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A Numbers Game 

Most people who have joined a health club know the drill. You get a tour of the facilities by an impossibly fit health club employee who then brings you to his or her office or cubicle to take a few measurements — height and weight — in order to calculate that dreaded number: body mass index (BMI).

BMI measures body weight relative to height, and a normal BMI is considered to be from 18.5 to 24.9. Overweight range is 25 to 29.5, and the obese range is anything above 30. That's it. Suddenly, you've been thrust into a category of good health or bad, and if it is determined that you are overweight or obese, the only way out is a lifetime dedicated to healthy eating and exercise.

Let's face it: Finding out your BMI can be a depressing experience, and unless you've had your head stuck in a bag of Doritos for the last 10 years, you've heard about the obesity epidemic in this country. According to the Centers for Disease Control (CDC), 64 percent of adult Americans are overweight or obese, with 72 million — 34 percent of the adult population — considered obese. There's no question Americans are getting fatter. What experts are debating is the severity of the problem and the reliance on BMI for determining how healthy we are. Is a person who works out four or five times a week but has a BMI of 27 really that unhealthy? Likewise, is a person with a normal BMI who doesn't work out healthier than an overweight person?

Linda Bacon, a nutrition professor at City College of San Francisco, thinks the national obesity issue has been greatly exaggerated, and she places most of the blame on the federal government. Bacon, who holds a doctorate in physiology as well as graduate degrees in psychology and exercise science, says the CDC published a report in 1999 that attributed upward of 325,000 deaths annually to obesity.

"Then they said it was a mistake and published 300,000 deaths and both of these reports were highly publicized — [the CDC] put out press releases and really pushed it," Bacon says. "When they published the last [report], which showed if you combined overweight and obesity, I think it was about 29,000 deaths."

Bacon adds that the final report wasn't nearly as publicized as the previous two and that the few press releases that accompanied it didn't mention the overestimate but simply concluded that obesity is still a major problem.

"So it was, 'Yes, but we're going to continue to ignore what we found,'" Bacon says.

What was discovered in that report, "Excess Deaths Associated with Underweight, Overweight, and Obesity" (2005), was that overweight people, a BMI between 25 and 29.5, actually had less risk of death than those with a normal BMI. Another recent study reported in the American Journal of Medicine went even further, suggesting that obese patients had a lower mortality risk than patients with normal weight. In the study, researchers from the cardiology division at Stanford University researched a population of 6,876 older veterans over the course of about seven years. Their research revealed that obese veterans were 22 percent less likely to die than their normal-weight counterparts. Additionally, the "obesity paradox" grew to 35 percent when the obese veterans had a higher cardiorespiratory fitness level than the normal-BMI veterans.

It's these kinds of reports and others that lead Bacon to declare that the United States doesn't have an obesity problem.

"We don't," she says. "It's certainly true that people are fatter than they were before, but this doesn't seem to be a problem. It just seems to be a shift: We're eating differently, leading different lifestyles, so people are heavier. But weight itself doesn't seem to be contributing significantly to poor health."

Bacon supports her argument that the obesity epidemic is a myth by pointing out in her book Health at Every Size: Finding Your Happy Weight that the average weight of the population has gone up only 7 to 10 pounds in the past 15 years, while life expectancy for the average American continues to increase and heart disease rates, often associated with obesity, have dropped.

In terms of overall health, Bacon says that diet isn't nearly as vital as regular exercise. Just as she feels that BMI has been used to narrowly define the population into convenient categories, she thinks Americans need to get over the one-size-fits-all idea of exercise. Exercise should be joyful, Bacon contends, so not everyone has to spend the standard half-hour on the treadmill at a health club. While some people will get a hormonal response from the treadmill that makes it enjoyable, others aren't wired that way and should look for "exercise that gives them joy."

