Eight months ago, while traveling on business, I went to see a doctor for a minor issue. After taking care of it, she scanned my chart. "Have you considered going on a diet?" she asked. "Your weight puts you at a higher risk of heart disease and diabetes." Ouch!
Blushing, I promised to follow up with my doc at home and hightailed it to my hotel, where I spent the rest of the day pacing between the full-length mirror and the jumbo bag of cashews in my purse.
It's not that I hadn't considered losing weight. I was sure I was too fat when I went to college at 113 pounds, and in my mid-30s when I weighed 140. What's different is that now, at 158, I'm clinically overweight. Experts define it as having a body mass index (BMI) between 25 and 29.9, and at 5-foot-4, mine is 27 — not even borderline.
On the brighter side, I live a healthier life than the average Jane. I exercise almost every day — walks, weights, yoga. My diet is packed with fruit, vegetables, and whole grains — albeit in larger portions than a dietitian might advise. I traded the high stress of New York City for rural Maine, where rush hour involves dogs, family, and wild turkeys outside my window. I knit. I garden. Heck, I even meditate.
Doesn't any of this count? Or is that darned scale the only thing anyone cares about?
Beyond the BMI
Turns out, I'm not the only one asking these questions. In fact, in light of several new studies, experts are divided on the danger posed by excess weight, especially if the person is, like me, generally healthy and fit. Much of the research linking excess weight and an increased risk of diabetes, heart disease, and cancer, among other chronic diseases (the list goes on and on), has been done on people who are obese, with a BMI of 30 or more. When the merely overweight folks are separated out, the health risks drop and sometimes even disappear.
"Being overweight may not be associated with any risk of heart disease," says Robert Eckel, MD, a professor of medicine at the University of Colorado and past president of the American Heart Association.
Recently, researchers from the CDC and the National Cancer Institute (NCI) caused waves in the medical community with a report analyzing the death records of 37,000 adults. Although obese folks had a greater risk of dying from cancer or heart disease, those who were simply overweight had, surprisingly, no greater risk than normal-weight people. Even more amazing, the findings suggested that being overweight may actually protect against death from a multitude of diseases other than cancer and heart disease. The research made headlines ("Is That Spare Tire a Lifesaver?"). Critics quickly responded that the study failed to consider quality-of-life issues caused by excess pounds and didn't appropriately control for unhealthy habits like smoking, which can keep people lean but undeniably raise cancer risk. Still, it added fuel to the ongoing debate of whether losing weight is absolutely necessary to reduce disease risk if you're not obese.
However, no one's debating that weight loss can be one part of an overall disease prevention plan. But is it the most essential first step? That depends on how many other disease risk factors you have, says Eckel. Among them:
Age: Anyone 45 or older is at a higher risk of diabetes, and a woman's risk of heart disease begins to rise at 55. Cancer risk also increases with age. (Talk about a midlife crisis.)
Family history: I always assumed that because many in my family had died from heart disease, I was in trouble. But it turns out that what really matters is early heart disease — for men that means a heart attack before age 55 and for women, age 65. Even then, only first-degree relatives — parents, children, and siblings — are considered red flags. And while it's true that type 2 diabetes rarely occurs in people who aren't overweight or obese, the risk of developing the disease is 5 to 10 times higher if a first-degree relative has it — regardless of your weight.
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As far as the big C is concerned, only about 5 percent to 10 percent of cancers are inherited, and those that are typically occur earlier in life. According to the American Cancer Society (ACS), most cancers are caused by gene mutations brought on by age, lifestyle, and environmental factors, like inactivity, smoking, excessive alcohol consumption, and increased exposure to radiation or carcinogenic chemicals, among others. In fact, researchers from Britain's Million Women Study found that 5 percent of all cancers affecting postmenopausal women in the United Kingdom are associated solely with excess body weight. Indeed, the ACS and the NCI acknowledge that while being overweight and obese are linked to an increased risk of cancer, there is limited evidence that losing pounds will reduce that risk.
