National Health and Nutrition Examination Survey, BMI, overweight, underweight, normal weight, obese, Cornell body image study, University of Pittsburg, diabetes, National Center for Health Statistics (NCHS), metropolitan life, waist hip ratio,

Ideal Weight: A Case of Myth-Information

Ideal Weight: A Case of Myth-Information

According to the most recent National Health and Nutrition Examination Survey (2001 – 2004) two thirds of adults in the United States are overweight. One third of adults are classified as obese. Furthermore, we are told, the percentage of overweight and obese people in the United States increased by 31 percent between 1976 and 1991 and by another 24 percent between 1994 and 2000. A 2004 analysis reported that the trend was continuing.

What those reporting the dramatic increase in the percentage of overweight and obese individuals do not bother to state is that nearly all of the growth occurred not because people became fatter, but because the definition of what is considered a normal weight changed. In the most recent surveys the “normal weight” cutoff has been a BMI of 25 (I will explain BMI later). In earlier surveys the cutoff was a BMI of 27.3 for women and 27.8 for men. The percentage of individuals who fall into the obese category has increased, but not nearly as much as press reports would suggest.

I do not question the finding that roughly one in three persons is thin, one is fat, and one is in the middle. What bothers me is that the medical profession now defines the person who is thin as “normal” or “ideal” and considers all others as sick and in need of treatment.

Americans are complying. The weight loss industry now boasts over $40 billion in annual revenue. Sadly, the results do not justify the costs. Fifty percent of “overweight” individuals who achieve their “ideal” body weight return to their pre-treatment weight within a year. Ninety-seven percent regain all of the weight within five years.

The percentages of thin, fat, and in-between people in Russia parallel those in the United States. There is a major difference between the two countries, however. Russians don’t consider a fat person unhealthy. A Russian saying suggests, “There should be a lot of a good person.”

Perhaps there is a ray of hope. Cornell University released a body image study in November 2007. Researchers interviewed 320 college undergraduates asking them whether or not they wanted to lose weight and, if they did, how much weight they wanted to lose. Fifty percent of female students and sixty percent of male students who were classified as being overweight did not plan to shed enough pounds to achieve an “ideal” body weight.

The results of the Cornell study were strikingly similar to a University of Pittsburg study published in 2006. The Pittsburg team interviewed 2,607 diabetics asking them what they considered to be their ideal weight. Forty percent named a weight that is defined as overweight and six percent gave a weight that is considered obese.

While the investigators were dismayed, I believe that the students and diabetics were simply being realistic. They knew from experience that they could not successfully lose enough weight to reach what is currently defined as an ideal weight, much less keep the weight off if they ever managed to achieve the impossible dream.

I am not saying that carrying excess body fat does not predispose an individual to health risks such as diabetes or high blood pressure. What I am saying is that the standard that has been chosen to define a “normal” physique is far too stringent to serve a useful purpose for a majority of the population.

During my years in medical school and residency training I was taught to carefully examine an infant’s legs and feet and aggressively treat the baby with nighttime splints or prescribe shoes with special soles for toddlers to assure that they would be able to walk with the feet pointing straight ahead as an adult. I soon noted that the splints did little to correct “in-toeing” or “out-toeing” and that building up one part of the shoe did more to break down the arch of the foot than it did to improve the child’s gait.

Shortly after entering private practice I attended a continuing medical education course on pediatric problems. One of the speakers was a wise old orthopedic surgeon who shared these words of wisdom: “If you watch people walk through the mall you will find that some are short and some are tall. Some are thin and some are fat. Some toe in and some toe out. So what?”

It should be undeniable that people are born with different types of bodies. A professional sumo wrestler could never have been a successful ballet dancer any more than the professional ballet dancer could have been a successful sumo wrestler if their dietary habits and training had been reversed. Stan Laurel was not born with the ability to develop the corpulence of Oliver Hardy, and no diet or exercise plan could have enabled Ollie to fit into one of Stanley’s suits. Actually, some of their most hilarious skits involved a mix-up of clothing.

