kyrasdad
Sat, May-05-07, 07:23
How Does Your Waistline Matter? Let Us Count the Ways. (http://www.nytimes.com/2007/05/01/health/01obesity.html)
May 1, 2007
By GINA KOLATA
AT age 39, with diabetes and high blood pressure in her family, Linda M. was starting to worry about her weight and its health consequences. She was 5 feet 6 inches tall and weighed 170 pounds, which placed her in the overweight category, according to the standard definition. Although she was not officially obese, she said, “I realized I was not at my ideal weight.”
But Linda was in for a surprise during an appointment last fall with Dr. Judith Korner, an obesity specialist at Columbia University. Instead of weighing her, Dr. Korner whipped out a tape measure and measured her waist.
It was 35 inches, putting her in a danger zone, Dr. Korner explained. An overweight woman with a waist 35 inches or larger, or an overweight man with at least a 40-inch waist, is at increased risk for diabetes and heart disease.
“That was an education,” said Linda M., who did not want her last name revealed because of her weight. “I did not realize that my waist determined my future risk.”
Obesity specialists differ on what measurements are best.
Linda’s body mass index, or B.M.I., for example, was 27.4, far from the obesity category, which starts at 30. She would have to weigh 185 pounds to have a B.M.I. that high. (For comparison, a man who is six feet tall and weighs 221 pounds is considered obese.)
If a doctor were to use B.M.I. exclusively to evaluate Linda, the conclusion would be that her weight was not a serious health risk. She had only one risk factor for heart disease — a high level of triglycerides — and the guidelines for B.M.I. say that overweight people need two factors, like high triglycerides and a high cholesterol or blood pressure levels, to be considered at serious risk.
B.M.I. has limitations. Muscular men might have high B.M.I.’s, which make them seem fatter than they are. Old people often have deceptively low B.M.I.’s because they have lost so much muscle in the aging process.
In Linda M.’s case, adding her waist measurement to her B.M.I. indicates a high health risk, according to guidelines published by the National Heart, Lung and Blood Institute. For Dr. Korner, the test is useful in assessing if people like Linda M. — overweight but in a gray zone — face a true health risk? If her waist had been less than 35 inches, Dr. Korner would have been less concerned.
Dr. Ned Calonge, chairman of the United States Preventive Services Task Force, said the panel preferred B.M.I. measurements to determine whether people are fat enough to place their health at risk. For most adults, he explained, B.M.I. “is more feasible or has better validity than other measures.”
But, Dr. Calonge added, it is not enough to simply diagnose someone as obese. The goal should be better health.
And the problem with testing for obesity, using B.M.I. or anything else, is that the sort of counseling most patients get from their doctors has not been shown to improve health, Dr. Calonge said.
“You now have a, quote, diagnosis,” Dr. Calonge said. And there is at least fair evidence from research that intense and expensive counseling about diet and exercise can help people lose weight and improve conditions that place them at risk for heart disease. But, he added, “it is uncertain whether less intense interventions have any impact at all.”
For Madelyn Fernstrom, the director of the Health System Weight Management Center at the University of Pittsburgh Medical Center, the goal of a medical exam is not to document how fat someone is but to rule out rare metabolic conditions that might be causing the weight problem. An exam also helps to determine whether there are associated medical conditions that should be treated, like diabetes or high cholesterol or blood pressure.
As for Linda M., waist measurement made the difference.
“After that, I got myself in gear,” she said. “I tried to eat less sugar and healthier snacks; I was more conscious of what I was selecting.”
She lost 20 pounds and a couple of inches from her waist. Her triglycerides are lower, yet still a bit high. But, she says, as she sees it, with a smaller waist, “I’m out of the danger zone.”
May 1, 2007
By GINA KOLATA
AT age 39, with diabetes and high blood pressure in her family, Linda M. was starting to worry about her weight and its health consequences. She was 5 feet 6 inches tall and weighed 170 pounds, which placed her in the overweight category, according to the standard definition. Although she was not officially obese, she said, “I realized I was not at my ideal weight.”
But Linda was in for a surprise during an appointment last fall with Dr. Judith Korner, an obesity specialist at Columbia University. Instead of weighing her, Dr. Korner whipped out a tape measure and measured her waist.
It was 35 inches, putting her in a danger zone, Dr. Korner explained. An overweight woman with a waist 35 inches or larger, or an overweight man with at least a 40-inch waist, is at increased risk for diabetes and heart disease.
“That was an education,” said Linda M., who did not want her last name revealed because of her weight. “I did not realize that my waist determined my future risk.”
Obesity specialists differ on what measurements are best.
Linda’s body mass index, or B.M.I., for example, was 27.4, far from the obesity category, which starts at 30. She would have to weigh 185 pounds to have a B.M.I. that high. (For comparison, a man who is six feet tall and weighs 221 pounds is considered obese.)
If a doctor were to use B.M.I. exclusively to evaluate Linda, the conclusion would be that her weight was not a serious health risk. She had only one risk factor for heart disease — a high level of triglycerides — and the guidelines for B.M.I. say that overweight people need two factors, like high triglycerides and a high cholesterol or blood pressure levels, to be considered at serious risk.
B.M.I. has limitations. Muscular men might have high B.M.I.’s, which make them seem fatter than they are. Old people often have deceptively low B.M.I.’s because they have lost so much muscle in the aging process.
In Linda M.’s case, adding her waist measurement to her B.M.I. indicates a high health risk, according to guidelines published by the National Heart, Lung and Blood Institute. For Dr. Korner, the test is useful in assessing if people like Linda M. — overweight but in a gray zone — face a true health risk? If her waist had been less than 35 inches, Dr. Korner would have been less concerned.
Dr. Ned Calonge, chairman of the United States Preventive Services Task Force, said the panel preferred B.M.I. measurements to determine whether people are fat enough to place their health at risk. For most adults, he explained, B.M.I. “is more feasible or has better validity than other measures.”
But, Dr. Calonge added, it is not enough to simply diagnose someone as obese. The goal should be better health.
And the problem with testing for obesity, using B.M.I. or anything else, is that the sort of counseling most patients get from their doctors has not been shown to improve health, Dr. Calonge said.
“You now have a, quote, diagnosis,” Dr. Calonge said. And there is at least fair evidence from research that intense and expensive counseling about diet and exercise can help people lose weight and improve conditions that place them at risk for heart disease. But, he added, “it is uncertain whether less intense interventions have any impact at all.”
For Madelyn Fernstrom, the director of the Health System Weight Management Center at the University of Pittsburgh Medical Center, the goal of a medical exam is not to document how fat someone is but to rule out rare metabolic conditions that might be causing the weight problem. An exam also helps to determine whether there are associated medical conditions that should be treated, like diabetes or high cholesterol or blood pressure.
As for Linda M., waist measurement made the difference.
“After that, I got myself in gear,” she said. “I tried to eat less sugar and healthier snacks; I was more conscious of what I was selecting.”
She lost 20 pounds and a couple of inches from her waist. Her triglycerides are lower, yet still a bit high. But, she says, as she sees it, with a smaller waist, “I’m out of the danger zone.”