Obesity epidemic appears underestimated
Americans might be even fatter than the Centers for Disease Control (CDC) have been warning for years, physicians were told at the Endocrine Society meeting in Chicago last week.
The weighty news came from researchers at the Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, who scanned 9,700 people with high-tech, dual-energy x-ray absorptiometry (DEXA) machines.
What they found was that the Body Mass Index (BMI) scores now the norm for identifying obesity in the U.S. identified only 47 percent of the obese.
This was not exactly a new discovery. Researchers using bioelectrical impedance analysis reported much the same thing in a peer-reviewed study in the International Journal of Obesity in 2008, but bioelectrical impedance analysis is not considered nearly as accurate as DEXA.
Exactly how fat Americans are now and how fast their waistlines are growing is a significant issue given the enormous health and financial costs of obesity.
Meanwhile, the invisible obese might well be indicative of a second epidemic – an epidemic of unfitness – running parallel to this country’s more often discussed and costly obesity epidemic, and that epidemic is costly.
“In 2016, chronic diseases driven by the risk factor of obesity and overweight accounted for $480.7 billion in direct health care costs in the U.S., with an additional $1.24 trillion in indirect costs
due to lost economic productivity.”
Then along came the pandemic and the reclassification of “chronic diseases” as “comorbidities.” Of these comorbidities, which often go hand-in-hand with obesity, a peer-reviewed study published in Nature in April had this to say:
“Geographic regions with a higher pooled prevalence of comorbidities – specifically, North America and Europe – had shown a high prevalence estimate of all the major comorbid conditions and mortality followed by South America, Asia and Africa.”
Africa, where the obesity rate is reported to be 18.4 percent for women and 7.8 percent for men, is at this time reporting 258,791 Covid-19 deaths from a population of 1.442 billion, according to Worldometer numbers.
In the U.S., where obesity is far more common than in Africa, the three states hit with the most Covid-19 deaths – California with 103,100, Texas with 94,594 and Florida with 88,695 – account for a total of 286,389 dead, according to the Worldometer tracker. That’s about 28,000 more deaths than all of Africa where obesity is not nearly the problem it is here.
The U.S. Centers for Disease Control reports that more than 40 percent of both men in women in this country today are obese, but that’s not the only thing that makes them different from Africans.
A lot of Africans still get around under their own power. The International Organization of Motor Vehicle Manufacturers estimates the “motorization rate” for Africa at 49 vehicles per 1,000 inhabitants.
The U.S. rate is the highest in the world at 860. That is about 34 percent higher than the second-highest rate of 641 in the European Union.
The health costs of motorized convenience appear reflected in the global body counts.
The Covid-19 death rate in the U.S. is about 349 per 100,000 as of this date – about 27 percent higher than the 275 per 100,000 rate of Europe, according to the Worldometer data, and this despite the fact that about a quarter of the European population was age 60 or older when the pandemic began.
Everywhere the aged suffered the worst in the pandemic of the old and the comorbid. As of this writing, the CDC is showing about 82 percent of U.S. dead were over the age of 60 in a country where only about 22 percent of the population has reached that age or gone beyond.
Many of these deaths appear linked to immunosenescence, the natural decay of the immune system with age, but the rate of this decay is in turned linked to exercise. Researchers have found there is something of a use-it or lose-it connection.
Americans have become world leaders in the lose-it category.
And since the end of World War II, the Europeans have been following the American trend toward increasingly sedentary lifestyles, though it’s hard to keep up.
The John Hopkins University has labeled this the “sitting disease,” and Korean researchers detailed why in a peer-reviewed 2020 study published in the Korean Journal of Family Medicine.
“A sedentary lifestyle has an array of adverse health effects, including elevated all-cause mortality; cardiovascular disease mortality; cancer risk; risks for metabolic diseases such as diabetes mellitus, hypertension, dyslipidemia; and musculoskeletal diseases such as knee pain and osteoporosis,” they reported.
They then underlined those observations by warning that “it is indisputable that the negative health impacts intensify with increases in the total daily sedentary times.”
