tag:theconversation.com,2011:/id/topics/healthy-at-any-weight-9821/articlesHealthy at any weight – The Conversation2023-07-13T20:06:13Ztag:theconversation.com,2011:article/2096812023-07-13T20:06:13Z2023-07-13T20:06:13ZShould GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts<p>Australian of the Year and body positivity advocate Taryn Brumfitt has <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">called for</a> doctors to avoid discussing a patient’s weight when they seek care for unrelated matters.</p>
<p>A 15-minute consultation isn’t long enough to provide support to change behaviours, Brumfitt says, and GPs don’t have enough training and expertise to have these complex discussions. </p>
<p>“Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">told the Nine newspapers</a>. </p>
<p>By raising the issue of weight, Brumfitt says, GPs also risk turning patients off seeking care for other health concerns. </p>
<p>So should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts.</p>
<h2>Three out of five said yes</h2>
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<img alt="" src="https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=138&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=138&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=138&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=174&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=174&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=174&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>Here are their detailed responses:</em></p>
<p><iframe id="tc-infographic-887" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/887/8a1d47185e014ea9461db2c1880afe8687edaa14/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p><em>Disclosure statements: <strong>Brett Montgomery</strong> is a general practitioner. He does not have a specific interest in obesity, but like almost all GPs, he treats many patients who are overweight or obese. He is a fellow of the Royal Australian College of General Practitioners; the college’s position statement on obesity prevention and management is linked to from this article. However, Brett writes here as an individual, and not on behalf of any organisation; <strong>Emma Beckett</strong> has received funding for research or consulting from Mars Foods, NHMRC, ARC, AMP Foundation, Kellogg, and the University of Newcastle. She works for Nutrition Research Australia and member of committees/working groups related to nutrition or the Australian Academy of Science, the National Health and Medical Research Council and the Nutrition Society of Australia. Emma has lived experience of GPs bringing up her weight; <strong>Liz Sturgiss</strong> receives funding from NHMRC, RACGP Foundation, National Centre for Healthy Ageing, Victorian Health Promotion Foundation. She is an appointed committee member of the Guidelines Development Committee for the review and update of the Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia and is the co-founder of the RACGP Specific Interest Group in Poverty; <strong>Nick Fuller</strong> works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program; <strong>Helen Truby</strong> has received funding from the NHMRC, the MRFF, the Commonwealth Department of Health, Health and Wellbeing Qld, Clinical Therapy Research in the Specialist Health Services (KLINBEFORSK, Norway), the Andrea Joy Logan Trust, the Victorian Cancer Agency Health Services Scheme.</em> </p>
<p><em>Editor’s note: This article has been updated to include Helen Truby’s final sentence, which was erroneously cut off during layout.</em></p><img src="https://counter.theconversation.com/content/209681/count.gif" alt="The Conversation" width="1" height="1" />
Australian of the year Taryn Brumfitt has called for doctors to avoid raising the issue of weight in consultations about other matters. We asked the experts if they should – or not.Fron Jackson-Webb, Deputy Editor and Senior Health EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1752882022-02-01T21:21:23Z2022-02-01T21:21:23ZThe baffling case of metabolically healthy obese people: Are they protected from chronic diseases?<figure><img src="https://images.theconversation.com/files/443086/original/file-20220127-9640-1k7cbpu.jpeg?ixlib=rb-1.1.0&rect=0%2C276%2C1211%2C783&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some studies have demonstrated that a significant number of obese people are metabolically healthy, leading to the contention that one could be healthy at any size.</span> <span class="attribution"><a class="source" href="https://www.instagram.com/juliakubow/">(Julia Kubow)</a>, <span class="license">Author provided</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/the-baffling-case-of-metabolically-healthy-obese-people--are-they-protected-from-chronic-diseases" width="100%" height="400"></iframe>
<p>There is a growing global body positivity movement to combat the <a href="https://www.euro.who.int/__data/assets/pdf_file/0017/351026/WeightBias.pdf">stigma and prejudice that overweight and obese individuals face</a>. Some of this stigma arises from the perception that obese individuals are unhealthy. </p>
<p>However, weight is only one of the metrics that medical professionals use to assess overall health. In fact, some studies have demonstrated that a significant number of obese people are metabolically healthy, leading to the contention that one could be <a href="https://dx.doi.org/10.2105%2FAJPH.2015.302552">healthy at any size</a>. This phenomenon is referred to as <a href="https://www.mdpi.com/2218-1989/10/2/48">metabolically healthy obesity</a> (MHO). Research is now starting to explore what this means. </p>
<p>A person who is MHO has healthy blood pressure, normal levels of blood lipids (cholesterol and triglycerides) and normal blood sugar. Having high values of one or more of these measures significantly increases one’s risk for cardiovascular disease. </p>
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<img alt="Illustration of foods representative of the Mediterranean diet: olive oil, seafood, nuts, grains" src="https://images.theconversation.com/files/443864/original/file-20220201-21-obngem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/443864/original/file-20220201-21-obngem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443864/original/file-20220201-21-obngem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443864/original/file-20220201-21-obngem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443864/original/file-20220201-21-obngem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=584&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443864/original/file-20220201-21-obngem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=584&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443864/original/file-20220201-21-obngem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=584&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">Healthy diets provide anti-inflammatory and antioxidant benefits that help achieve a healthy metabolic profile.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>It has been proposed that metabolically healthy obese individuals might be protected against obesity-related diseases. The extent of this protection has been controversial within the scientific community, and this is partly because we still <a href="https://www.karger.com/Article/Fulltext/495852">don’t have a standardized definition of MHO</a>. </p>