Bacon takes a similar view when it comes to nutrition. Instead of focusing on BMI figures or numbers on the scale, Bacon thinks the populace should start getting more in touch with their bodies. If people paid attention to how food made them feel physically instead of worrying about whether a food was "right" or "wrong," their bodies would function better and their anxiety about food would lessen.

"I'm not suggesting you eat higher fiber foods because it's the right thing to do," Bacon explains. "I'm suggesting you do it because it'll make you feel better."

The same sort of thinking should apply to how people see their bodies, she says. If they feel physically healthy and are in tune with their bodies, then they can take pride in how they look regardless of what society deems is beautiful. Bacon says the culture is at fault, not the individual.

"It's not allowing the culture outside of you to define you," Bacon says. "If we did that all the time, we would only see white men with blue eyes and muscled bodies as attractive. We have to recognize how limiting that is and that we can set our own beauty standards."

Bacon admits that having this kind of confidence in body image can be challenging, especially when our slim-or-fat cultural perceptions are cut-and-dried.

"The majority of the population might never quite see you as attractive, which is a really hard thing to face," Bacon says.

Marion McGavran works with women who have taken the idea of thin or fat to the extreme. She is the program director of the eating disorders unit at River Oaks Hospital, and her patients are either anorexic or bulimic. She says that in general, people have an obsessive desire to measure themselves against others and that influences how they perceive themselves. Her patients, she says, constantly measure themselves against others, using the mirror, the scale or BMI calculators.

"Most of my patients have a core belief that if they're not anorexic, then they're fat," McGavran says. "There's no middle ground. It really involves a lot of black-or-white or all-or-nothing kind of thinking."

McGavran thinks that BMI lends itself to this kind of reasoning, so patients in her department aren't allowed to know what they weigh or their current BMI.

"BMI isn't a tool for the general public. It's a tool for nutritionists," McGavran says.

Most experts don't agree with Bacon when it comes to the obesity epidemic. Dr. Tom Farley, a medical doctor and chairman of Tulane University's community health sciences department, says that obesity is still the nation's No. 2 health problem (smoking is No. 1) and that obesity is still responsible for more than 100,000 deaths in the U.S. annually.

"There's no question that people who are obese are much less healthy than people who are either overweight or normal weight," Farley says, adding that the risk for Type II diabetes increases with each additional pound of excessive weight.

Farley does concur with Bacon when it comes to healthy overweight people. He says that during a recent visit to a bookstore, he counted 142 diet books on the shelves. If there was a magic diet for everyone, he says, it would have been discovered by now. Unlike Bacon, Farley doesn't care if people are motivated to be healthier because they're overweight, but he does think they should place an emphasis on physical activity and healthy eating.

"To a certain extent [Bacon] is right," Farley says. "If people exercise a lot and are overweight, they're actually healthier than people who don't exercise at all and are not overweight."

Although Bacon goes so far as to say there's no question an obese person can be healthy, Farley disagrees, saying there are too many health risks associated with obesity. If someone is overweight, he says, they should worry about becoming obese and take precautions to avoid it. Farley does, however, suggest that it might be time to rethink the BMI category for overweight.

"These days, the average person is overweight and the term 'overweight' was drawn up during an earlier era when people were eating differently and everything was different," Farley says. "It's changed a little bit, so maybe then the term isn't an appropriate term now." In fact until the late '90s, the BMI category for overweight began at 27.3 BMI for women and 27.8 BMI for men. In June 1998, the National Institutes of Health changed the overweight definition to start at 25 BMI for both sexes, adopting the standards of the World Health Organization. The day the new rules went into effect, 26 million Americans suddenly became cataloged as overweight.

Bacon says that ultimately is the problem with the BMI rating system. They're just numbers — labels — and don't take into account the people to whom they're being applied.

"They're useless," she says. "They don't tell us anything. If you want to find out how healthy someone is, you can ask them what their exercise habits are and their eating habits and that'll tell you a lot more about their health and longevity issues than BMI will."

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