Annotated Bibliography
Are overweight people really more unhealthy than underweight people? More specifically, are people classed as overweight but not obese at greater risk for negative health outcomes than those classed as underweight but not severely underweight?
Anna Jankowski
COMHE 306
Dr. Lynn Roberts
Bluher, M. MECHANISMS IN ENDOCRINOLOGY: Are metabolically healthy obese individuals really healthy? European Journal of Endocrinology. 2014;171(6). doi:10.1530/eje-14-0540.
Blüher examines recent hype around the concept of “metabolically healthy obesity” (MHO) yet acknowledges that there is a need for a clear definition of MHO as there are currently manu. MHO is typically defined as “the absence of any metabolic disorder such as type 2 diabetes, dyslipidemia, and hypertension in an obese individual.” Insulin sensitivity is also often taken into account when determining MHO. Individuals with MHO are not at increased risk of acute myocardial infarction compared with their metabolically healthy normal-weight counterparts, thus showing that their weight does not seem to pose a major risk to their health. Furthermore, individuals with MHO may not improve their health by lifestyle changes, pharmacological, or bariatric surgery-induced weight loss as standard recommendations for obese individuals are not effective for MHO individuals. Blüher suggests that MHO may sometimes be transient or even is transient by nature, citing a case in which a metabolically unhealthy obese patient underwent bypass surgery and within 6 months of the surgery he was classified as MHO. While the underlying cause(s) of MHO are unknown, high physical activity in obese children is one of the strongest predictors of MHO later in life. Yet physical activity alone is not enough to explain MHO. Insulin sensitivity also does not explain reduced cardiovascular risk despite often being used as a criterion of defining MHO. The review concludes by calling for a more standardized definition of MHO.
Bostrom, G, Diderichsen, F. Socioeconomic differentials in misclassification of height, weight and body mass index based on questionnaire data. International Journal of Epidemiology. 1997;26(4):860–866. doi:10.1093/ije/26.4.860.
This study was a questionnaire about SES and all aspects of health, but particularly related to height, weight and BMI of Swedish people. It reaffirmed that people of low SES tend to be shorter than people of high SES. It highlighted some of the weaknesses of self-reporting data. BMI was underestimated by the obese, women, male non-manual workers, and female manual workers. On the contrary, male manual works as well as short, elderly men tended to overestimate their height. Height differences across SES could be related to a lack of nutrition during childhood or adolescence. Short people are also more likely to be categorized as overweight or obese because of BMI’s dependence on height.
Burke, MA, Heiland, FW, Nadler, CM. From “Overweight” to “About Right”: Evidence of a Generational Shift in Body Weight Norms. doi:doi: 10.1038/oby.2009.369.
This study surveyed people’s self-reported weight classification. Participants were asked to identify whether they were “underweight,” “about right,” and “overweight.” There was a large decline in the likelihood of classifying oneself as “overweight.” The researchers acknowledged that using the term “about right” “implies a normative judgment,” meaning that people may feel compelled to classify themselves as “about right.” Even if someone knows they are overweight, they also may not feel that there is anything wrong with their weight, therefore not classifying themselves as “overweight.” This seems sort of like a confusing and misleading question. While the title implied that more and more people are accepting themselves as being overweight, its also worth noting that many underweight people classified themselves as “about right,” but the researchers did not write about this trend in depth or create an alarming title.
Cespedes, ML, Vicente-Herrero, T, Yanez, A, Tomas-Salva, M, Aguilo, A. Body Adiposity Index and Cardiovascular Health Risk Factors in Caucasians: A Comparison with the Body Mass Index and Others. doi:10.1371/journal.pone.0063999.
This article discusses BMI, BAI, and other methods of measuring body fat. It notes that BMI is flawed because it can lead to misclassifying an individual with higher muscle mass as overweight or obese. BAI is based on hip circumference and height, but can be even less useful than BMI. The study weighed and measured 65,200 Spanish adult workers and found significant differences between genders, with men having higher height, weight, and waist and hip circumferences. The study found that while BAI can be useful, like BMI, it also has its limitations. Body fat distribution is actually a better indicator of cardiovascular risk than categories like “obese,” “overweight,” etc. because different kinds of fat are more harmful than others. Body fat distribution takes into account more than an arbitrary number like weight, which can be fat, muscle, or a combination of both. Additionally, BAI was less associated with cardiovascular risk factors than BMI.