<p>So, over the past few years, researchers have gone to work to find out who can be defined as MHO, and to what extent people with MHO are protected from chronic disease. </p>
<h2>Emerging consensus</h2>
<p>Several large population studies have been initiated towards this end. So far, results show that, indeed, more rigorous definitions of MHO are needed. This can be achieved by <a href="https://doi.org/10.1172/JCI129186">including other measures of health</a> such as insulin resistance and blood markers of inflammation. Insulin resistance is when the body does not respond well to the insulin hormone that helps to take up sugar from the bloodstream for use as a fuel for energy. This leads to elevated blood sugar and the consequent health complications.</p>
<p>An emerging consensus has been that although MHO individuals show some protection from chronic disease, they still seem to be significantly less protected than those who are metabolically healthy and lean.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/443629/original/file-20220201-21-t6nwbh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic showing different combinations of health status and obesity" src="https://images.theconversation.com/files/443629/original/file-20220201-21-t6nwbh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443629/original/file-20220201-21-t6nwbh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443629/original/file-20220201-21-t6nwbh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443629/original/file-20220201-21-t6nwbh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443629/original/file-20220201-21-t6nwbh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443629/original/file-20220201-21-t6nwbh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443629/original/file-20220201-21-t6nwbh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&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">Individuals with metabolically healthy obesity have lower risk of disease than those with metabolically unhealthy obesity, but still higher risk than non-obese, metabolically healthy individuals.</span>
<span class="attribution"><span class="source">(Kubow/Iskandar)</span>, <span class="license">Author provided</span></span>
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<p>The fact that people with MHO still have a relatively higher disease risk led some researchers to suggest that the term “metabolically healthy obesity” could be a misnomer. Moreover, <a href="https://doi.org/10.1172/JCI129186">a majority of the MHO population tends to progress towards “metabolically unhealthy obesity” or MUO over a number of years</a>, leading to enhanced risk of diabetes, cardiovascular disease and other disorders linked with obesity. </p>
<p>This leads to another question: is MHO truly protective over an entire lifetime, or is it just a question of time before MUO sets in, making MHO a transient state? </p>
<h2>Protective factors</h2>
<p>One factor to consider that might differentiate metabolically healthy versus unhealthy obesity is how fat is distributed in the body. A <a href="https://doi.org/10.3390/ijms20153690">genetic predisposition for depositing fat under the skin</a>, called subcutaneous fat, seems to play a protective role. </p>
<p>People with this predisposition are mostly premenopausal women who accumulate subcutaneous body fat in the hips rather than the waist (pear-shaped). They are <a href="https://doi.org/10.1016/S2213-8587(19)30084-1">better protected against diabetes and cardiovascular disease</a> compared to people whose body fat is located more in the abdomen (apple-shaped). </p>
<p>In contrast, obese individuals with a high waist circumference show excessive fat deposition in the abdomen and a <a href="https://nutrition.org/inflammation-what-is-it-and-how-can-my-diet-and-behavior-affect-it/">pro-inflammatory</a> state that leads to insulin resistance, which can be a precursor to Type 2 diabetes.</p>
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<a href="https://images.theconversation.com/files/443863/original/file-20220201-14-4iu6yf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Series of illustrations of a woman in exercise clothes" src="https://images.theconversation.com/files/443863/original/file-20220201-14-4iu6yf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443863/original/file-20220201-14-4iu6yf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=269&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443863/original/file-20220201-14-4iu6yf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=269&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443863/original/file-20220201-14-4iu6yf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=269&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443863/original/file-20220201-14-4iu6yf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=338&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443863/original/file-20220201-14-4iu6yf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=338&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443863/original/file-20220201-14-4iu6yf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=338&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 with metabolically healthy obesity are involved in regular physical activity to a greater extent than those with metabolically unhealthy obesity.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Researchers have also looked at the lifestyle habits that differentiate MHO from MUO individuals to see if development of metabolically unhealthy obesity can be prevented. </p>
<p>One factor is exercise. People with MHO are involved in <a href="https://doi.org/10.1016/j.pcad.2018.07.008">regular physical activity to a greater extent than MUO individuals</a>. The other is diet. Although <a href="https://doi.org/10.1172/JCI129186">dietary studies show mixed results</a>, it seems that <a href="https://doi.org/10.3390/nu13113925">MHO people consume healthier diets</a> such as the Mediterranean diet, which is rich in fish, fruits, vegetables, whole-grain products, legumes, extra virgin olive oil and nuts. </p>
