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What this series is about As we age, keeping physically active is essential. It not only improves the appearance of the body, it also prevents the occurrence of health complications in the future. Join the discussion in this series as we research the various programs that can help maintain a healthy body. |
Part 3: Staying Young - Nutrition (d)
Classifying body weight
There are two main methods used for monitoring body weight in settings such as population health surveys: body mass index (BMI) and waist circumference. Both provide an acceptable alternative to more accurate measurement of total body fat, which is only feasible for specialised clinical or other settings.
Body mass index
The most common measure of body weight is the BMI, calculated by dividing weight in kilograms by the square of height in metres (kg/m2). Classification of body weight is based primarily on the association between BMI and illness and mortality. The standard recommended by the WHO (WHO 2000) and included in the National health data dictionary for adults aged 18 years or over is:
• underweight (BMI <18.5)
• healthy weight (BMI ≥18.5 and BMI <25)
• overweight (BMI ≥25; includes obese)
• overweight but not obese (BMI ≥25 and BMI <30)
• obese (BMI ≥30).
This classification may not be suitable for all ethnic groups, who may have equivalent levels of risk at lower BMI (for example Asians) or higher BMI (for example Polynesians) compared with the standard. For children and adolescents aged 2–17 years, Cole and others (2000) have developed a separate classification of overweight and obesity based on age and sex.
Waist circumference
For monitoring overweight, waist circumference is a useful addition to BMI because abdominal fat mass can vary greatly within a narrow range of total body fat or BMI. The National health data dictionary defines waist circumference cut-offs for increased and substantially increased risk of ill health. Waist circumferences of 94 cm or more in males and 80 cm or more in females indicate increased risk (referred to here as abdominal overweight). For those aged 18 years or over, waist circumferences of 102 cm or more in males and 88 cm or more in females indicate substantially increased risk (referred to here as abdominal obesity) (NHDC 2003). This classification is not suitable for use in people aged less than 18 years and the cut-off points may not be suitable for all ethnic groups.
BMI is more commonly used than waist circumference as a measure of overweight and obesity in the population (particularly in self-report surveys), as people are more likely to know their height and weight than their waist circumference.
Self-reported versus measured data
Height and weight data may be collected in surveys as measured or self-reported data. People tend to overestimate their height and underestimate their weight, leading to an underestimate of BMI. Thus, rates of overweight and obesity based on self-reported data are likely to be underestimates of the true rates, and should not be directly compared with rates based on measured data (Flood et al. 2000; Niedhammer et al. 2000).
The number of obese Australian adults is estimated to be as high as 3.3 million and the number of overweight but not obese is estimated at around 5.6 million, according to a bulletin released this month by the Australian Institute of Health and Welfare (AIHW).
In addition, the prevalence of obesity rose alarmingly in only 10 years over the 1990s: by 71 per cent for men, and by 80 per cent for women.
[Overweight is usually indicated by a body mass index (BMI) between 26 and 30; obesity is usually indicated by a BMI greater than 30. To calculate your BMI, divide your weight in kilograms by your height in metres squared].
A growing problem: Trends and patterns in overweight and obesity, 1980-2001
The bulletin, A growing problem: Trends and patterns in overweight and obesity 1980 to 2001, draws together data from all relevant national surveys conducted since 1980. It shows that at least 16 per cent of men and 17 per cent of women aged 18 and over were obese, with a further 42 per cent of men and 25 per cent of women being overweight but not obese.
The monetary costs of obesity
Obese individuals also show increased incidence of mental health problems, such as low self-esteem, negative body image self-concept, increased stress levels and poor socialisation ability.
The Australian Institute of Health and Welfare has stated that there is a direct positive relationship between degree of obesity, duration of obesity, and the relative risk of premature death. Estimates indicate that excess weight accounts for around 4.5% of all deaths in Australia. Further, trends show that the risk of premature death almost doubles at body mass indexes between 25 and 32, and at severe obesity levels, as measured by a body mass index of 40 or greater there is a 12 fold risk of mortality in 25-35 year olds compared to lean individuals.
Looking beyond dollars and cents
In addition to the negative financial impact that excess weight carries, there are also impacts on quality of life. People who are severely overweight may have difficulty performing simple daily tasks, such as tying one's shoes or walking up a flight of stairs. Many obese people have trouble sitting in standard furniture or fitting into airplane or movie theater seats.