To label one person healthy and another sick solely on the basis of his or her body type does a disservice to both of them. The person who is naturally skinny has no incentive to be physically active or choose foods that support long-term health and the one who is naturally plump is given the message that a future of disability and an early death await no matter what path is chosen.

When two-thirds of the population is defined as abnormal it is time to examine the definition of normality. Something is seriously wrong when people are told that they must achieve a weight that is impossibly low if they want to be healthy. Interestingly, the facts do not support the contention that people who are “overweight” are less healthy than those who are not.

The prevailing opinion that only individuals who are overweight or obese are at risk of developing health challenges is simply not true. Women of ideal body weights are far more likely to develop osteoporosis than women who are classified as overweight or obese. This is significant, for more women in the United States die each year of hip fractures than die of breast cancer. Many young women, struggling to maintain an ideal weight, turn to cigarette smoking as a means of weight control. This creates additional health risks.

What research studies actually reveal is that people who are currently classified as “overweight” live the longest. One of the best analyses of weight and longevity was published in the Journal of the American Medical Association in 2005. The work was done by researchers at the National Center for Health Statistics (NCHS), a major United States’ government research facility.

Prior to the NCHS publication, it was widely reported that approximately 400,000 more overweight and obese individuals die each year than those with a normal body weight by the current National Institutes of Health (NIH) standards. The NCHS analysis found, however, that this was not the case. When compared to the normal weight category, obesity was associated with 111,909 excess deaths and underweight with 33,746 excess deaths. The overweight category, however, had 86,094 fewer deaths than those of normal weight, making overweight the healthiest category by the standard of longevity.

Even obesity is not an absolute indication of health risk. Since 1970, the Cooper Institute for Aerobics Research in Dallas, Texas has been studying the effect of exercise on health. Their findings show that physical activity cancels most of the health risks associated with obesity. One study even showed that obese men who exercise regularly are at a lower risk of having a heart attack than lean men who are out of shape.

Merriam Webster’s New Collegiate Dictionary defines the term obese in two words: excessively fat. Simply stated, obesity means that an individual has more body fat than they need. In our society, however, obesity is an emotionally charged term. Telling someone “You’re obese!” is very much akin to saying “You’re lazy!”, “You’re a pig!”, or even “You’re ugly!”

As a physician I have no difficulty telling someone with an expanding waistline that he or she would benefit by making better food and beverage choices and by becoming more physically active. In my experience, people do make positive changes when encouraged to do so. On the other hand, many people have told me that they gave up their efforts to maintain their weight after a nurse or physician told them they were obese.

Very few people see themselves as obese. Obesity, most believe, is a condition that occurs in other people. When I tell an audience that a third of the population is obese, those in attendance usually begin to nod in agreement. “That’s obvious,” someone will comment. “You just have to watch people walking through the mall.” More times than not, the commentator will be obese by today’s standard. When confronted with that fact the individual usually expresses stunned disbelief.

From a medical standpoint obesity has traditionally been defined as a body fat content exceeding 30 % in women and 25 % in men. Unfortunately, obesity as defined by the National Institutes of Health (and hence the definition used by the most physicians and researchers) has absolutely nothing to do with the amount of body fat a person is carrying.

Rather than considering body fat content, which is difficult to measure accurately, the NIH defines overweight and obesity in terms of the body mass index (BMI). A person’s BMI is simply a ratio of their weight and height. Weight in kilograms is divided by the square of the height in meters. Anyone with a BMI of 24.9 or less is said to be of “normal” or “ideal” weight. Any man or woman with a BMI of 30 or more is considered obese. Those in between are said to be overweight.

It is virtually impossible for short women to achieve a normal BMI, as it is very close to lean body weight (the weight of the body without any fat). Men also have difficulty achieving an ideal weight as defined by BMI. In fact, the BMI classifies many superbly conditioned athletes as “obese”.

By NIH standards, Minnesota Vikings’ and former Oklahoma University star running back Adrian Peterson, who has a BMI of 28, is seriously overweight. His BMI is actually low for a running back. Former Dallas Cowboys’ star Emmett Smith had a BMI of 31.9, categorizing him as very obese. Virtually all football linemen are classified as obese and nearly all other players are deemed overweight or obese by the current definition.

