Imaginary Weight Problem Sam Island

This illustration is for an opinion piece that ran in the New York Times last year, “Our Absurd Fear of Fat.” This piece comments on a study that showed that the risk of death overall (from any cause) is actually lower in people whose BMIs are over 25 to 30.

We don’t really know exactly what that means. These results don’t come from a study that was designed ahead of time and then carefully controlled. Some issues that could be at play:

— Genetic factors, such as health risks in light people or more favorable genetics among heavier people
— A bit of extra weight might make it easier to recover from illness
— This is just mortality; it may obscuring “morbidity” — lost work days, reduced quality of life, and greater healthcare costs as a result of obesity-related issues
— A fairly high proportion of people with BMIs over 25 may have healthy habits that keep them “metabolically healthy”

The Times piece oversells the idea of weight not mattering much, if at all. The cardiology and diabetes professional literature contains many studies showing that even modest weight losses, generally through some combination of fewer calories and more activity, can improve lab results that indicate risk for serious medical problems. People whose BMIs are solidly over 25 can improve their health in a meaningful way with weight losses of as little as 5-10%. This is sadly out of step with what doctors believe — in a study in the Journal of the American Board of Family medicine, doctors characterized a weight loss of 10% as “disappointing” and around 20% as “acceptable” for the patients to whom they recommended weight loss.

But it still supports the larger picture of weight: that the number on the scale is not a precise measure of health. Our health relies as much — arguably more — on our habits (and sometimes genetics). It is possible to have a body that is running smoothly even if it is large (and not just muscular). This is great news, especially for people who feel daunted by a scale weight that would mean big losses to get down to a BMI of 25. Small changes can make a big difference.

Illustration by Sam Island


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