What Does it Mean to be “Obese?”

The question “What does it mean to be healthy?” is a much more comfortable conversation to have with ourselves if we understand the behaviors and measures that can help us reach our fullest health. Obesity is one aspect of health that is frequently discussed due to its overwhelming prevalence. So, what is obesity and why is it detrimental to our health? If we can better understand what it is measuring and what this tells us about our overall health, we can leave the stigma behind and leverage that knowledge to live a longer and healthier life. After all, knowledge is power, right? Our own Heather Huntsman, Ph.D., CSSC explains below.

According to the World Health Organization (WHO) obesity is defined as “abnormal or excessive fat accumulation that presents a risk to health.”¹ If you are familiar with body mass index (BMI), which is calculated by weight in kilograms divided by the square of height in meters, having a BMI over 30 is classified as obese. While this is a crude measure with many limitations, it is widely used for its simplicity.

A more precise measure of obesity is an accurate screening of the amount of fat one has on their body. This can be done a number of different ways, with a DEXA scan being one of the more respected and valid methods. The obese classifications for measured body fat percentage vary by sex and age, but in general, a reading of 27% body fat for men and 32% body fat for women is considered obese. A BMI measurement and a DEXA scan are different in accuracy, much like having your friend assessing the health of your heart by checking your pulse with a stopwatch versus going to a doctor to get an EKG test.

After tackling the first part of the definition with regard to excess fat accumulation, what about the second part? Does excessive fat present a risk to your health? The answer to this question is emphatically, “yes.” Obesity contributes to a greater risk for many different diseases including^2,3, but not limited to:

• High blood pressure
• High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides
• Type 2 diabetes
• Coronary artery disease
• Stroke
• Gallbladder disease
• Osteoarthritis
• Sleep apnea and breathing problems
• Many types of cancer
• Mental illness such as clinical depression, anxiety, and other mental disorders
• Body pain and difficulty with physical functioning

Yes, it’s quite a list. How can having too much fat increase the risk for so many different diseases and conditions? There are many hypotheses, but the simple answer is likely inflammation. Although fat used to be considered a stagnant tissue of stored energy, it’s actually a very dynamic endocrine-like tissue.⁴ This means fat produces its own hormones and other signaling molecules that interact and communicate with the brain, immune system and other organs throughout the body. When the body is in balance, appetite, metabolism, and other important bodily functions are regulated. The problem begins when the body becomes out of balance due to too much body fat. Too much body fat leads to chronic inflammation and suboptimal performance of many organs like the heart and immune system.⁵ What makes that fact even scarier is with the data that we have right now, obesity is the second most common underlying condition that leads to poor health outcomes in COVID-19 patients.⁶

Now that we have knowledge, what about power? While no one wants to hear they are in an unhealthy category, especially when it comes with the label of “obese,” it can be a good reminder that body fat percentage is a measure like any other piece of health information you receive from your doctor. It’s similar to learning about high blood pressure, high cholesterol, thyroid levels, or white blood cells counts. These are all examples of health information that you and your doctor use to inform steps towards a healthier lifestyle or treatment regimen. What makes body fat information more difficult is the stigma around a label of “obese,” rather than purely a measurement of high body fat percentage. Just remember, you are not defined by being “obese.” This measurement is strictly a gauge of health and an opportunity to take information to become healthier and lower your risk for chronic disease.

References:

1. World Health Organization. https://www.who.int/topics/obesity/en/
2. The Health Effects of Overweight and Obesity. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/effects/index.html
3. Adult Obesity Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html
4. Upadhyay J et al. (2018) Obesity as a Disease. Medical Clinics of North America. 102(1): 13-33. doi: 1016/j.mcna.2017.08.004.
5. Apovian CM (2016) Obesity: Definition, Comorbidities, Causes, and Burden. The American Journal of Managed Care. 22(7 Suppl): S176-S185. PMID: 27356115.
6. Garg S et al. (2020) Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 – COVID-NET, 14 States, March 1-30, 2020. Morbidity and Mortality Weekly Report. 69:458–464. doi: 10.15585/mmwr.mm6915e3.