Given all the time some people spend sitting behind computer screens as part of their jobs these days, the researchers did recognize that in some cases “sedentary time cannot be reduced for unavoidable reasons, (but) it is advisable to engage in sufficient exercise equivalent to or more than 150 to 300 minutes of moderate physical activity per week, as studies found that physical activity could offset the adverse effects of sedentary behavior.”
The U.S. National Center for Health Statistics reported in 2020 that only 46.9 percent of Americans were meeting the minimum limit of 150 minutes of aerobic exercise per week, and when the recommendation of doing some sort of muscle-strengthening exercise at least twice per week, was added, the number of Americans falling to meet basic exercise needs ballooned to 75 percent.
The obesity and fitness epidemics are related, but they are not the same as pandemic data compiled by researchers in the United Kingdom well-illustrated early in the pandemic.
When British researchers tapped the UK Biobank, they were able to access data on more than 400,000 Brits who had recorded their walking pace (people still walk in England) and found a direct link between walking pace, a simple measure of fitness, and death.
Obesity, they noted, was a Covid-19 risk factor, but a lack of fitness even more so.
“Both obesity and walking pace are independently associated with the population level risk of severe Covid-19 in UK Biobank (data),” they reported. “However, slow walkers had the highest risk of severe Covid-19 regardless of their obesity status, with normal weight, overweight or obese slow walkers all having over twice the risk of severe COVID-19 compared to normal weight brisk
The study was first published online at MedRxiv in 2020, and then in the peer-reviewed Journal of Obesity in 2021.
Exercise is medicine
The new report on BMI versus actual obesity does raise some questions about how much the UK results might have been skewed by an unknown number of obese among that group of “normal weight” slow walkers, but there is no doubt fitness proved protective as other studies have confirmed.
And all the DEXA data is really saying is that people can be fat without really looking fat, which makes a certain amount of sense.
If one loses muscle mass because of the sedentary lifestyle while gaining fat mass in the same proportion, his or her body shape and size isn’t going to change any more than that of a balloon filled with an equal amount of water, air or helium.
The balloon filled with helium looks just like the balloon filled with water but the latter is so heavy that if released from the hand it drops to the ground and bursts while the former floats off into the sky.
The CDC warned of the dangers of being the water-filled, human balloon two years ago as the pandemic was only beginning.
“Obesity Worsens Outcomes from Covid-19,” it headlined on one of its webpages above a report that through Nov. 18, 2020 “models estimate that 271,800 (30.2 percent) of 900,000 adult hospitalizations were attributed to obesity.”
The new data would indicate that might be a serious undercount of the percentage of hospitalizations linked to obesity and its sometimes companion, lack of exercise,
The CDC report also added that there was an “increased risk for (obesity-related) hospitalization or death (that) was particularly pronounced in those under age 65.”
Simply put, a high percentage of the less than 25 percent of the U.S. population under age 65 that the CDC shows dead of Covid-19 may have died largely because they were fat and out of shape, though this was not necessarily their fault.
Some of them, maybe many of them, might have suffered from an addiction to food. Many of them, probably most of them, likely did nothing to try to protect themselves from Covid-19 by beginning a program of regular exercise when the pandemic began.
Why would they?
Few in the U.S. government talked up the protective value of being physically fit, though that was obvious early on.
Instead, however, the government focus was on vaccines to the extent of ordering members of elite military units such as the Navy Seals and the Army Special Forces to get vaccinated because of the danger of Covid-19.
What was the average American to think then? If exercise doesn’t protect the youngest, fittest people in the country from Covid-19, why would anyone want to get hot and sweaty thinking it would protect them?
(OK; there are benefits other than protection from the SARS-CoV-2 virus that causes Covid-10. Recent research has shown that increasing exercise up to a maximum of 600 minutes (10 hours) per week can add years to your life, but the many rushing to get through the day seldom bother to contemplate adding years to their lives decades in the future.)
Lack of leadership
And government messaging – which devotes more time to appeasing motorists with reports of all that is being done to make motor traffic flow more efficiently rather than stressing the benefits of getting out of a motor vehicle to walk, run, bicycle, pogo stick or otherwise exercise – is pretty much worthless when it comes to this subject.
