Debate about cut offs for obesity should not obscure need for population strategy

Although the health hazards of obesity have been clearly established, exactly where healthy weight ends and unhealthy weight begins is a matter of controversy.1 Numerous studies have evaluated the association between weight and the metabolic abnormalities or diseases that occur in people whose weight is at the higher end of the scale, but comparatively few have examined these associations in people who fall into the lower or middle range of being overweight.

In the January issue of the European Heart Journal, Ashton and colleagues investigated the relation between body mass index (calculated as weight (kg)/(height (m)²) and several established risk factors for coronary heart disease using a cross-sectional survey of 14 077 apparently healthy women aged 30 to 64 years.2 Ashton et al found that as the women's body mass index (BMI) increased from <20 to >30, blood pressure also increased significantly, as did concentrations of total cholesterol, low density lipoprotein (LDL) cholesterol, apolipoprotein B, fasting triglycerides, and fasting blood glucose. Concentrations of high density lipoprotein (HDL) cholesterol and apolipoprotein A I decreased. Using a modified version of the Framingham heart study's algorithm for predicting the risk of coronary heart disease, the investigators showed that the estimated 10 year risk of coronary heart disease also increased significantly in …