Chang, H-W, Li, Y-H, Hsieh, C-H, Liu, P-Y, Lin, G-M. Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis. Cardiovasc Diagn Ther Cardiovascular Diagnosis and Therapy. 2016;6(2):109–119. doi:10.21037/cdt.2015.12.06.
This article discusses the obesity paradox, which states that increased BMI improves survival among patients with cardio-vascular diseases (stroke, coronary heart disease, and renal failure). It analyzed multiple studies done on ethnically diverse populations and different genders. When compared to the normal weight group, the underweight group had higher risk of all-cause mortality, while the overweight and mildly obese were associated with lower all-cause mortality. When broken down by sex, only in males was overweight associated with lower all-cause mortality. Mild and morbid obesity was not associated with all-cause mortality in either men or women. These studies found that overweight and mild obesity may act as a protective factor, while underweight diabetic patients had the highest all-cause mortality.
Gao, S, Juhaeri, J, Reshef, S, Dai, W. Association between body mass index and suicide, and suicide attempt among british adults: The health improvement network database. Obesity. 2013;21(3). doi:10.1002/oby.20143.
This article examines links between suicide and several health categories, including BMI. The researchers limited their area of research surrounding suicide to suicide attempts and deaths resulting from suicide (as opposed to other suicidal behaviors such as thoughts, making plans, etc.). Patients with depression were more likely to engage in suicidal behaviors. The incidence rate of suicide was significantly higher in men than in women, yet the incidence rate of suicide attempt was higher in women. Both varied between age groups. Furthermore, the incidence rate of suicide tended to decrease with BMI, but the researchers noted that this was not statistically significant. This implies that suicide and BMI do not correlate, even though there is some association.
Goday, A, Calvo, E, Vazquez, LA, et al. Prevalence and clinical characteristics of metabolically healthy obese individuals and other obese/non-obese metabolic phenotypes in a working population: results from the Icaria study. BioMed Central. 2016;16(248). doi:10.1186/s12889-016-2921-4.
This cross-sectional study focused on working adults in Spain and examined metabolically healthy overweight and obesity as well as metabolically unhealthy overweight and obesity. The factors associated with MUHO were “BMI, age, presence of hypercholesterolemia, male sex, being a smoker or heavy drinker, and undertaking no physical exercise” while factors associated with individuals with MHO were “younger and more likely to be female or participate in physical exercise; they were also less likely to smoke or to be a heavy drinker.” The authors also acknowledged that there are limits on the data of the determinants of MHO. Within this study, 87.1% of overweight and 55.5% of obese people were metabolically healthy. As this is a large portion of people, it is imperative to keep these MH people at that stage with interventions so that they do not transition to becoming MUH.
Kaluski, DN, Keinan-Boker, L, Stern, F, et al. BMI May Overestimate the Prevalence of Obesity Among Women of Lower Socioeconomic Status*. Obesity. 2007;15(7):1808–1815. doi:10.1038/oby.2007.215.
This article examines the associations between low SES and high BMI in developed countries, using Israel as its example. It points out discrimination of overweight and obese people in the workforce. Low SES women are typically shorter than their low SES male and high SES female counterparts, therefore causing their BMI to appear higher because BMI measurements are so dependent on height. Interviewers did in-depth home interviews with questionnaires and performed anthropometric measurements with each participant. They found that “obesity was significantly and independently associated with SES among women only.” The study also acknowledges the inherent limitations of the BMI measurement because the taller someone is, the less likely they will be classified as obese when using the BMI measurement, meaning that men are less likely to have an obese BMI. The researchers recommend taking the growth curve into account when measuring BMI to get a more accurate measurement of their body makeup and to less adversely affect short women of low SES.
Kolata, G. After 'The Biggest Loser,' Their Bodies Fought to Regain Weight. The New York Times. http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html?smid=fb-nytimes&smtyp=cur&_r=0. Published May 2, 2016. Accessed May 2, 2016.
This article is a news article centered around the popular television program “The Biggest Loser” and how many successful contestants end up gaining back all of the weight they lost for the duration of the show. This article was incredibly frustrating to read because it describes how these contestants exercised for seven hours a day, were exhausted and hungry all in the name of achieving a thinner body. Of course, this is an unsustainable practice as no one can (or should) exercise for seven hours a day and restrict calories to the point that they cannot move for two weeks, as was the case with one contestant. On top of these metabolically damaging practices, the article discusses how when these contestants lose large amounts of weight in such short periods of time (over one hundred pounds in seven months), their metabolisms slow down, meaning that they have to restrict their calorie intake even further just to maintain their weight. One contestant described how his friends would have a beer and be fine, but if he had a beer, he would gain twenty pounds. This is clearly a function of a damaged metabolism, which the article emphasizes at the end. While this is difficult for the contestants to live with, it does give them some peace as they feel less like failures.
