Sarah Jacoby wrote for SELF that by now you probably know that your BMI isn’t a great way to measure your overall health. But, as we move away from that standard, the pressure is on to find a replacement. And, according to a group of researchers, the key may be in using the term “overfat” rather than “overweight” because it more accurately captures the relationship between the makeup of our bodies and our health. However, other experts aren’t convinced this is the way to go.
In a follow-up to work published earlier this year, the group argues that the link between weight and health issues (such as heart conditions and diabetes) is actually better understood as a connection between body fat and those conditions—especially fat that sits around your stomach. This type of fat has been more conclusively linked to health problems than fat that sits around your hips, and is usually measured by calculating the ratio of the circumference of your hips to that of your waist. So, being overfat simply means having an excess of fat—particularly around your tummy—even if you would be considered a “normal” weight by BMI standards.
The group’s new analysis, published recently in the journal Frontiers in Public Health, used these criteria to find out how many people around the world would qualify as overfat. They found that a huge chunk of humanity could be deemed overfat—including those who are already in overweight and obese categories (per BMI measures). In fact, the vast majority of adults (80 to 90 percent) in the U.S. would be included.
Basically the entire country would be considered overfat.
“[The concept of overfat is] helpful from a public health standpoint because it brings to light the seriousness of this pandemic,” lead author Philip B. Maffetone, Ph.D., an independent researcher specializing in alternative medicine, acupuncture, and physiotherapy, tells SELF. In a currently unpublished analysis of data just from those in the U.S., he says, the percentage of people considered overfat actually comes out to be more than 90 percent.
However, others aren’t so sure this is a useful way to measure health. “These authors focused on bodyweight percentage and hip-to-waist ratio, which tend to outperform the BMI when predicting health, but BMI sets a fairly low bar,” Jeffrey Hunger, Ph.D., a researcher who studies the health effects of stigma at UCLA, tells SELF. David Frederick, Ph.D., an assistant professor specializing in health psychology at Chapman University, agrees. “With how broadly they’ve defined overfat, it included about 90 percent of the population,” he says. “[That] tells you that you’re a person in the U.S. rather than anything meaningful about your health status.” That high percentage is “a little absurd,” Hunger says.
The major issue is that, although both weight and fat may be correlated with poorer health outcomes, neither is actually a direct representation of your health. “Whether you’re calling it ‘overfat,’ ‘overweight,’ or ‘obese,’ it’s important that people recognize that body fat percentage is linked to health, but it’s not necessarily the fat itself that is determining health,” Frederick explains.
Indeed, according to one of Hunger’s studies published last year in the International Journal of Obesity, he and other researchers looked at health data for over 40,000 people from a nationally-representative survey. They found that 47 percent of those considered overweight by the BMI actually had totally normal and healthy biomarkers, including blood pressure, insulin resistance, and cholesterol levels. Another 30 percent of those considered obese had similarly healthy biomarkers. Based on this research, Hunger says he found the new estimate that 90 percent of us are unhealthy to be “very, very high.”
Feeling stigmatized has serious effects on mental and physical health.
Another major part of the problem is the term itself, which Maffetone says people “used to find offensive.” In their previous paper, he and his coauthors argued that stigmatized words are more effective at motivating weight loss and, therefore, it’s totally fine to use words like overfat. But Hunger worries the term may still contribute “to the already-strong stigma that’s associated with fatter bodies.” It’s especially troubling because adding “over” to the beginning of anything implies that there is some acceptable range to be within—and, in this case, most of us exist outside of that. “You’re problematically [putting them] into a negative category,” Frederick says.
This is worrying because there is strong evidence to show that feeling stigmatized can have serious, long-term effects on mental and physical health—including increased stress, anxiety, depression, and disordered eating. Because this is a new proposal, we don’t know how it will affect patients. “But we know more generally that people who are categorized as overweight or obese know it’s their weight that will be focused on [at a doctor’s appointment],” Frederick says. That can lead people to delay or avoid seeing a doctor, potentially worsening any health issues they do have.
Focus on behaviors—not weight or fat.
If we’re not emphasizing weight or fat, how are we supposed to talk about the health behaviors and consequences that are associated with both of those concepts? Actually, it’s pretty easy: “We can promote health for everyone by just getting over this obsession with weight,” Hunger says. “Instead of trying to find a brand new measure to approximate health, let’s actually measure health.”
That means we should be looking at direct indicators of health (e.g. blood pressure) and staying aware of how well we’re sticking to our healthy behaviors—keeping active, eating a balanced diet, and getting good sleep—rather than trying to find one magic formula that estimates all of that.
f nothing else, the advent of “overfat” proves that we may never truly be rid of the BMI or the way of thinking that it encourages. So the best thing we can do is see these measure for what they really are: shorthand at best, dangerous oversimplification at worst.