Feature
Carry that weight
by Cordelia Lockett
Are we really in the grip of an “obesity epidemic”? Can that many New Zealanders really be too big? In a society already very confused about body image and neurotic about personal health, maybe it’s time to weigh up the evidence behind these claims.
There seems to be a new one each week. In the last three months alone, we have had a swathe of them reported: shoplifting, methamphetamine addiction, diabetes, meningitis, schizophrenia. Yes, we are in the midst of an epidemic of … epidemics.
The most serious, costly and deadly of these, say health experts, is obesity. We are told that our ballooning weight leads to disease and early death and is costing millions in health spending. Competing headlines make a catastrophe of the situation, as we “declare war” on this “ticking time bomb”. We are force-fed a monotonous mantra: we are fat and getting fatter, and we must lose weight.
But is obesity as serious and prevalent as we are led to believe? It used to be that the words “obesity” and “epidemic” were rarely used, let alone in the same sentence. Epidemics were rare plagues that swept unchecked through lands, causing misery. Surely, there were always fat people; obesity should be something exceptional.
Is terrorising people about their weight helpful? Will bandying about the word “epidemic” just make us give up and dunk another doughnut? The lose-weight message doesn’t apply to everyone (although that doesn’t stop weight-loss organisations advertising how “you can lose 10 percent of your body weight”), so how are normal or underweight people meant to respond?
We are certainly more mixed up than ever about our bodies. Pick up any women’s magazine: “Stars pile on the pounds,” shrieks one, while asking, on the same cover, “Is Nicole too skinny?” Neurotically, our society manages to simultaneously glorify thinness, stigmatise fatness, promote overeating and endorse “quick fix” approaches to weight loss. Tried the “beach panic diet” yet?
Is it any wonder that many young people and adults have stopped listening to their bodies’ natural cues about when and what to eat? That they no longer eat normally and intuitively, but agonise over every eating decision? The two extremes of obesity and chronic dieting may be part of the same problem: a generally troubled relationship with food.
Much of the obesity panic in New Zealand originates from two surveys: the Ministry of Health’s 1997 National Nutrition Survey, comparing the prevalence of overweight and obesity in 1989 and 1997, which concluded that 52 percent of us were overweight or obese; and the just-released 2002 National Children’s Nutrition Survey, which found that 31 percent of five-to-14-year-olds were overweight or obese. Half of all adults? A third of all children? The figures seem hard to believe as you walk down the street. Where are all these people?
The main tool used in these studies (and around the world) for classifying overweight and obesity is the Body Mass Index (BMI). BMI is a simple height-weight ratio calculation (BMI = weight in kilograms divided by height in metres squared, or kg/m2, so if, for example, you are 1.70m and weigh 70kg, your BMI will be 24).
But BMI thresholds haven’t always been constant. Dr Paul Ernsberger, associate professor of medicine at the Case Western Reserve University in Cleveland, Ohio, says that, in 1998 the National Institutes of Health lowered the overweight classification from a BMI of 27 to 25, in response to pressure from the World Health Organisation. A healthy person of 1.75m weighing 78kg would have had a normal weight in 1997, but be overweight in 1998, although their weight remained stable. (See box for more detail.)
Shifting definitions aside, BMI is an extremely crude yardstick for determining weight-based health, according to Dr Michael Gard, senior lecturer in physical education at Charles Sturt University in New South Wales and author of a forthcoming book titled The Obesity Epidemic: science, ideology and morality. “BMI makes no concessions for things like bone density or muscularity. It doesn’t take into account the physiology of a person,” he says. He notes that BMI classifications are unhelpful for children and older people, and are culturally skewed.
Auckland dietitian Jeni Pearce also thinks that too much emphasis has been put on BMI. “BMI tells us nothing about body fat, fat distribution, people’s frame, fitness level, age or gender. We have this idea that if you’re lean, you’re healthy. But it’s much better to be a little overweight and fit than thin and unfit.”
Pearce wonders whether hitting everyone with the same message is the right approach. “We’ve got to remember, if 52 percent of people are overweight or obese, then there are 48 percent who aren’t – who are normal or underweight. We often forget about that.” The “obesity epidemic”, she believes, has been overhyped. “People come to see me who are terrified of getting obese when they’re older – and they’re not even overweight. We need to stop scaremongering and emphasise the positives more.”
There aren't a lot of positives in “Nutrition and the Burden of Disease” – the 238-page report released by the Ministry of Health in August – which analyses current and projected obesity-related diseases. Obesity has been linked to an increased risk of heart disease, stroke, type 2 diabetes, some cancers and other conditions. The report estimates that high BMI accounted for 3154 deaths in 1997 (11 percent of all deaths) and 37,373 years of life lost. What’s more, it says, these figures will grow along with the predicted increased average BMI. And the cost? A 1997 paper reporting six top obesity-related conditions estimated total health care costs of $135 million for one year.
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