<p>Healthy diets provide <a href="https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation">anti-inflammatory and antioxidant</a> benefits that help achieve a healthy metabolic profile. Indeed, of the MHO population, those who <a href="https://doi.org/10.1038/ijo.2016.114">follow the Mediterranean diet seem to have lower mortality rates</a>. Adopting these healthy lifestyle habits could help prevent the trajectory of metabolically healthy obesity moving towards metabolically unhealthy obesity over the course of a lifetime. </p>
<h2>Is metabolically healthy obesity real?</h2>
<p>So is MHO real and does it protect against disease? There isn’t a yes or no answer yet. The more we learn about it, the more nuance is injected into the concept that one can be perfectly healthy at any size. Based on the information we have so far, <a href="https://doi.org/10.1038/s41574-021-00619-6">only a narrow segment of obese individuals are without risk</a> of developing obesity-related chronic diseases. </p>
<p>We also know a lot more about their characteristics. They have less abdominal fat and more subcutaneous fat. They have less insulin resistance, less inflammation and a metabolically healthy cardiovascular profile. They also have healthy lifestyle habits such as regular exercise and a healthy diet. It seems that genetics play a role as well. </p>
<p>We can expect more insight from major international population studies and clinical trials that are currently underway. But in the meantime, the age-old advice holds truer than ever: regular physical activity and a healthy diet are crucial to maintain health and longevity.</p><img src="https://counter.theconversation.com/content/175288/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some obese people lack the classic metabolic risk factors of high blood pressure, high cholesterol and high blood sugar linked with obesity. But are they still at risk for heart disease and diabetes?Stan Kubow, Associate Professor, School of Human Nutrition, McGill UniversityMichele Iskandar, Research Associate and Lecturer, School of Human Nutrition, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1003872018-07-25T07:00:01Z2018-07-25T07:00:01ZWeighing kids at school has more pros than cons but the reasons may surprise you<figure><img src="https://images.theconversation.com/files/229193/original/file-20180725-194140-13pocfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The key concerns is that kids will develop body image problems and adopt unhealthy behaviours to lose weight.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/75942880?src=fMPJINO0WF_Num8z3kez3g-1-1&size=huge_jpg">AGorohov/Shutterstock</a></span></figcaption></figure><p>A <a href="http://www.abc.net.au/news/2018-07-21/obesity-plan-to-weigh-and-measure-children-at-school/10021260">Deakin University proposal</a> to measure the height and weight of all Australian school children has understandably generated controversy. Some commentators have <a href="https://www.smh.com.au/lifestyle/health-and-wellness/the-proposal-to-weigh-kids-at-school-is-misguided-20180722-p4zszh.html">labelled it misguided</a>, fearing it could encourage kids to “pursue weight loss at any cost”.</p>
<p>While there are benefits and downsides of measuring kids’ height and weight at school, the pros outweigh the cons.</p>
<p>But <a href="https://au.news.yahoo.com/school-kids-height-weight-measured-plan-tackle-obesity-000701006.html">some reports</a> have confused the purpose of the scheme, which is intended to generate data to inform obesity research and policy responses, rather than provide feedback on the individual child’s health status. </p>
<p>Let’s start at the beginning at look at the difference between <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1746-1561.2007.00249.x">screening and surveillance</a>, and what the Deakin team has proposed. </p>
<h2>BMI report cards</h2>
<p>Screening programs weigh kids to identify those who are at risk of health problems associated with their fatness. This is generally based on BMI (body mass index), which measures weight in relation to height. The results of the screening – “BMI report cards” – are sent to parents, and sometimes to the kids and schools as well. </p>
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<strong>
Read more:
<a href="https://theconversation.com/does-my-bmi-look-big-in-this-and-does-it-really-matter-35156">Does my BMI look big in this? And does it really matter?</a>
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<p>Screening programs are rare in Australia, but are widely used <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1746-1561.2007.00249.x">in several US states</a>, notably Arkansas and California.</p>
<p>The logic behind screening is that obesity is a health issue like ADHD or movement disorders, and schools have a duty of care to report these conditions to parents. There is <a href="https://www.ncbi.nlm.nih.gov/pubmed/12728143">strong evidence</a> that parents are not very good at identifying the weight status of their children.</p>
<p>Screening programs are controversial. In the US, they are generally <a href="https://www.ncbi.nlm.nih.gov/pubmed/12912782">well-received by parents</a>, who claim to take action if their child is identified as overweight. </p>
<p>But there is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206196/">growing evidence</a> that these programs are <a href="https://www.jahonline.org/article/S1054-139X(15)00223-2/abstract">ineffective</a>. </p>
<h2>Collecting data for research</h2>
<p>The Deakin group is not recommending BMI screening or BMI report cards. They are arguing for a system of surveillance, which is quite different.</p>
<p>Surveillance is the systematic collection and analysis of data on kids’ fatness from a representative sample, or from a census. </p>
<p>For surveillance purposes, neither children, nor the teachers, nor the parents are told the child’s BMI. Children may be identified by coded numbers which are known only to the researchers. </p>
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<img alt="" src="https://images.theconversation.com/files/229199/original/file-20180725-194134-hbd05u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/229199/original/file-20180725-194134-hbd05u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229199/original/file-20180725-194134-hbd05u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229199/original/file-20180725-194134-hbd05u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229199/original/file-20180725-194134-hbd05u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229199/original/file-20180725-194134-hbd05u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229199/original/file-20180725-194134-hbd05u.jpg?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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<span class="caption">The Deakin proposal doesn’t include reporting on the child’s BMI to parents, teachers, or students themselves.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/21375247?size=huge_jpg">Belinda Pretorius/Shutterstock</a></span>
