Obesity: No longer just a "cosmetic" issue
POSTED 16 JULY 1998. Talk about heavy honors! On June 1, the American Heart Association raised obesity to the exalted status of "independent major risk factor" for heart disease. Translated, that means being obese raises your chances of having a coronary heart disease -- even if your blood cholesterol is normal and you run a marathon every week.

No longer will we Whyfilers be able to claim, as we chase whole cheesecakes with creamy coffee, that being fat isn't bad for our hearts, so long as we don't smoke cigarettes or have high blood pressure or bad blood cholesterol.

The Why Files was tempted to joke that an extra-thick chocolate malt is still the perfect finish to a gravy-drenched rib dinner, but our advisors warned us that laughing would stress the heart.

UPDATED 27 APRIL 1999 Yesterday, the Food and Drug Administration approved the first of a new type of anti-obesity drug that works by blocking the absorption of fat in the intestine. Unlike earlier drugs, the new drug does not affect appetite, fat metabolism or activity. Orlistat, sold by Hoffman-LaRoche under the name Xenical, was approved for people who are 30 percent overweight, or who are 20 percent overweight but also have high blood pressure, diabetes, or high cholesterol. Studies showed that the drug, when combined with an anti-obesity diet, reduced weight by 5 percent to 10 percent over a year. Because orlistat blocks a chemical the body needs to digest fat, about one-third of a person's fat intake ends up in feces. Side effects include loss of fat-soluble vitamins (A, C, E and K), and bloating, diarrhea and oily stools. The approval was controversial, because the drug's long-term effects are unknown, and there were signs that the effects can taper off after a year or so.

Levity aside, obesity remains serious business, as the National Institutes of Health (NIH) stressed in June while issuing clinical guidelines for treating overweight and obese patients. (Here's a news release.)

After reading hundreds of scientific studies, the NIH committee concluded that you could lower your risk of many grim diseases by losing weight and keeping it off, mainly through exercise. Even a 10 percent weight loss is helpful, the government experts said, so long as you keep it off. And they said the risks were excessive even for overweight people, not just the obese.

Since our main form of exercise is punching keys, we decided to pester the experts with blindingly obvious questions: "What's the big deal with being fat, and can we do anything about being overweight or obese?"

Bad news -- and good news
The bad news is that when the medical profession looks at American waistlines, it doesn't like the scenery. Robert Eckel is an endocrinologist who heads the American Heart Association's nutrition committee -- which branded obesity as a risk factor for heart disease in June. He says, "Obesity itself has become a life-long disease, not a cosmetic issue, nor a moral judgment -- and it is becoming a dangerous epidemic." (See "American Heart Association Call..." in the bibliography.)

The good news is that losing just 10 percent of your body weight can lead to major improvements in health.

The promotion of obesity from "contributing risk factor" to "major risk factor" reflects the conclusions of large, long-term studies that show that being overweight (which for a person who's 5-foot-10 means weighing at least 174 pounds) increases the rate of disease and early death. Fully 97 million American adults -- 55 percent of the population -- are overweight or obese.

Another 38 million American men and women are obese -- 5-foot-10 and at least 209 pounds. Overall, the death rate among the obese is 50 to 100 percent above normal.

The increasing rate of obesity in the American population can be blamed on a less active population that is gobbling more total calories each week, even while it eats a smaller percentage of fat.

And that's not all
And the problems extend way beyond cardiovascular disease. Being overweight or obese also raises the risk of hypertension and stroke, adult-onset diabetes, osteoarthritis, sleep apnea and certain cancers.

The total annual cost of obesity in the United States is $100 billion, including more than $51 billion in direct medical costs. Overall, fatness is second only to tobacco as a preventable cause of death. That's one reason the World Health Organization has begun calling obesity a "global epidemic."Ouch!

What is "obesity," and why is it so durn bad for you?