Kuebler, M, Yom-Tov, E, Pelleg, D, Puhl, RM, Muennig, P. When Overweight Is the Normal Weight: An Examination of Obesity Using a Social Media Internet Database. PLoS ONE. 2013;8(9). doi:10.1371/journal.pone.0073479.
This study was conducted on Yahoo Answers and looked for correlations between users who fit into different BMI categories, the county they live in, and occurrence of bullying. The article notes the significance of weight discrimination against overweight and obese people and that this phenomenon is on par with racial discrimination. 68% of men who asked questions about being “fat” or “obese” were overweight or obese according to CDC guidelines, whereas only 40% of women asking this question were actually overweight or obese. Overweight women posted the most health-related questions of anyone while men did not post about health much at all. Yet, men who were overweight or obese posted more questions related to diabetes than any other group studied. Obese men were also the most likely to ask questions related to bullying but as the mean BMI for a county increased, questions related to bullying decreased, in keeping with the researchers’ hypothesis. This suggests that an individual’s location and the BMI of people around them changes that individual’s experience of bullying.
Lee, K. Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans: characteristics and health behaviors. Asia Pacific Journal of Clinical Nutrition. 2009;18(2):280–284.
This article explores cultural, ethnic, and racial variations in metabolically healthy obese by comparing results in a Korean cohort to an American cohort. The terminology used in this study is slightly different from others; instead of “metabolically unhealthy normal weight,” this paper uses the term “metabolically obese but normal weight.” People in the Korean cohort had almost twice the rates of MONW than in the United States. While this suggests that there are cultural and ethnic differences in regards to MH status, many other factors contributed to poor MH status. Lack of education, smoking, and consuming more than two drinks of alcohol per day also contribute to MONW status. The researchers recommended that interventions targeted this group of MONW as the prevalence was so high.
Lv, S, Zhang, A, Di, W, et al. Assessment of Fat distribution and Bone quality with Trabecular Bone Score (TBS) in Healthy Chinese Men. Sci Rep Scientific Reports. 2016;6:24935. doi:10.1038/srep24935
The authors of this article set out to clarify whether fat is actually beneficial or detrimental to bones using multiple screening methods. They note that: “fat has been proposed to exert a harmful role in the development of osteoporosis . . . on the contrary, excess fat increases mechanical loading on the bone and links to higher bone mineral density (BMD, g/cm2). Therefore, the exact relationship between fat and bones is still unknown.” The authors use the Trabecular Bone Score (TBS) and Bone Mineral Density (BMD) measurements to determine bone strength, citing that BMD alone is inaccurate because it does not take “bone quality” into consideration. Their goal was to see how different types of fat effects bones and how the TBS measurement compared to BMD. They tested 228 healthy Chinese men between 39-89. These men were then classified into “normal,” “overweight,” and “obese.” While lumbar spine BMD increased with higher BMI. but there were no statistical findings or correlations between BMI and TBS. In fact, there was a very string correlation between whole body fat mass and lumbar spine BMD. Yet, whole body fat correlated negatively with TBS, meaning that people with more body fat were more susceptible to fracture risk as TBS measures bone quality and BMD measures bone quantity.
Samouda, H, Beaufort, CD, Stranges, S, et al. Adding anthropometric measures of regional adiposity to BMI improves prediction of cardiometabolic, inflammatory and adipokines profiles in youths: a cross-sectional study. BMC Pediatrics BMC Pediatr. 2015;15(1). doi:10.1186/s12887-015-0486-5.
This article discusses the debate surrounding different measurements of body fat; BMI, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and waist circumference (WC). There is no consensus in the scientific community about which of these measurements is the best or the worst for measuring body fat. Body fat distribution is a significant predictor of cardiovascular disease when it is measured by anthropometry. BMI is most commonly used in pediatrics, but this study found that combining BMI with even one anthropometric measure (WHR, WHtr, or WC) improves the prediction of health outcomes in children. This is in keeping with previous research by numerous physicians cited earlier in the study. Using a measurement in addition to BMI may be helpful in creating interventions for overweight and obese individuals.