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<p>Parents can opt out by ticking a box, and no measurement can be made without the verbal assent of the child. </p>
<p>Measurements are done by trained clinicians, in private. </p>
<p>No child, parent or teacher is made aware of any measurement, and any questions about the results are defused by comments such as:</p>
<blockquote>
<p>Kids of your age come in all shapes and sizes, and anyway, they change so quickly. If you’re worried, why not ask your mum or dad to measure you?</p>
</blockquote>
<p>These procedures are now standard practice in research settings.</p>
<h2>Downsides of weigh-ins</h2>
<p>The biggest concern is that overweight (or underweight) kids may feel sensitised to weight issues, and may adopt unhealthy weight management practices like purging or extreme dieting. </p>
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Read more:
<a href="https://theconversation.com/health-check-should-you-weigh-yourself-regularly-92177">Health Check: should you weigh yourself regularly?</a>
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</p>
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<p>A review of the <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1746-1561.2007.00249.x">Arkansas program</a> found that 7% of kids were embarrassed about being weighed at school. It is likely that some kids will be <a href="https://www.bustle.com/articles/103297-arkansas-schools-bmi-report-cards-just-made-me-my-classmates-self-conscious-so-its-no-surprise">distressed</a> by the procedure. </p>
<p>In one <a href="https://www.babycenter.com.au/thread/3779534/weighing-children-at-school-?startIndex=10#ixzz5M4SfTYNW">discussion forum</a>, a mum said:</p>
<blockquote>
<p>I experienced eating disorders in high school and if I knew there were weigh-ins (even occasionally) it’d send me into a near-constant state of panic and restricting and purging.</p>
</blockquote>
<p>Other kids may find the “normalisation” of weighing reassuring. </p>
<p>The Arkansas review found that kids were not more likely to be teased about their weight, or go on diets, or have more concerns about body image after the introduction of the measurement program.</p>
<p>Some people feel that obesity is not a disease, that kids can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935663/">healthy at any weight</a>, and that we should be focusing on behaviours such as healthy eating and physical activity, not fatness. </p>
<p>However, there is a strong association between fatness a wide range of diseases, notably diabetes, and pretty powerful genetic and experimental evidence that <a href="http://circ.ahajournals.org/content/135/24/2373">the relationship is causal</a>. </p>
<h2>So what are the benefits?</h2>
<p>The main benefit is that BMI surveillance will provide a rich source of accurate data. </p>
<p>At the moment, we only collect data on samples of kids who put up their hands to be measured. As you would expect, fatter kids are less likely to do this, so our data underestimate, and by a pretty large margin, how many kids are overweight or obese. </p>
<p>In <a href="http://www.mdpi.com/1660-4601/15/4/747/htm">one study</a>, an opt-in method estimated obesity prevalence at 10%. The opt-out method estimated 14%. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/229235/original/file-20180725-194134-zui5dz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/229235/original/file-20180725-194134-zui5dz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229235/original/file-20180725-194134-zui5dz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229235/original/file-20180725-194134-zui5dz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229235/original/file-20180725-194134-zui5dz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229235/original/file-20180725-194134-zui5dz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229235/original/file-20180725-194134-zui5dz.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 find weigh-ins traumatising, while others find the normalisation of it reassuring.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/education-boy-hand-pen-writing-english-1078743548">kwarkot/Shutterstock</a></span>
</figcaption>
</figure>
<p>Having regular, opt-out, population-level surveys of kids’ height and weight allows us to chart historical trends, geographical distributions, and, if measurements can be linked to de-identified personal data, associations with socioeconomic status, environments, and health outcomes. </p>
<p>All this helps to direct resources where they are needed, and to plan more effective interventions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-real-reasons-why-parents-struggle-with-childrens-portion-sizes-85882">The real reasons why parents struggle with children's portion sizes</a>
</strong>
</em>
</p>
<hr>
<p>The potential uses of data of this sort are enormous. Here are two examples. </p>
<p>Some recent studies have linked obesity to <a href="https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-13-49">air pollution</a>. By looking at the associations between where kids live, their exposure to pollution, and fatness, we can test this theory.</p>
<p>Another recent study in the US found that the <em>entire</em> increase in children’s fatness in the first three years of primary school occurred during the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27804271">summer holiday period</a>. By weighing kids at the start and end of each school year, we could see if the same thing is happening in Australia.</p><img src="https://counter.theconversation.com/content/100387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Olds receives funding from the National Health and Medical Research Council, and the Australian Research Council. </span></em></p>The proposal is very different to schemes in the US where BMI report cards are sent to parents. Instead, the data would feed into obesity research and prevention programs.Tim Olds, Professor of Health Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/411782015-05-06T19:49:05Z2015-05-06T19:49:05ZThe numbers don’t have it: why measuring won’t lead to better health<figure><img src="https://images.theconversation.com/files/80596/original/image-20150506-940-12w2473.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Weighing people may do more harm than good by giving an unreliable picture of the complex realities of health and weight.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/jonathancohen/9260950448">Jonathan Cohen</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>A recent study of patient data from Melbourne’s eastern suburbs <a href="https://www.mja.com.au/journal/2015/202/7/obesity-management-general-practice-does-current-practice-match-guideline">published in the Medical Journal of Australia (MJA)</a> showed GPs are not checking their patients’ Body Mass Index (BMI) or measuring their waist circumference. The article’s authors interpret this as a shortcoming but these doctors may actually be avoiding the trap of thinking simplistic measurements help patient health and well-being.</p>
