An Urban's Rural View

What is your definition of "fat?" How heavy does a person have to be to qualify as "overweight?"

In everyday life most of us use the definition a Supreme Court justice once used for pornography: "I'll know it when I see it." Health professionals use body mass index, a number that compares a person's weight and height. When you read articles lamenting that nearly a third of Americans are overweight, the definition used was most likely a BMI of 25 or higher, the standard the professionals have agreed on.

That was also the standard invoked in the recent stories (for example, http://tiny.cc/… or http://tiny.cc/…) with headlines like "Study Suggests Lower Mortality Risk for People Deemed to Be Overweight."

What? Fat is good? That was the sheepish spin some stories put on the result. Oh, of course there were caveats and qualifications. After all, the study measured risk of death, not overall health. Perhaps overweight people have a lower risk of death because they're more likely to be sick and thus to go see the doctor. Seriously obese people -- BMI of 35 or above -- had a higher risk of death. All in all, the experts in the stories said, no one should now think they can improve their health by gorging on cheeseburgers.

Nonetheless, the brunt of the reaction was we need to rethink the dangers of becoming fat. No one I read shared my reaction to the study, which was to wonder whether we need a new definition of overweight.

Start from the premise that our perception of who is fat and who isn't has changed over time. Our culture worships the thin physique and is quick to condemn failure to conform to it. When our great grandparents applied the "I'll know it when I see it" test, they were less likely than we are to classify someone with a BMI of 25 as overweight. Some people, in their view, were born to be "stocky" or "big-boned;" they weren't overweight, they were at the natural weight.

The Centers for Disease Control and Prevention has a website that discusses BMI, including some of its limitations (http://tiny.cc/…). "It is also important to remember," the CDC says, "that BMI is only one factor related to risk for disease." A densely muscled athlete and a couch potato might have the same BMI but they won't necessarily have the same propensity for heart disease. A high BMI is much more worrisome in a person with high cholesterol and blood pressure.

Maybe it's just a semantic quibble, but isn't it possible the real problem isn't just that that there are other things to look at beside BMI, but that our BMI-based definition of overweight is set too low? I remember once being told by someone who worked in the health field that an ideal BMI is 16.

Having once hit that mark, I can report that at a 16 BMI I looked sunken-cheeked and friends asked if I was OK. I'm currently at 24 and not feeling at all on the verge of being overweight, thank you.

Of course, I'm not about to go out and start gorging on cheeseburgers.

Urban Lehner can be reached at urbanity@hotmail.com

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