People in all industrialized countries are being harmed by a world-wide obesity epidemic. We generally determine if we are the proper weight by calculating the BMI (Body Mass Index): dividing your weight in pounds x 703 by your height in inches squared. If you weigh 140 pounds and are 5 feet, 8 inches, your BMI would be 21.28-
(140 x 703/68 x 68). Normal is 18.5-24.9, overweight is 25-29.9 and obese is over 30. A study of patients in 30 European countries found that over 70,000 new cancer cases were attributable to excess BMI in 2002. Obesity is also associated with an increased incidence of diabetes, hypertension, arthritis, coronary artery disease and dementia.

Keeping trim is a challenge but a recently published article in JAMA, based on a 20 year study suggests a way. It showed that maintaining a high level of physical activity was associated with smaller increases in waist lines and lower BMIs with women being more affected than men.

Is it ever better to be overweight? Many studies have suggested that obese patients (determined by high BMI) with heart failure have a better prognosis than leaner patients. This observation termed the obesity paradox, is also true in patients undergoing dialysis for renal failure. A systematic review (a study of a group of high quality similar studies) of patients on dialyisis found that higher BMI was associated with increased survival. Looking only at BMI however may be misleading. The BMI can reflect changes not only in the amount of fat but also the amount of muscle.

Muscle mass can be estimated by measuring the amount of a chemical in the blood, creatinine, which is produced as a product of muscle metabolism. Another paper from Mayo Clinic reported that with a variety of serious medical illness, low levels of creatinine (reflecting low muscle mass) were associated with a greater chance of dying.

Supporting this observation is a study of 50,831 patients with renal failure who received hemodialysis. For those who survived the first 6 months, the group that lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level.

BMI is only a general reflection of your body composition. It doesn’t tell you the relative contribution of fat and muscle. In addition to being conscious of your BMI, it is best to have a regular exercise program (even if it is severely modified because of disease) to maintain or increase your muscle mass.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY
“Your New York City Pain Relief doctor”

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