<p>The paper’s authors assume – <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n57_obesity_guidelines_131204_0.pdf">as does the National Health and Medical Research Council</a> – that if GPs weighed and measured their patients, they’d be better able to address weight-related health problems. </p>
<p>But there are good reasons to be sceptical about whether scales are an effective weapon in the so-called “war on obesity”. In fact, weighing people may do more harm than good by giving an unreliable picture of the complex realities of health and weight.</p>
<h2>Poor indicators</h2>
<p>Take, for example, Body Mass Index (BMI), which is calculated by dividing weight (in kilograms) by the square of height (in metres). BMI was originally devised to determine the “average” person in a given population. While a population is obviously made up of individuals, the two are clearly not the same thing and BMI is a blunt instrument when it comes to the latter.</p>
<p>Consider <a href="http://archinte.jamanetwork.com/article.aspx?articleid=770362">this 2008 article in Internal Medicine</a> that found just over a half (51.3%) of people in the overweight range (BMI of between 25 and 30) and almost a third (31.7%) of those considered obese (BMI of between 30 and 35) are metabolically healthy. That means they don’t have raised blood sugar levels, raised cholesterol, or high blood pressure, all of which pose a risk to good health. The study authors also found nearly a quarter (23.5%) of people in the so-called “healthy” range, that is, with a BMI between 20 and 25, may have these risks to their health. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/80617/original/image-20150506-5455-29ifed.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/80617/original/image-20150506-5455-29ifed.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80617/original/image-20150506-5455-29ifed.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80617/original/image-20150506-5455-29ifed.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80617/original/image-20150506-5455-29ifed.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80617/original/image-20150506-5455-29ifed.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80617/original/image-20150506-5455-29ifed.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">Pulling a measuring tape around someone’s waist simply won’t tell you if they’re healthy or unhealthy.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-153129221/stock-photo-slim-girl-with-centimeter-isolated-on-white.html?src=g9oZBOIedmxduWsUEHfxnQ-1-1">Africa Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Waist circumference is similarly inaccurate. Pulling a measuring tape around someone’s waist simply won’t tell you if they’re healthy or unhealthy because health is far more complex than a certain number of centimetres.</p>
<p>In fact, one number — be it BMI, waist circumference or whatever comes next — will never tell you about any one individual’s health and well-being. If we’re looking across a population, then we may see some associations between increased BMI and an increased risk of diabetes, for instance, but that’s completely different to assessing any one person visiting a doctor.</p>
<h2>Numbers aren’t a map</h2>
<p>Even supposing you could reduce something as complex as health to a number, how this might help someone make positive changes to their well-being and health is another question entirely. Doctors have been weighing and measuring patients in an effort to get them to lose weight for over half a century. But there’s nothing to suggest this approach has been remotely successful.</p>
<p>Many GPs are also time poor and, in many cases, through no fault of their own, poorly equipped to discuss health-related weight issues. There’s virtually no training for GPs and other health professionals in how to help people be the healthiest they can be, or the healthiest weight they can be.</p>
<p>In many cases, this lack of training results in insensitive discussions about weight. A <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2008.636/full">2012 study in the journal </a> Obesity, for example, found 69% of women reported experiencing weight-related stigma from a GP on at least one occasion; 52% said it had happened on multiple occasions.</p>
<p>Such comments can lead to worse health outcomes as people start to avoid seeing doctors for other health-related matters for fear of being judged and weighed. A 2005 study <a href="http://www.brown.edu/Student_Services/Health_Services/Health_Education/main/CEBWoword.PDF">published in the Californian Journal of Health Promotion</a> found:</p>
<blockquote>
<p>the most important factor in women postponing or cancelling medical appointments was fear of being weighed, and increase BMI is consistent with decreased preventive health services.</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/80597/original/image-20150506-954-5q12cc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/80597/original/image-20150506-954-5q12cc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80597/original/image-20150506-954-5q12cc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80597/original/image-20150506-954-5q12cc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80597/original/image-20150506-954-5q12cc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80597/original/image-20150506-954-5q12cc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80597/original/image-20150506-954-5q12cc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This is not the answer.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/alancleaver/4222532649">Alan Cleaver/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Of course, there will be GPs — some of whom will be reading this article — who will say it’s their duty to give patients the unvarnished truth. But this misses the point. Our argument is not that doctors ought to remain silent about the relationship between health, weight and well-being. Rather, that research shows weight is an extremely poor proxy for health.</p>