Tatsumi, Y, Higashiyama, A, Kubota, Y, et al. Underweight Young Women Without Later Weight Gain Are at High Risk for Osteopenia After Midlife: The KOBE Study. Journal of Epidemiology. 2016. doi:doi:10.2188/jea.JE20150267.
This study surveyed healthy Japanese women between the ages of 40-74 about their health and weight at age 20 and present. The study found that women who were underweight at age 20 and never became a normal weight or overweight were at a significantly higher risk for osteopenia. Women who were underweight but gained weight later in life were less likely to develop osteopenia. Similarly, women who were normal weight or overweight at age 20 and remained in the same classification were also at a lower risk for osteopenia. The women who remained underweight had lower BMD which made them more susceptible to fractures. The researchers also hypothesized that it is likely that some of the underweight women suffered from anorexia nervosa in their younger years and never fully recovered.
Zadarko, E, Barabasz, Z, Nizioł-Babiarz, E, et al. Leisure time physical activity of young women from the Carpathian Euroregion in relation to the Body Mass Index. Annals of Agricultural and Environmental Medicine. 21(3). doi:10.5604/12321966.1120614.
This study looks at the effects of physical activity on BMI and metabolic health on girls in Carpathian Europe (Poland, Slovakia, Hungary, Romania, and Ukraine). BMI was lower for the girls living in towns and cities than for girls living in rural areas. Similarly, physical activity was higher for girls in towns and cities than for girls living in rural areas. More than one third of participants did not meet the minimum required amount for leisure time physical activity, yet only 10% of participants were classified as overweight or obese. Being underweight was a concern to every Polish girl between the ages of 15 and 19, which could explain why one third of girls in the study did not exercise enough.
Commentary:
I found this research fascinating and very eye-opening. I set out to find out whether overweight people are more unhealthy than underweight people. Living in a society that is bombarded with fad diets and that worships a slender physique seemingly at all costs has ingrained into me and my peers that skinny is always better than fat, and that if someone is overweight or obese, it is their fault and that they should change their phenotype by any means necessary. But with the body positivity and fat acceptance movements on the rise, the views have begun to shift ever so slightly. Tess Holliday, the size 22 supermodel is an outspoken proponent of body positivity, insisting that she does not need to lose weight because she is perfectly healthy the way she is. Then there were viral videos of plus-size yoga teachers doing head-stands and other incredibly advanced yoga poses, which also forced people to re-think what healthy can look like. The air of doubt still lingers, though. Can Tess, or anyone, truly be healthy when she has so much body fat? If she, or anyone like her, works out four times a week, shouldn’t she be losing weight? Is it always better to be thin?
The answer is complicated and not definitive as there is much more to health than simply body mass index (BMI) or risk of cardiovascular disease. The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” A number on a scale does not take into account a person’s mental health or the presence of chronic pain, therefore only looking at an individual as overweight, underweight, obese, normal, etc. does not take into account all of their health anyway. After reading so many studies and articles surrounding BMI, it became clear to me that how we classify people’s bodies is inherently flawed.
Perhaps the most interesting phenomenon I came across was “metabolically healthy obesity” (MHO). MHO does not have one definition, but is generally thought of as the absence of any metabolic disorder including hypertension, type 2 diabetes, and dyslipidemia in obese people. Insulin sensitivity/resistance is often taken into account as well. To put it into perspective, these MHO individuals have the same risk of a heart attack as metabolically healthy normal weight (MHNW) individuals. Their obesity acts as a protective factor, which is in keeping with the theory of the “obesity paradox”: the observation that obese individuals are more likely to survive cardiovascular disease than underweight individuals. Interestingly, the typical recommendations for metabolically unhealthy obese individuals (MUHO) to lose weight are not effective when applied to MHO individuals (e.g., bariatric surgery, lifestyle changes, prescription medication).
Some studies estimate that as many as 87.1% of the overweight population and 55.5% of the obese population is metabolically healthy. The exact reasons why are unknown, especially because there is not one standard definition of MHO. Typically, people with MHO are younger, exercise, do not smoke, and are not heavy drinkers. It is not necessarily surprising that people who have these healthy behaviors do not have the same incidence rate of disease. The fact that MHO and MHNW have the same risk for a heart attack suggests that excess body fat in of itself may not be intrinsically unhealthy. Another study cited MHO individuals as consuming high fat and low carbohydrate diets, which explains why they remain obese but still seems bizarre since carbohydrates give the human body energy to exercise.