The media, meanwhile, only adds to the problem with its push for “fat acceptance” and “body positivity,” and its unwillingness to recognize that the obesity issue isn’t about how people look; it’s about how they’re harming themselves and costing the economy with their lack of fitness.
As one of the many Americans classed among the “overweight,” I can write these things in all fairness, although there is a legitimate question as to whether I should be classed as overweight.
Don’t get me wrong. I just got off a scale that read 189 pounds. That’s at least 15 pounds overweight by my personal standard, which dates back to my high school football days when I constantly tried to put on weight but couldn’t.
And when I punched 189 pounds into the online, BMI calculator of the National Institute of Health just now, it produced a nice, fat score of 27.1, which is right in the middle of the 25 to 29.9 range for “overweight.”
When I was an inch taller and a college sophomore oh-so many years ago, my 215-pound weight would have enrolled me in the obese category that starts at a score of 30.
Funny how going from a highly active high-school athlete to a university student spending more time drinking beer than exercising can change one’s body.
Thankfully the phase didn’t last long. I was doing a lot of SCUBA diving at the time, and one winter while pulling on a wetsuit in preparation for an ice dive outside a friend’s family cabin on a Minnesota lake, I happened to look in a mirror and see Porky Pig’s face inside a wetsuit hood staring back at me.
I started an exercise program not long after. The only good thing about being 215 pounds was that I could almost float, which brings this back to the problem with BMI.
A bad yardstick
BMI has always been a flawed metric.
It has long been known to indicate short people are leaner than they are and the opposite for tall people, but the biggest flaw – or what was at least once thought to be the biggest flaw – was related to muscle mass.
“Muscle weighs more than fat (it is denser, a cubic inch of muscle weighs more than a cubic inch of fat),” as Medical News Today put it. “Therefore, BMI will inevitably class muscly, athletic people as fatter than they really are.
“A six-foot-tall, Olympic, 100-meter sprinter weighing 200 pounds may have the same BMI (26) as a couch potato of the same height and weight. A BMI calculation would class both of them as overweight.
“That calculation is probably right for the sedentary couch potato, but not for the athlete.”
This would now seem to be the least of the problems with BMI though it is the one with which I am personally most familiar.
Back in my serious marathoning days, my much-desired but seldom-reached race weight was 170 pounds. The only way I could get there was to go on a near-starvation diet.
At 170, my BMI was 23.7, putting it in the high end of the 18.5 to 24.9 “healthy” range. At 175, which was more often my actual weight, the number was 24.4 and creeping very close to the “overweight” standard.
Needless to say, when I quit running 100 miles per week and counting calories, I quickly joined the more than a third of American men judged to be overweight, making it easy to empathize with anyone having trouble keeping the pounds off.
In fact, there aren’t many American men left who qualify as “normal” weight, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which ranks 34.1 percent of men overweight and 43 percent obese with about a quarter of the latter qualifying as severely obese.
These numbers put almost three-quarters of American men in the overweight or obese categories. These are scary numbers.
To reach obese status, a man’s body must be compromised of more than 25 percent fat. I don’t know what my body fat percentage is these days, but given that I once again can’t float, I suspect that it is well below 25 percent.
This negative buoyancy issue appears somewhat common in men.
And it’s been well illustrated that BMI has been over-counting obesity to some degree by classifying muscular men as obese for a long time. Men’s Health made a big deal in 2015 of how actor Dwayne “The Rock” Johnson had a BMI of 34.3, which put him well into the obese category.
But the story also ended with this:
“We can LOL at the idea that a rock-solid athlete or actor is classified as obese. But for every guy who’s misclassified because of his muscle mass, a bunch more are given a government-approved but certifiably false assessment of their health status, despite a dangerously high body-fat percentage.”
This might have been a laugh-out-loud matter before the pandemic. But a lot of Americans have now died because of this false assessment of their health status, and because so little was done to encourage them to get up and get moving.