<h2>A better approach</h2>
<p>Before giving any advice, doctors need to find out whether a person is likely to be above their most healthy weight or not. That means taking an appropriate history, and asking questions such as the amount of physical activity they may be doing, whether that particular person is doing a significant amount of “non-hungry eating”, whether he or she is a fast eater, and so on. You can’t determine all this simply by looking, or measuring anything.</p>
<p>And if blood pressure or blood tests reveal some areas the patient would be willing to discuss further, it’s vital to talk about them in a non-judgemental and supportive fashion. This doesn’t mean sugarcoating the message; it means doctors should opt for neutral language, which does not carry pejorative overtones or imply a moral judgement about the person.</p>
<p>Such a discussion would avoid BMI and tape measures, as well as the prescription of one-size-fits-all weight-loss diets, or unhelpful advice such as “eat less and exercise more”. Instead, it would focus on giving doctors the best chance of finding out the reasons why their patient may be above their most healthy weight.</p>
<p>If we’re serious about supporting people to be healthy, it’s time to end our fixation with unhelpful and inaccurate measures of weight. Instead, we need to train GPs and other health professionals to better discuss weight concerns with their patients in a meaningful way; one that focuses on the complexities of the individual and eliminates the stigma and shame around fat.</p><img src="https://counter.theconversation.com/content/41178/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Rick Kausman is a Director of The Butterfly Foundation. Dr Rick has been in Medical Clinical Practice for over 25 years, specifically supporting and caring for patients with difficulties with respect to food, eating behaviour, weight and body image concerns. He has also written the Award winning book 'If Not Dieting, Then What?', and created and facilitates an RACGP accredited 2-day training program for all Health Professionals on the person-centred approach to well-being and healthy weight.</span></em></p><p class="fine-print"><em><span>Christopher Scanlon 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>Weight and girth have become shorthand for health but these are blunt instruments that provide an unreliable and reductive snapshot of its complexities.Rick Kausman, Casual academic, Deakin UniversityChristopher Scanlon, Academic Director, Learning Focus Area Hub, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/351562015-01-08T19:24:33Z2015-01-08T19:24:33ZDoes my BMI look big in this? And does it really matter?<figure><img src="https://images.theconversation.com/files/67592/original/image-20141218-31043-1og408g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being lean and unfit is worse than being fat and fit.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/raulito39/14913654773">Raúl González/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>This month, the toxic combination of extreme heat and summer holidays will probably mean that you’re going to expose more flesh than you would like to someone whose opinion you care about. </p>
<p>January is the month of fat-phobia, when you regret that you allowed the gym membership you took out in August (the most <a href="https://fitness.org.au/article.php?group_id=2749">popular month</a> for gym sign-ons) to lapse in September. You’re not alone: 67% of people with gym memberships <a href="http://www.statisticbrain.com/gym-membership-statistics/">no longer use them</a>. </p>
<p>So let’s cut to the bone on this fat business: How do we measure fatness? What is this BMI thing, and is it all it’s cracked up to be? Is life just one long slide into adiposity, and what can I do about it?</p>
<p>Epidemiologists most commonly use <a href="http://www.heartfoundation.org.au/healthy-eating/Pages/bmi-calculator.aspx">body mass index</a> (BMI) as a measure of fatness. BMI is calculated by dividing your weight in kilograms by the square of your height in metres. </p>
<p>Take me, for example. I weigh 81kg, and am 1.8m tall, so my BMI is exactly 25. BMIs less than 18.5 are considered to be dangerously low, 18.5-25 in the “normal” or “healthy” range (so I just scrape in, fasted, nude, fairly dehydrated, on a good day), 25-30 is considered overweight, and greater than 30 obese. </p>
<p>These <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065990/">cut-offs</a> came from studies of relationships between BMI and all-cause mortality in non-smokers in the 1950s, when the risk of dying was lowest for BMIs of 20-25. </p>
<p>Now the limitations of BMI should be obvious to anyone. What if I’ve got a lot of muscle and not much fat? Michael Hooper (the current Wallabies’ captain), boxing champion Mike Tyson and Rugby League great Mal Meninga in their prime would all be classified as obese, but I wouldn’t describe them as fat, and certainly not to their faces. </p>
<p>What about Samoans and Fijians, who have a very large muscle mass, or Asians who tend to be much more lightly muscled? Some researchers recommend higher or lower cut-offs for specific ethnic groups. </p>
<p>There’s some evidence that adults are getting fatter at the same BMI — that is, someone with a BMI of 25 today is fatter than someone with a BMI of 25 a few decades ago. BMI is probably also <a href="http://www.medicalnewstoday.com/articles/255712.php">biased</a> against taller people due to some inappropriate scaling assumptions. </p>
<p>Some rather more surprising difficulties with BMI have emerged recently. While the risk of death may indeed have been lowest in the normal range in the 1950s, it certainly isn’t now. A slew of <a href="http://www.nature.com/ejcn/journal/v67/n6/full/ejcn201361a.html">recent studies</a> have shown that the risk is now lowest for people right in the middle of the overweight range, with a BMI of about 27.</p>
<p>The problem is that BMI measures relative weight, at best a poor proxy for fatness, which may be the real metabolic culprit. Fatness may be better estimated from skinfolds (pinches of fat at embarrassing sites on the body), which the <a href="https://www.essa.org.au/membership/accreditation/">Exercise and Sports Science Australia-accredited</a> exercise professional at your local gym should be able to measure for you. </p>
<p>Even more to the point is the distribution of body fat: being fat in the wrong places (around the abdomen) is worse than being fat in the right places (hips and thighs). In fact, thigh fat <a href="http://www.ncbi.nlm.nih.gov/pubmed/1870428">appears to be protective</a>, leading to a healthier blood fat profile, but unfortunately less chance of attracting the desirable targets on the beach. </p>