Many studies mentioned the possibility of MHO as transient, meaning that MHO will either become MUHO or MHNW. One study cited a patient who underwent bypass surgery and within six weeks, he could be categorized as MHO. Therefore, researchers are primarily recommending a standard definition of MHO in order to find ways to keep people who are MHO from progressing to MUHO.
Since health is “not merely the absence of disease” which MHO focuses on, I researched other areas related to health and weight. Findings on bone quality related to BMI are mixed. One study noted that taking bone mass density (BMD) does not account for the structural quality of the bones the way trabecular bone score (TBS) does. When they conducted their research, they look the BMD and TBS of 228 healthy Chinese men and found that TBS decreased with BMI except for lumbar spine TBS, which was stronger the higher the BMI. BMD increased with BMI, but as they mentioned before, this does not take into account the bone quality. They found that people with higher BMI were at a greater risk for fracture. The researchers did not seem to know why lumbar spine TBS improved with BMI while TBS for all other bones was lower.
Another study concerning osteopenia in Japanese women found that women who were underweight at age 20 and did not become either normal weight or overweight by their midlife had much higher risk of developing osteopenia and were more susceptible to fractures. It is clear that weight and BMI can have different effects on bones and that more research needs to be done to better understand how weight and BMI effect bones. It is also possible that gender and cultural differences confounded the the seemingly opposite findings of these studies.
A study conducted in Korea concerning MHO also highlighted cultural, racial, and ethnic differences. This study used the term “metabolically obese but normal weight” (MONW) as opposed to “metabolically unhealthy normal weight.” It found that incidence of MONW were almost double that of the United States, so while Korea may have higher obesity, it may not necessarily have better health outcomes. Lack of education, smoking, and heavy drinking were major contributors to MONW. This suggests that MHO and its presentation can vary between cultures, races, and ethnicities.
When examining mental health and weight, Gao. et al had no statistically significant findings regarding BMI and suicide. Not surprisingly, depression was the main association with suicide. Another study used data from Yahoo Answers and analyzed information from users who posted asking whether their height and weight made them fat or skinny. The researchers calculated their BMI and then observed what other health related questions these users posted. Obese men were most likely to post about bullying and diabetes, while obese and overweight women posted about a range of health questions. The researchers also noticed that questions about bullying decreased when users lived in counties with higher BMI, which is beneficial to these users’ mental health.
There were times when this research became incredibly frustrating. A recent article in the New York Times titled “After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight.” The article summarized a study that followed the contestants on Season 8 of “The Biggest Loser” for six years. Most of the contestants had gained all of their weight back and some gained even more. The underlying cause was damage to their resting metabolisms, which actually burned more calories when they were obese because their metabolisms suited their sizes. But when they dropped over one hundred pounds – sometimes over two hundred pounds – in a seven month period, their resting metabolisms “slowed radically and their bodies were not burning enough calories to maintain their thinner sizes.” Now, if these contestants eat the average amount of calories for a person their size, the excess calories turn to fat. One contestant exercised for seven hours a day and barely ate anything. His body was so depleted that he barely moved for two weeks following his national tour. All of this extreme weight loss was in the name of improving health but also because our idea of what health looks like is thin and toned. Now they are obese again, ravenous, and have a lot of damage to their metabolisms. These contestants became thin and toned in a very short time frame because of a fixed idea of “health” and are arguably worse off for it.
The limitations of BMI were mentioned in many articles. One study proposed using the body adiposity index (BAI) instead of BMI and found that both had different limitations. Another study recommended using BMI with either waist circumference, waist to hip ratio, or waist to height ratio for more accurate results.
Furthermore, use of BMI may negatively impact women of low SES. Low SES people generally are shorter than high SES people, and women are generally shorter than men. Therefore, women of low SES are likely to be classified as obese because BMI relies to heavily on height. A study conducted in Israel showed that “obesity was significantly and independently associated with SES among women only.” Because people of low SES are more likely to be short, the BMI system adversely effects low SES short women. The researchers recommended that physicians consult patient growth charts in order to be able to diagnose the patient more comprehensively.
A questionnaire about SES and BMI in Sweden reinforced that people of low SES were more likely to be classified as obese. This study was completely self-reported, unlike the one in Israel in which in-home interviews were conducted by professionals. Men in this study often over-estimated their height. Obese people, women, male non-manual workers, and female manual workers were more likely to underestimate their BMI.
