Think Thin

"Pleasingly plump" is a misconception, a federal panel that has studied the health effects of obesity warns. Far more accurate to think in terms of disease-inducing and life-threatening plumpness, with the degree of risk rising as excess body weight increases. The health threat is not limited to the obviously obese. People who may consider themselves only moderately overweight also have reason for concern. Dr. William Castelli, director of the famous Framingham Heart Study, believes that weight exceeding desirable norms by even 10% or less can be a serious health-risk factor.

What are those norms? The standards most often used to define desirable weight according to body frame and height are two tables produced by Metropolitan Life Insurance Co. One of those tables dates from 1959. The second was issued in 1983, and has prompted some controversy because it elevates acceptable weight ranges by some pounds over the earlier figures. But neither of these tables takes into account age in determining preferable weight, or where fat is distributed on the body. The location of body fat, some studies now suggest, could be an important factor in promoting illness. For example, men whose waists are as big or bigger than their hips, or women whose hips are larger than their waists by 20% or more, might be at particular risk. How, then, should a lay person gauge overweight? An honest look in the mirror is one way to begin.

For all the emphasis on fitness and proper diet, the National Institutes of Health panel found that more Americans are overweight today than a generation ago. An estimated 34 million weigh at least 20% more than they should, and more than 11 million of these are at severe risk of developing obesity-related diseases. As the panel reported, the evidence linking obesity to life-shortening conditions is overwhelming. Among these are high blood pressure, heart disease, adult-onset diabetes, gallbladder disease, arthritis and a half-dozen or more different cancers. Dr. Jules Hirsch, panel chairman, summed up the problem of overweight bluntly: "Obesity is a killer."

To define the problem is one thing, to understand it so that effective remedies might be promoted is something else. Obesity, as the panel noted, is no longer considered by some researchers to stem from a single simple cause--overeating--but instead is now increasingly seen as a complex disease "deeply rooted in biologic systems." Losing weight is often hard, but not impossible. Keeping weight at a desirable level is the real goal, and far harder. The panel did not involve itself with questions about the causes of obesity or the control of weight; perhaps a subsequent panel will. But it did add emphasis to what many researchers and physicians have been saying for a long time: Overweight is unquestionably unhealthy and demonstrably life-threatening. With so many at risk, obesity must now be regarded as a public-health issue of basic importance.

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