<p>A simple measure is waist girth — measure it with a tape half-way between the bottom of the ribs and the top of the hip bones. The Australian government recommends cut-offs of 94 cm (bad) and 102 cm (very bad) for men, and 80 cm and 88 cm for women. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/67601/original/image-20141218-31031-15gmlev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/67601/original/image-20141218-31031-15gmlev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/67601/original/image-20141218-31031-15gmlev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/67601/original/image-20141218-31031-15gmlev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/67601/original/image-20141218-31031-15gmlev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/67601/original/image-20141218-31031-15gmlev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/67601/original/image-20141218-31031-15gmlev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When it comes to disease risk, getting fat is worse than being fat.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/yourdon/2625987077">Ed Yourdon/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>If you’ve really got some time and money to spare, universities and some radiologists can give you a DXA (dual-energy X-ray absorptiometry) scan, pretty much the gold standard these days, which will tell you just how much fat you have and where it is. </p>
<p>Does getting older inevitably mean getting fatter? Just about every longitudinal study shows weight gain with age. <a href="http://www.nature.com/ijo/journal/v27/n4/full/0802263a.html">American</a> and <a href="http://www.biomedcentral.com/1471-2458/14/1219">Australian</a> studies report weight gains of 0.2 to 1.0 kg/year in adults aged 20 to 60, with slower rates of gain for people who are physically active, and richer. </p>
<p>There are good physiological reasons to expect increasing body fat with age: anabolic hormones responsible for converting excess calories into muscle rather than fat — testosterone, human growth hormone — decline rapidly with age, and physical activity becomes harder with age-related musculoskeletal and joint problems. </p>
<p>There’s bad news on the weight gain front, I’m afraid: getting fat is worse than being fat. In a <a href="http://aje.oxfordjournals.org/content/early/2013/09/07/aje.kwt179.abstract">16 year follow-up</a> of almost 10,000 Americans aged 51 or more, those least likely to die were overweight people who remained overweight, while gaining weight led to higher risk.</p>
<p>Certain life events can trigger rapid weight gain. There is a sudden weight gain of a few kilograms when women move in with a partner — perhaps it’s the “I’m no longer on the market” effect. But there’s still hope: divorce will <a href="http://www.sciencedaily.com/releases/2013/04/130403200416.htm">reverse it</a>. </p>
<p>Mothers’ weight <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930888/">increases permanently</a> by up to 4 kg after the birth of their first child, for reasons which any mother will be happy to tell you about. After about age 60, weight starts to fall, usually marking the beginning of the slow decline to frailty and death. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/67603/original/image-20141218-31021-1jubixc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/67603/original/image-20141218-31021-1jubixc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/67603/original/image-20141218-31021-1jubixc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/67603/original/image-20141218-31021-1jubixc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/67603/original/image-20141218-31021-1jubixc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/67603/original/image-20141218-31021-1jubixc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/67603/original/image-20141218-31021-1jubixc.jpg?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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<span class="caption">Avoiding weight gain comes down to good diet and exercise.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/yourdon/5831004570">Ed Yourdon/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>So what can you do to avoid weight creep, or at least minimise its effects? I have nothing new to offer in this department: eat lots of fruit and veges and wholegrains, get lots of exercise, get a <a href="https://theconversation.com/how-sleepless-nights-can-lead-to-weight-gain-12736">good sleep</a>, <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">get rich</a>. </p>
<p>Remember that being lean and unfit is worse than being fat and fit. In <a href="http://www.ncbi.nlm.nih.gov/pubmed/10546694">one study</a>, men who were lean but unfit had almost twice the risk of dying compared to men who were overweight but fit. And all the rest, from crossfit to core training, from carbs to quinoa, all the rest, as Verlaine says, is just literature.</p><img src="https://counter.theconversation.com/content/35156/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Olds receives funding from the NHMRC and ARC.</span></em></p>This month, the toxic combination of extreme heat and summer holidays will probably mean that you’re going to expose more flesh than you would like to someone whose opinion you care about. January is the…Tim Olds, Professor of Health Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/250332014-04-09T20:45:46Z2014-04-09T20:45:46ZFat and fit? There’s no such thing for most people<figure><img src="https://images.theconversation.com/files/45846/original/xv4kpfpq-1396935544.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A small proportion of overweight and obese people are metabolically healthy but that doesn't mean we should become complacent about aiming for a healthy weight.</span> <span class="attribution"><a class="source" href="http://www.stockybodies.com/Physical%20Activity/SB_IB_activity-34.jpg.php">Isaac Brown/Stocky Bodies</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The idea that people can be healthy at any weight has gained credence in recent years, despite widespread evidence that obesity creates health risks. While the idea is attractive, it’s also dangerous because it can lull people who need to lose weight now into a <a href="http://www.ncbi.nlm.nih.gov/pubmed/24533128">false sense of security</a>. </p>
<p>In a new book <a href="http://www.amazon.com/The-Obesity-Paradox-Thinner-Healthier/dp/1594632448">The Obesity Paradox: When Thinner Means Sicker and Heavier Means Healthier</a>, for example, US cardiologist Carl Lavie argues that people with certain chronic diseases who are overweight, or even moderately obese, often live longer and fare better than normal weight people with the same ailments. </p>
