h2>You can’t change your genes</h2>
<p>Associations between genes and human traits are likely to be cause not consequence. We can make this statement because your genes don’t change. </p>
<p>A disease can’t change your DNA sequence, but your DNA sequence can influence your chances of developing a disease, growing more, or your vulnerability to obesity. Once your father’s sperm has fertilised your mother’s egg, you are stuck with those two copies of the human genome and with some exceptions, such as in cancer cells, those two DNA sequences change very little during our lifetimes. </p>
<p>The different environments we encounter, the lifestyle choices we make, and the diseases we develop do not change the DNA sequences we inherit from our parents – to be clear, we are not discussing <a href="https://theconversation.com/explainer-what-is-epigenetics-13877">epigenetics</a> here, where the environment can change how genes activate and deactivate.</p>
<h2>Shorter men and heavier women are poorer</h2>
<p>We used demographic and genetic data from 120,000 people (aged between 40 and 70) in the UK Biobank. The study used 400 genetic variants that are associated with height, and 70 associated with BMI, together with actual height and weight, to ask whether or not shorter stature or higher BMI could lead to lower chances in life – as measured by information the participants provided about their lives. </p>
<p>Having analysed the data, we found that men who were 7.5cm shorter, for no other reason than their genes, on average earned £1,500 a year less than their taller counterparts. Meanwhile, women who were 6.3kg heavier, for no other reason than their genes, on average earned £1,500 a year less than the lighter women of the same height. </p>
<p>It’s important to note that these are estimates and averages – short men and heavier women can, and do, succeed in life. Instead, it shows that across the population overweight women and shorter men are, on average, slightly worse off. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/114319/original/image-20160308-22147-sar5ja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/114319/original/image-20160308-22147-sar5ja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=856&fit=crop&dpr=1 600w, https://images.theconversation.com/files/114319/original/image-20160308-22147-sar5ja.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=856&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/114319/original/image-20160308-22147-sar5ja.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=856&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/114319/original/image-20160308-22147-sar5ja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1076&fit=crop&dpr=1 754w, https://images.theconversation.com/files/114319/original/image-20160308-22147-sar5ja.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1076&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/114319/original/image-20160308-22147-sar5ja.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1076&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Short men can do well in life.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=iljjzsudhfaidjjawn&searchterm=bernie%20ecclestone&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=152636234">Featureflash / Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>What are the implications?</h2>
<p>We now need to understand the factors that lead people who are overweight or short to lower standards of living. Is the link down to low self-esteem or depression, for example? Or is it more to do with discrimination? </p>
<p>In a world where we are obsessed with body image, are employers biased? And do we need to pay more attention to potential unconscious biases in order not to unfairly discriminate against people who are shorter (especially men) or overweight (especially women)?</p>
<p>More studies are needed using data from other birth cohorts – the UK Biobank is biased towards thinner people and wealthier people because they had to actively participate in a study about health and this bias may have affected the results (that is, made the associations slightly weaker).</p>
<p>The study was also limited to people born between 1935 and 1971 and so the effects may no longer exist in younger adults today. It will be interesting to study the effects in young adults – it may be that the higher levels of obesity would exacerbate the problem, or it may be that society is far more accepting of fatter people and that factors such as discrimination and social esteem, if they were key to this data, are less important in younger generations. </p>
<p>The study provides a much needed advance in understanding a classic chicken or egg problem. But something about having a higher BMI as a woman, and shorter height as a man, does lead to being worse off in life.</p><img src="https://counter.theconversation.com/content/54671/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Timothy Frayling receives funding from the Medical Research Council, the European Research Council, Diabetes UK and The Wellcome Trust. </span></em></p><p class="fine-print"><em><span>Jessica Tyrrell receives funding from Diabetes Research and Wellness Foundation.</span></em></p>Short men and overweight women are less likely, on average, to succeed in life. But why?Timothy Frayling, University of ExeterJessica Tyrrell, Research fellow, University of ExeterLicensed as Creative Commons – attribution, no derivatives.