Waist measurement: For women, a waistline of 35 inches or larger is a risk factor for heart disease, no matter how much you weigh or how trim your arms and legs are. And a measurement of 31.5 inches or more indicates an elevated risk of some cancers.
Fitness: Walking briskly for 30 minutes, five days a week, is enough to protect you from disease, no dieting required. "Fitness is achievable, and may do more to improve health than simply losing weight," says Steven Blair, PED, a professor of exercise science at the University of South Carolina and a leading expert on the benefits of exercise among the overweight. In fact, a recent study from the university tracked 2,600 people age 60 and older for a 12-year period, and found that fit overweight people outlive unfit normal-weight people. (Score one for me!) However, if you're overweight and it hurts just to walk up and down stairs, weight loss may be called for; obese women are 4 times more likely to develop knee osteoarthritis than normal-weight women.
Cholesterol and inflammation:A total cholesterol level of 200 mg/dL or more, an HDL reading of less than 40 mg/dL, or triglyceride levels above 150 mg all point to trouble. Being overweight tends to increase cholesterol, and losing weight can help lower total and LDL levels, while raising HDL levels, according to the National Heart, Lung, and Blood Institute. (So can increasing your daily activity if you're sedentary.)
Many experts feel that your rate of systemic inflammation, as defined by the results of a C-reactive protein (CRP) test, is an even stronger indicator of heart disease risk. Being overweight raises your risk of inflammation.
Weighing my options
When I returned home, I did indeed follow up with my doctor. We discussed all of this — my high BMI, cholesterol, low blood pressure, fitness level, and CRP score — and then he calculated my Framingham Risk Score, a measure widely used to assess a 10-year risk of heart attacks. (You can take an online version of this test at prevention.com/links.) Thanks to no smoking, my family history, a good diet, and an active lifestyle, my risk level came up as "very low" at 1 percent. Together, we decided that I could stay, er, voluptuous and still expect to live a reasonably long and healthy life.
I should have felt vindicated, but instead I felt like a quitter. Truth was, I hated that my knees hurt after a walk and that I dreaded bathing suit season. And so I decided to slim down anyway but resolved to go about it as sensibly as I knew how, to follow the most proven weight loss principles available.
First, I dropped my fantasy goal of 130 (last seen before getting pregnant with my now college-bound daughter). Instead, I aimed low — 5 percent of my body weight, or 7 to 8 pounds. (Experts advise shooting for no more than 10 percent at a time.) If you're overweight and have numerous risk factors for chronic disease, even a loss this small can offer some protection. Bigger goals — say, fitting into your wedding dress again — may set you up for regain.
I resolved to lose no more than a pound a week, and not to panic if I lost as little as a pound every 10 days. Researchers are adamant that the changes that bring about small losses — walking 15 minutes more a day, or using fat-free milk instead of cream in coffee — are more likely to become lasting ones. I didn't exactly ban foods like butter, cheese, ice cream, and bacon, but I cut back — switching to reduced-fat alternatives and smaller portions. I also intensified my exercise to at least an hour most days, which is what the U.S. Dietary Guidelines recommend for weight loss. I woke up earlier, dug out my heart-rate monitor, and added jogging intervals to my walking routine. On weekends, I didn't do yoga or go on a hike; I did both.
Is weight loss worth it?
I'm proud to say I lost 7 pounds in 4 months, and I'm fitter and stronger. My back and knees feel better; my cholesterol is a bit lower. Maintenance, though, is a daily struggle, and as the scale number rises and falls, so does my mood. I recalculated my Framingham Risk Score with my new weight — still the same 1 percent risk. Just for fun, I keyed in my dream weight of 130. Maddeningly, no change.
Still, I realized something. Even if it wasn't about my heart health or my "relative risk of mortality," it simply feels good to weigh less. I'm happy I can walk my dogs without pain, slide into my jeans without struggle, and buy a one-piece without cringing. If that's not quality of life, what is?
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