<p>This may indeed be the case for a small proportion of people, but messages such as this are cause for concern because they can lead to complacency and delays in action against overweight by governments, health professionals and individuals alike. </p>
<h2>Being fat and fit?</h2>
<p>Lavie’s idea is not new. An increasing number of reports show it’s possible to have a body mass index (BMI) in the overweight (25 or more kilograms per height in metres squared) or obese (30 or more kilograms per height in metres squared) range and <a href="http://www.ncbi.nlm.nih.gov/pubmed/20628408">still be metabolically healthy</a>. The latter is defined as the absence of certain risk factors for metabolic diseases typically associated with being overweight or obese, such as diabetes and cardiovascular disease. </p>
<p>While the proportion of obese people who are metabolically healthy varies depending on how obesity and health are defined, it’s much smaller proportion than those who are <a href="http://www.ncbi.nlm.nih.gov/pubmed/20628408">not metabolically healthy</a>. And it’s not possible to predict who will remain metabolically healthy despite excess weight gain.</p>
<p>What’s worse, recent research suggests it’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Are+metabolically+healthy+overweight+and+obesity+benign+conditions%3F%3A+a+systematic+review+and+meta-analysis">only a matter of time</a> before obese people who are metabolically healthy start facing health issues. And whether or not a person with excess weight develops illness, sooner or later the mechanical effects of excess weight and the resultant gait abnormalities, combined with systemic inflammation, are likely to take their toll.</p>
<p>Overweight adults are more than twice as likely to develop <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Risk+factors+for+onset+of+osteoarthritis+of+the+knee+in+older+adults%3A+a+systematic+review+and+meta-analysis">knee osteoarthritis</a>, and the risk increases with weight. Carrying excess weight also contributes to escalating difficulties in performing <a href="http://www.ncbi.nlm.nih.gov/pubmed/22632704">everyday activities</a>, such as walking, getting out of a chair and climbing stairs.</p>
<p>Any delay in action is <a href="http://www.jeatdisord.com/content/2/1/8">even more worrying</a> because of <a href="http://purl.library.usyd.edu.au/sup/9781920899851">emerging research</a> in animals such as mice, rats and monkeys that suggests there may be a limited window of opportunity to do something about excess weight. </p>
<p>After a while on an excessive diet (several months in rodents; unknown in people), carrying excess weight may become “hard wired” into the parts of the brain that regulate appetite. It may then become almost impossible to lose weight.</p>
<h2>Effects of processed food</h2>
<p>Exposure to a processed, energy-dense diet that’s high in fat, or high in fat and sugar (the default diet of modern societies), initially leads to physiological changes in animals and humans that tend to <a href="http://purl.library.usyd.edu.au/sup/9781920899851">counteract weight gain</a>.</p>
<p>These include a loss of appetite, but whether you actually lose weight in this phase depends on whether you pay attention to how you feel or eat when you’re not hungry. Problems arise when signals for reducing food intake are ignored and people continue eating more than they need.</p>
<p>Chronic exposure to excess food in rodents leads to the <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=lin+international+journal+of+obesity+2000">breakdown of these compensatory responses</a>. Changes in the brain similar to those seen in <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Dopamine+D2+receptors+in+addiction-like+reward+dysfunction+and+compulsive+eating+in+obese+rats">drug addiction</a> also occur. Both changes are thought to contribute to a compulsive drive to overeat. </p>
<p>So, instead of the body fighting ongoing fat build-up, as is the case during the initial stages of kilojoule excess and weight gain, long-term excess and fat accretion lead to physiological changes that enable the body to put on weight more easily.</p>
<p>While we know this happens, we don’t know why or how eating too much over time breaks down the body’s natural defences against weight gain. And we don’t know whether the effects of long-term overconsumption to promote a seemingly permanent state of obesity in rodents also occur in humans. </p>
<p>More importantly – and more worryingly – we don’t yet know whether the detrimental effects of long-term excess can be reversed by switching to a healthier, lower-kilojoule diet.</p>
<h2>Advantages of acting early</h2>
<p>While there are gaps in the evidence for this idea, in light of emerging evidence from animals showing similarities with human brain pathways controlling body weight, it’s probably safer to act now rather than wait. </p>
<p>That’s why the increasingly widespread promotion of the idea of being healthy at any weight, which is potentially a recipe for complacency, is bad.</p>
<p>Governments should take urgent action to ensure that healthy diets are readily accessible to everyone, and that highly processed high-fat, high-sugar diets are difficult to access. We also need more research to find better ways to help people to lose excess weight. </p>
<p>Anyone carrying excess weight should do whatever it takes to rid themselves of it gradually. They should start as soon as possible – while their body is still likely to be amenable to weight loss. </p>
<p>If you put off losing those excess kilos until later, it may be impossible to do it without bariatric surgery or other extreme measures that leave you feeling permanently hungry.</p>
<p>As a society we need to work together to nip excess weight in the bud – the earlier the better, while it is still possible. </p><img src="https://counter.theconversation.com/content/25033/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Salis receives funding from the National Health & Medical Research Council (NHMRC) of Australia, in the form of research project grants and a Senior Research Fellowship. She is the author of The Don’t Go Hungry Diet (Bantam, Australia and New Zealand, 2007) and Don’t Go Hungry for Life (Bantam, Australia and New Zealand, 2011) and owns shares in a company (Zuman International Pty Ltd) that sells these books.</span></em></p>The idea that people can be healthy at any weight has gained credence in recent years, despite widespread evidence that obesity creates health risks. While the idea is attractive, it’s also dangerous because…Amanda Salis, NHMRC Senior Research Fellow in the Boden Insitute of Obesity, Nutrition, Exercise & Eating Disorders, University of SydneyLicensed as Creative Commons – attribution, no derivatives.