Some athletes, of course, have weights that place them in the normal range. Gymnast Cathy Rigby, for example, performed with a BMI between 20 and 21, placing her in the ideal range. She later revealed that she had only been able to maintain her weight by not eating for as long as a week at a time. She struggled with bulimia for 12 years.

How did BMI originate and become the standard by which people in the United States are judged? For many years, weight tables published by the Metropolitan Life Insurance Company were used to determine an individual’s ideal body weight. The tables were purported to represent the weights that were associated with the greatest longevity.

The Met Life tables divided people into small, medium, and large frames based upon the width of their elbow. (Since fat does not accumulate around the elbow it is a reliable indicator of bone size.) This allowed for some variation based upon body build.

Researchers, however, felt that the tables were too cumbersome and therefore selected BMI numbers that approximated weights and heights in the table as a simple method to determine ideal body weight. BMI standards do not take frame size into account, and, on average, define normal body weight twenty percent lower than the tables.

The accuracy of the tables themselves in predicting good health is questionable. The population studied was affluent and predominantly white. Ten percent of the people studied were not weighed by the researchers; they simply reported their weight to an interviewer. The weights were accepted as accurate, even though people typically report a lower than actual body weight when asked. All others were weighed fully clothed, and for reporting purposes it was estimated that men wore 5 pounds of clothing, women 3 pounds of clothing, and that all subjects wore 1 inch heels.

Individuals with a history of a heart attack, cancer, diabetes, or high blood pressure were excluded from the study. In addition, the ideal weights listed were determined by taking the mean weight of individuals between the ages of 25 to 59, even though the weight most associated with survival increased with age.

Despite all of their shortcomings, the Met Life weights became the standard by which healthy weight was judged. BMI standards, which mandate lower body weights, are almost universally accepted by physicians as the gold standard by which a patient’s weight is to be judged.

What purpose is served when the people with the lowest rate of premature death are told that they are abnormal? Such a representation harms rather than helps those people. The myth that an individual who is “overweight” is at a greater risk of dying only furthers the interests of our burgeoning weight loss industry. I argue that it also creates an undue pressure on physicians to prescribe and patients to take drugs to supposedly lower their high risk of premature death.

You may have a weight problem, but my advice is to ignore BMI recommendations and use more realistic methods to determine whether or not a challenge exists. I have found that an individual’s ideal body weight is almost always the weight that he or she maintained as a young adult two or three years into marriage or career. Studies have shown that individuals who maintain that weight fare better than those who repeated attempt to achieve their ideal body weight as defined by BMI.

The simplest means of determining whether weight reduction is necessary is measuring one’s waist size. A waist size above 40 inches in a man or 35 inches in a woman is associated with a greater risk of developing diabetes, high blood pressure, and related conditions. This is not the most accurate means of assessing one’s condition, however, as it does not take one’s overall size into consideration.

A more objective means of determining whether you at risk of developing health challenges due to the amount of fat you are carrying is to determine your waist to hip ratio. This is done by dividing your waist circumference at the navel by that at your hips. Individuals with the lowest waist to hip ratios are much less likely to develop diabetes and atherosclerosis than those with the high ratios. Waist/hip ratio ranges and their relative risks are shown in Table 1.



Health Risk
Based Solely on WHR

0.95 or below

0.80 or below

Low Risk

0.96 to 1.0

0.81 to 0.85

Moderate Risk



High Risk

Table 1

If you have a waist to hip ratio in the low risk category you almost certainly do not have a medically significant weight problem. If, on the other hand, you find that your waist to hip ratio is in high risk range you should seriously consider taking measures to improve it.

If you are not at increased risk of developing health problems as defined by your waist to hip ratio, I encourage you to maintain your current weight rather than seeking to reach an ideal weight as defined by BMI.

Above all, I ask you to accept the body you were given. The best evidence available suggests that the body weight achieved while eating a sound diet and performing regular physical activity is right for you. Attempting to reach a lower weight to satisfy our society’s ideal will only lead to frustration and, quite possibly, to an earlier death.