These problems may seem trivial to some, but they represent serious, multi-layered difficulties that can have a cumulative effect. If your size affects your lung capacity, you may have trouble sleeping, which may affect your performance at work, which may worsen the experience of day-to-day financial strains.
Despite all these challenges, there is reason to hope that people who are very overweight can achieve normal weight. The fact that obesity can be described as a multi-layered disease only reinforces the fact that a multi-layered treatment plan may be needed. It is possible to change a long-standing weight problem.
And, finally how we see ourselves is important. Some people with serious weight problems may deny they have a problem. Experts who study obesity-related issues often use a person's body mass index (BMI) score as a measure of the degree of obesity. BMI scores fall into the following categories:
BMI |
|
Normal weight |
18.5-24.9 |
Overweight |
25-29.9 |
Obese |
30-34.9 |
Severely obese |
35-39.9 |
Morbidly obese |
40 or above |
Our BMI score is very useful. It can give us a sense of how severe a weight problem we may have. People who are morbidly obese (BMI of 40 or more) or severely obese (BMI of 35 - 39.9) with associated medical problems may want to consider weight-loss surgery, and their doctor is the person to talk to about weight-loss options that are likely to be safe and highly effective.
For this reason, a doctor's objective evaluation of the situation is helpful, whether it is being overweight or obese, our doctor can help to decide on an overall weight-loss strategy. We cannot afford not to act; in addition to other issues, obesity can cause a decreased quality of life.
MAYO CLINIC HEALTHY WEIGHT PYRAMID SERVINGS
Fruits |
1 |
Carbohydrates |
1 |
Protein and dairy |
1 |
Fats |
1 |
DIABETES MEAL PLAN EXCHANGES
Starches |
1 |
Fruits |
1 |
Milk and milk products |
1 |
Fats |
1 |
DASH EATING PLAN SERVINGS
Grains and grain products |
1 |
Fruits |
1 |
Dairy foods (low-fat or fat-free) |
1 |
Fats and oils |
1 |
Source:
Used with permission of Mayo Foundation for Medical Education and Research (MFMER). All Rights Reserved.
https://www.mayoclinic.com/health/healthy-diet/HQ00599
References
1. ABS 2006d;
2. AIHW analysis of “Filling the gaps in data pooling” survey (December 2004), AIHW.
3. AIHW analysis of VIC Population Health Survey (DHS 2004);
4. NSW Population Health Survey, (unpublished data); SA Monitoring and Surveillance System, (unpublished data); WA Health and Wellbeing Surveillance System, (unpublished data).
5. Fries JF, Koop CE, Beadle CE, et al. Reducing health care costs by reducing the need and demand for medical services. New England Journal of Medicine 1993; 329: 321- 325.
6. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (Final Version), National Heart Lung and Blood Institute, June 1998.
7. Household Spending on Food, "Household Food Security in the United States", 2004/ERR-11, Economic Research Service, USDA,
www.ers.usda.gov/publications/aer821/aer821e.pdf
8. R. Sturm. "The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs," Health Affairs. Mar/Apr 2002: 245-253.
9. Zagorsky JL. "Health and wealth. The late-20th century obesity epidemic in the U.S." Econ Hum Biol. 2005 Jul; 3(2):296-313.
Dieting Linked to Increased Wealth, Study Finds, Ohio State University, Research Communications, Center for Human Resource Research
10. Is Obesity Associated with Major Depression? Results from the Third National Health and Nutrition Examination Survey, Chiadi U. Onyike, Rosa M. Crum, Hochang B. Lee, Constantine G. Lyketsos, and William W. Eaton, Am J Epidemiology 2003; 158:1139-1147.
11. Prevalence of Overweight and Obesity among Adults: United States, 1999-2002 http://www.cdc.gov/nchs/products/pubs/pubd/hestats/obese/obse99.htm
12. Perception of weight status and dieting behaviour in Dutch men and women. Blokstra A, Burns CM, Seidell JC, International Journal of Obesity Related Metabolic Disorders. 1999 Jan; 23(1):7-17.
13. Private insurance spending on obesity-related problems increased tenfold in 15 years. The Nations Health, online article http://www.apha.org/tnh/index.cfm?fa=Adetail&id=1243
Monika
Monika Bhatia
Project Manager and Editor, Quality4life
4 August 2006
