A study was released last month by the Trust for America’s Health and the Robert Woods Johnson Foundation titled: “F is for Fat 2009”. The essence of the report once again raised the apparent hopelessness of our national “condition” – we are a “supersized” nation. The report ranked the neck in neck race between four states for the distinction of having the highest rate of obesity in the nation. While the competition was intense, the distinction for the fifth year in a row was awarded to Mississippi, (with honorable mentions to Alabama, West Virginia and Tennessee.) From “sea to shining sea” these states are certainly not alone in this national epidemic. We seem to have lost all rational thought when it comes to the food levels we consume and the eroding levels of activity we collectively engage in.
Barely a day goes by that there is not some reminder, some mention of this challenge confronting our population – promising to shorten lives, lower the quality of life and – dramatically increase the cost of healthcare. The facts are clear – excess weight is perhaps the number one “controllable” factor influencing the most costly and debilitating chronic diseases; type II diabetes is presenting at younger ages – this “old persons” disease is now affecting teenagers when they have far more years to live with the disease and therefore suffer some of the most severe implications related to diabetes; cholesterol levels are increasing in children – none of this is news. All of it should scare the life out of us – if not as a threat to the health of those we care about, then certainly to the financial burden it places on all of us. Yet, we continue to get bigger. So what will it take? Obviously, telling people to lose weight is not the silver bullet we hoped it would be. Is it time to change the national dialogue? As our elected officials debate healthcare reform and evaluate various solutions to revamp an industry that represents about 17% of our economy – will changing how we pay for care be enough? Fortunately, much of the discussion also includes some reference to encouraging “personal responsibility”. As we pursue this path, the reality is that the most controllable health risk factors are related to diet and activity. Perhaps a place to start is how we define and measure health from a weight perspective. It is 2009 and our primary tools for baseline measurement of health relative to weight consist of a mirror, the bathroom scale, or that state of the art measurement the Body Mass Index. A bit of trivia on BMI, it was first developed in the 1830’s by a Belgian statistician. While globally adopted by the World Health Organization as the measurement of weight – it fails to take into account that there is any physiological difference between a man and a woman. Unfortunately, in our culture there tends to be two images of “fitness” those we see in ads – the super fit, and those we see in the news – the – “jiggley” images. There seems to be no in between. For the vast majority of people – the in between is where we should be. Not model like, but low risk body composition that reduces the weight related risk factors associated with excess body fat. Perhaps – “it is not about weight – at all”. Perhaps the dialogue should be and the measurement should be body composition vs. absolute weight. Body composition represents the ratio of lean body mass to body fat. The greater the lean mass, the more efficient the human body, the more effectively it processes calories, the lower the health risk factors. Take a 6’ male weighing 188 pounds. BMI rates them as 25.5, or overweight. An actual body composition analysis of this individual measured them at 16.5% body fat, or “fit”. So at one level, we have a problem with measurement. At another, we have a misguided view of what is “healthy”. If we begin to change how we measure and set targets – perhaps we can change the dialogue and actually engage people in proactively and realistically managing their weight – for health.
As we debate the enormity of 17% of our national economy, perhaps we need to change the way we think about, talk about and measure weight and health risk factors. We need to get people to begin focusing on improving their ratio of lean mass to body fat, reducing weight related risk factors and not set themselves up for failure trying to achieve a body type that may be unattainable or even unnatural in our fast paced, fast food, no activity world. Let’s change the national dialogue!
Brian Baum was the co-founder and CEO of the Health Record Network launched by Duke University in 2003, and most recently serves as the President of Stayhealthy.