The obesity measure used in the studies cited here is the body mass index (BMI).

Benefits of the BMI

BMI is a guide. Many primary care clinicians include BMI in the vital signs collected on all patients. In clinical care, it can be useful as an ice breaker to initiate discussions about weight and weight-related health issues. It helps destigmatize weight issues and shifts focus from pounds to overall health.

BMI is a research tool. Researchers use it to look for trends. One concern is that they may regard BMI with tunnel vision rather than as a component of overall health, as clinicians do. Perhaps "over"-correcting for confounding factors can itself be "confounding."

Limitations of the BMI

BMI has many drawbacks. The scale is not age- or gender-specific. It does not intuitively make sense that a male who is 5 feet 8 inches tall, as I am, should be judged by the same yardstick. Also, using height as "one size fits all" does not account for racial and ethnic differences in body composition or in fat distribution.

BMI is a face-value calculation of assessing excess accumulation of pounds, which means that energy is out of balance: more calories going in than calories burned. What the calculation does not tell you is how patients got to that weight. Where did the extra calories come from? Did those excess pounds accumulate through ingestion of healthy foods from a healthy diet, such as one comprising nuts, low-fat dairy, whole grains, fruits, vegetables, and omega-3-rich foods like salmon? Did the extra calories come from junk food with less nutritive value, the so-called "empty calories"? The expression "you are what you eat" applies.

BMI measurement also does not incorporate the patient's level of fitness, another important variable. Do they engage in regular physical activity? Of that weight, how much is fat and how much is lean muscle? Researchers found that when it came to reducing death from all-cause and cardiovascular mortality, fitness trumped weight loss. Compared with men who didn't exercise and who lost fitness, men who maintained their fitness level had, on average, a 30% lower death rate. For men who improved their fitness, the results were even better. These men had, on average, a 40% decrease in mortality rate. Staying fit requires activity and that means exercise.

In clinical practice, we cannot limit our discussions with patients to just weight and BMI. Discussions must go to the next level and include queries about exercise and activity as well as nutrition.

Looking at the Obesity Paradox

Clinicians depend on research to help improve patient care. As it relates to the obesity paradox, this means taking a deeper look at why being overweight can be or appear to be beneficial.

Protective Role of Fat and Calories

Experts have suggested that body fat may play a protective role, perhaps in secreting certain beneficial cytokines and hormones. Extra body fat also means extra padding and thus a physical protective barrier from traumatic injuries. In times of illnesses, the additional caloric reserve may give patients more nutritional backup in the healing process.

More Aggressive Approach to the High-Risk Obese Patient

One explanation for the paradox might be how we in the medical community manage and treat risk factors in obese patients. Are we more aggressive in our approach? Do we start treatment for chronic diseases sooner because these patients are obese?

Age

content aggregation:healthPrior21

source:Medscape surgery