Called Lethal, ‘as Smoking Is’ : Obesity Kills, Government Health Committee Warns

Calling obesity “a killer” in the same sense as smoking, a federally convened health panel warned Wednesday that an estimated 34 million Americans are so overweight that they put themselves at a significantly higher risk for a range of life-threatening conditions, including high blood pressure, heart disease, diabetes and cancer.

“We want the average American to know that obesity is a disease--it is not a state, like loneliness,” said Dr. Jules Hirsch, professor at Rockefeller University in New York, who was chairman of the committee. “It is a disease and carries an increased risk of mortality. It deserves to be treated and considered just as seriously as any other illness.”

The 14-member National Institutes of Health panel, after hearing two days of testimony from scientists, physicians and other experts in the field on the health implications of obesity, concluded that the “evidence is overwhelming” that being overweight contributes to serious health consequences and shorter lives.

“Obesity is a killer,” Hirsch said. “It is a killer, as smoking is. Not every cigarette smoker dies of lung cancer and not every obese person is going to die of these related diseases. But the risk of developing a variety of illnesses has been increased--and obesity is a killer in that way.”

Eventually, obesity “will be seen in the same historical context with what we’ve been through with smoking,” said Dr. Edward Huth, a panel member and editor of the Annals of Internal Medicine of the American College of Physicians.

The panel, composed of physicians, nutritionists and scientists, defined obesity as being 20% above the desirable weight set by life insurance tables. Even five to 10 pounds of extra weight “puts one at risk,” the committee said--especially if the person is suffering from high blood pressure or diabetes or if there is a family history of these diseases.

“Almost any degree of obesity has an adverse effect,” Hirsch said.

Fatness Linked to Cancer

The committee said that obesity is clearly associated with high blood pressure, abnormally increased levels of cholesterol in the blood, non-insulin-dependent diabetes and certain cancers, including colon, rectum and prostate in men and gallbladder, biliary passage, breast, cervix, uterus, ovarian and endometrium in women.

It noted also that obesity “creates an enormous psychological burden--in fact, in terms of suffering, this burden my be the greatest adverse effect of obesity.”

Even the location of body fat can make a difference, the panel said, although it could not explain why. Hirsch said, for example, that fat in the waist and abdomen “seems to carry (a) greater hazard” than fat in the thighs and buttocks. “The pot belly may be an unusually adverse occurrence,” he said.

Childhood Obesity

“Treatment is strongly advised” for persons 20% or more over their desirable weight, the panel said. It recommended that obese children “be encouraged to bring their weight to within normal limits.” It added: “Although childhood obesity does not necessarily lead to obesity in adults, there is evidence that it is a significant risk factor for obesity in adults.”

The committee called for additional research into biological factors in childhood as predictors of adult obesity and factors that regulate the regional distribution of excess weight.

The group used the midpoint of the ideal weight tables produced in 1959 and 1983 by the Metropolitan Life Insurance Co. The 1983 revised tables added several pounds to the earlier figures. Although the panel did not recommend which table to use, Hirsch said that he uses the 1983 figures.

According to the 1983 figures, for example, a man who is 5 feet, 3 inches tall should weigh 127 to 151 pounds; 5 feet, 8 inches, 137 to 171 pounds, and 6 feet, 3 inches, 157 to 202 pounds. A 5-foot-tall woman should weigh 103 to 137 pounds; 5 feet, 5 inches, 117 to 156 pounds, and 5 feet, 11 inches, 135 to 176 pounds.

Not Applicable to All

The panel cautioned that the tables are formulated on specific populations, did not take age or body fat distribution into account and may not be applicable to the entire population, “particularly those of lower socioeconomic and some ethnic groups.”

The panel did not address problems experienced in losing weight or the causes of obesity, but it said: “Formerly, obesity was considered fully explained by the single adverse behavior of inappropriate eating in the setting of attractive foods.” But, it added, studies and other data now show “that this disease in man is complex and deeply rooted in biologic systems. It is almost certain that obesity has multiple causes and that there are different types of obesity.”