Reasons we should be cautious of the new finding that being overweight reduces the risk of death

A recent article published in the Journal of the American Medical Association entitled “Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories concluded that “Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality.” In other words, based on body mass index, these authors found that being overweight was a good thing and that being obese is not a problem.

Well, here is the problem: the authors used body mass index (BMI). This is a ratio of one’s height and weight. It can be calculated by dividing your weight in kilograms by your height in meters-squared. A BMI of 18.5-24.9kg/m2 is considered to be normal where as a BMI of 25-29.9 is considered overweight and a BMI of 30-34.9 is considered grade 1 obese. The problem with this measure is that it does not take into account the distribution of fat. For example, let’s say I had a BMI of 28, but the majority of my fat was located in my thighs and arms. This may not be desirable, but it isn’t necessarily a health risk. It is when fat is located in the mid-section that we should be concerned. Specifically, fat located in the mid-section underneath the muscle i.e. visceral fat is of great concern. Waist circumference is therefore a better predictor of disease and mortality risk than BMI as it tells a more complete story. Let’s go back to my original example. If my BMI were 28 and I had a waist circumference of more than 88cm (102cm for males) then I would be at HIGH risk for death and diseases.

So, my quick take on this paper is that it should be ignored by the media and the general population. There is unequivocal data to show that being over-fat is a health risk. Granted, having a BMI that categorizes one as overweight or obese doesn’t necessarily mean the person is over-fat. It is because of these limitations that the Edmonton Obesity Staging System was created. Please read my previous post on this comprehensive approach here: http://sdogra.com/2012/06/18/healthy-obese/ and please stay committed to your Healthy Active Lifestyle Forever!

 

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Pole Dancing…I mean Pole Walking is good for your health!

Well, pole dancing is probably good for your health too, but in this article I will be focusing on the health benefits of pole walking a.k.a Nordic walking or Nordic pole walking. If you’ve ever seen someone out for a walk with ski poles in their hands, you’ve witnessed Nordic walking. You might wonder why they have these poles in their hands. The short answer is that Nordic walking is a much more effective way to improve health than standard walking. Adding poles to a standard walk allows you to walk faster and also allows you to engage the muscles of the upper body; muscles often neglected in a standard walk. This form of walking has been shown to be especially beneficial to those with type 2 diabetes, people who have arthritis and of course to those hoping to lose weight.

A recently published intervention among overweight adults with varying levels of blood glucose control (normal, impaired and type 2 diabetes) assessed the benefit of unsupervised Nordic Walking among middle-aged and older adults. The researchers randomly assigned participants to either a control group (i.e. no exercise changes) or a Nordic walking group. The Nordic walking group was instructed to increase their weekly physical activity levels by 5 hours per week for 4 months using the Nordic poles. They attended an instructional class and were explained what intensity range they should walk within. At the end of the 4 months the Nordic walking had differing effects in the three groups. In the group with normal blood glucose levels body weight and waist size (waist circumference) both improved significantly. In the groups with impaired blood glucose levels, exercise capacity and physical fitness levels improved significantly. Finally, in the diabetes group, blood glucose levels and exercise capacity improved significantly. Another noteworthy finding was that those in the Nordic walking groups increased their weekly physical activity levels by 4-5 hours per week in each of the three groups. This is great news as it seems that Nordic walking is an activity that overweight individuals enjoyed and therefore were able to stick with!

It appears that one simple addition or change to your walking routine can have a fairly significant influence on your health and fitness levels. While it wasn’t assessed in the study described above, and research certainly is limited in this area, I can say from personal experience that Nordic walking can lead to improvements in muscular endurance of the upper and lower body as well as increase the speed with which you can walk. All in all, it is a great way to increase the intensity of your walking and a great way to derive greater health benefits while spending the same amount of time being active. If you are interested in learning how to walk with Nordic poles please check the following website for instructors and groups in your area: http://nordixx.com/find-a-walking-group/

TAKE HOME MESSAGE: Adding some Nordic poles to your walk can lead to significant improvements in your health and fitness levels. Be sure to give it a try, but make sure you learn the proper form before purchasing a pair of poles. This will ensure you prevent injuries and that you maximize the benefits derived from the activity. This activity is particularly beneficial if you are trying to lose weight, have diabetes or cardiovascular disease or arthritis. So be sure to give it a try and see if a simple pair of poles can help you get closer to your HALF!

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Can you be healthy if you are obese?

It seems like a paradox. The notion that obese people can be healthy is completely contrary to any public health message we have ever seen, yet, there is increasing evidence that SOME obese individuals may be just as healthy as their normal weight peers.  The question that arises then is: what is it about being obese that makes a person “unhealthy”?

The simple answer to this question is that obesity is associated with a higher risk of cardiovascular disease, type II diabetes, cancer and early death. This is primarily because people who are obese generally have a poor diet and low physical activity levels; they might also consume more alcohol. In other words, the lifestyle that is leading to their obesity is also leading to higher cholesterol, blood pressure, blood glucose levels etc. These of course are primary risk factors for the above mentioned diseases.

Recent research indicates however, that just because someone is obese it does not necessarily mean that they have these risk factors. In a study published in the Canadian peer-reviewed journal, Applied Physiology, Nutrition and Metabolism, Dr. Kuk and her colleagues used a large database (Aerobics Centre Longitudinal Study) to establish just this. They used the Edmonton Obesity Staging System (EOSS), a risk-stratification system that classifies obese individuals using health indicators on a scale of 0-4 with 0 being low risk and 4 being high risk. Using over 20 such indicators, Kuk and colleagues found that only obese individuals in stage 2 or 3 (they were unable to assess stage 4 because of limitations in the dataset) were at an increased risk of death, cardiovascular disease and a variety of other conditions. In other words, there were some obese people (those in stage 1) who were not at a higher risk when compared to normal weighted people. Interestingly, this was not the case for cancer. Regardless of which stage the obese individual was in, they had a higher risk of cancer when compared to their normal weighted peers. In addition, they found that even when they took into account the diet and fitness levels of their obese participants, the risk remained high for people in stage 3.

So, how is this possible? How are SOME obese people able to maintain normal or near optimal health levels?  The present study does indicate that the obese individuals in stage 1 were more fit than the others. It is also entirely possible that the healthy obese individuals were consuming more fruits and vegetables, were getting 8 hours of sleep, drinking their 8 glasses of water and coping better with life stress. It is possible that these individuals had “healthier” lifestyles than their obese peers and therefore successfully reduced their risk for many chronic conditions.

TAKE HOME MESSAGE: If you are obese make sure you understand what your risk is before setting off on a stressful weight loss program. It is important to realize that weight loss does not necessarily mean improved health. Stop focusing on the scale and re-focus on your overall lifestyle. This will reduce your risk for several chronic diseases and in time (perhaps more time than you hoped) you will lose weight!

And remember, you have control of your HALF!

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