While their is much emphasis on being overweight or obese in the United States, a study conducted in the Carpathian Euroregion (Poland, Slovakia, Hungary, Romania, and Ukraine) showed that one third of young women they studied did not meet the minimum exercise requirements yet only 10% could be classified as overweight or obese. One of the reasons for this could be that every single Polish girl between the ages of 15 and 19 expressed concern about being underweight. They may have feared becoming underweight from exercising. This is a stark contrast to the United States where other research suggests that more overweight people view themselves as having “about right” weight. However, this study did not take into account that a person who has a lot of muscle could easily be classified as having an overweight BMI because it only takes into account height and weight. While this study emphasized the trend in overweight people classifying themselves as “about right,” it did not show the same alarm for the many underweight people who classified themselves as such. Furthermore, the use of the term “about right” instead of “normal weight” could be confusing, especially with the rise of the body positivity and fat acceptance movements.
Overall, this research forced me to re-evaluate many pre-conceived notions about weight and BMI. My original research question had excluded the extremes of obesity and the severely underweight (for which, unlike overweight and obese, there is no separate category for on the BMI scale or in widespread use that I came across) because I had assumed that obese people must have been the most unhealthy regardless of their lifestyle, genetic makeup, etc. While I had wanted to support people like Tess Holliday and the plus size yoga teachers, a large part of me was convinced that there was no way that they could actually be healthy.
It became apparent that I could not ignore the obesity question and I am glad to report that I was wrong. Metabolically healthy obesity shows that it is very possible to be overweight or obese and to have a low risk of cardiovascular disease as well as the absence of any metabolic disorder. With one study showing that as many as 87.1% of overweight and 55.5% of obese people are metabolically healthy, it becomes ever more clear that society’s prejudice against people with higher BMI may be prejudice acting as thinly veiled concerns about their health. Discrimination against overweight and obese people has been well-documented and is almost as widespread as racial discrimination.
Perhaps we should not look at the number on the scale with as much scrutiny as we should look at certain weight loss regimens. In the article about “The Biggest Loser” contestants, it is clear to me that they were set up for horrific metabolic damage and unsustainable change by eating too few calories and exercising for too much of the day. The researchers brushed this off as the reality of weight loss; the body will want to get back up to what it was and that this is why two-thirds of Americans can’t lose weight or keep it off. I disagree with this profoundly. Many people are able to lose weight and keep it off by doing it in a more gradual, sustainable way. They do not exhaust their bodies to the point where they cannot move for two weeks so that now they have to consume hundreds of calories fewer than the average person their size; they simply make better choices.
A perfect example of this is a YouTuber who goes by Freelee the Banana Girl. She is a certified nutritionist (not just a random person on YouTube) and lost over forty pounds by eating a high carbohydrate and low fat vegan diet (pioneered by Dr. John McDougal) and riding her bike for about an hour a day. She does not work out to the point of exhaustion and eats until she is satisfied, usually filling up on potatoes, pasta, rice, fruit, and veggies. Freelee has also noted that it took her body years to heal from the metabolic damage she caused by poor diet and smoking in the past.
It is likely that the metabolic damage these contestants caused themselves will not go away anytime soon and that their extreme weight loss regimens in a short time frame are culpable for why they gained so much weight back. What I find so incredibly frustrating is that a person like Freelee is viewed as extreme and “out there” for adopting a vegan diet for sustainable weight loss, yet shows like “The Biggest Loser” normalize unsustainable and exhausting methods of weight loss that wear down the body and do not yield long-term results. I would also be curious to know if any of these contestants were MHO status before the show and what their status is now after re-gaining the weight. If they were MHO and now they are not, it is clear to me that weight loss may not leave people better off. We need to examine exactly why we are pushing weight loss onto obese and overweight people, especially if they are MHO status, because losing as much weight as possible as soon as possible is clearly problematic.
In conclusion, it is almost impossible to say definitively whether one group is healthier than another. The two studies I found regarding bone strength and obesity had conflicting results, with one citing obese people as having a higher fracture risk and the other claiming underweight people are more susceptible to fractures. However, what is obvious is that people who are overweight and obese live in a very different world from normal weight and underweight people regardless of whether or not they have the same exact risk for cardiovascular disease and metabolic health status. The higher an individual’s BMI is in the United States, the more unhealthy they are perceived to be. We need to stop emphasizing how an individual looks and pathologizing the number on the scale or the BMI chart and encourage exercise, smoking cessation and other healthy because they improve health outcomes for all people. Until we all understand overweight and obesity more comprehensively, we should probably keep our health concerns about strangers’ bodies to ourselves.