Emma Lewis has written an excellent article demonstrating the stigmatising and negative effects on health of well-meaning but ultimately insensitive and flawed interventions on the “problem” of overweight and obesity by GPs. Notwithstanding the important issues Emma raises, a significant further problem may well be the common conflation of these two categories.
Emma describes herself as having a lifelong BMI of over 30, thus falling into the “obese” category. Yet, in a rapid response Simon Howard suggests that one of her key messages is not supported by the evidence because many “overweight” people do not recognize their own overweight [1]. Of course, the evidence to support this focuses on a BMI of 25-30 [2], not the obese category of a BMI of 30+. Commonly in the media, everyone with a BMI of over 25 is condemned as “fat”, this despite increasing and converging evidence that the overweight BMI range of 25-30 has a lower all-cause mortality risk than the “normal” category of 18.5-25 [3, 4, 5].
One important “key message”, therefore, should be that many of those often labeled “fat” have a largely low-risk BMI of 25-30, and perhaps do not recognize themselves as “overweight” because the technical BMI definition of overweight bears little resemblance to a common understanding of what “fat” looks like, nor to a statistical elevated all-cause mortality risk. Perhaps, then, next time we read about the problem of overweight and obesity, we should ask of ourselves and others: Who are YOU calling fat?
[1] Howard SJ. One minor factual correction. Rapid response to: Lewis E. Why there’s no point telling me to lose weight. BMJ 2015; 350: g6845 (http://www.bmj.com/content/350/bmj.g6845/rr-35)
[2] Health and Social Care Information Centre (2013) Health Survey for England 2012: Adult anthropometric measures, overweight and obesity
[3] Flegal KM, Kit BK, Orpana H, Graubard BI. (2013). Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis. JAMA 2013; 309(1): 71-82.
[4] McGee DL; Diverse Populations Collaboration. Body Mass Index and Mortality. Ann Epidemiology. 2005; 15(2): 87-97.
[5] Orpana HM, Berthelot JM, Kaplan MS, et al. BMI and Mortality. Obesity; 2010; 18(1): 214-218.
Competing interests:
No competing interests
10 February 2015
Mike Weed
Professor of Applied Policy Sciences and Head of the School of Human & Life Sciences
Canterbury Christ Church University, UK
North Holmes Campus, Canterbury, Kent, CT1 1QU, UK
Rapid Response:
Emma Lewis has written an excellent article demonstrating the stigmatising and negative effects on health of well-meaning but ultimately insensitive and flawed interventions on the “problem” of overweight and obesity by GPs. Notwithstanding the important issues Emma raises, a significant further problem may well be the common conflation of these two categories.
Emma describes herself as having a lifelong BMI of over 30, thus falling into the “obese” category. Yet, in a rapid response Simon Howard suggests that one of her key messages is not supported by the evidence because many “overweight” people do not recognize their own overweight [1]. Of course, the evidence to support this focuses on a BMI of 25-30 [2], not the obese category of a BMI of 30+. Commonly in the media, everyone with a BMI of over 25 is condemned as “fat”, this despite increasing and converging evidence that the overweight BMI range of 25-30 has a lower all-cause mortality risk than the “normal” category of 18.5-25 [3, 4, 5].
One important “key message”, therefore, should be that many of those often labeled “fat” have a largely low-risk BMI of 25-30, and perhaps do not recognize themselves as “overweight” because the technical BMI definition of overweight bears little resemblance to a common understanding of what “fat” looks like, nor to a statistical elevated all-cause mortality risk. Perhaps, then, next time we read about the problem of overweight and obesity, we should ask of ourselves and others: Who are YOU calling fat?
[1] Howard SJ. One minor factual correction. Rapid response to: Lewis E. Why there’s no point telling me to lose weight. BMJ 2015; 350: g6845 (http://www.bmj.com/content/350/bmj.g6845/rr-35)
[2] Health and Social Care Information Centre (2013) Health Survey for England 2012: Adult anthropometric measures, overweight and obesity
[3] Flegal KM, Kit BK, Orpana H, Graubard BI. (2013). Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis. JAMA 2013; 309(1): 71-82.
[4] McGee DL; Diverse Populations Collaboration. Body Mass Index and Mortality. Ann Epidemiology. 2005; 15(2): 87-97.
[5] Orpana HM, Berthelot JM, Kaplan MS, et al. BMI and Mortality. Obesity; 2010; 18(1): 214-218.
Competing interests: No competing interests