.....Even though C. Everett Koop, the former Surgeon's General, has declared obesity a disease and cause of significant morbidity/mortality within the United States, three decades of research have not supported such a clear causal link.^1,2 It has been noted that fat distribution and BMI explain only about 9-13% of the variance in cardiovascular risk factors.³ Further, research findings are diverse, revealing that the nature of the relationship between weight and morbidity/mortality remains unknown. While it does appear that some health risk exists at both extremes of BMI, concluding that increased weight is a major component of cardiovascular risk seems premature given the lack of valid scientific evidence appropriate for general application to the American public.

.....The following summarizes the contradictory nature of the available weight-related literature by specific disease entity. It is suggested that readers consider the following tables (just click on the topic headings below), then review the listed references and make an independent, but informed decision regarding the evidence upon which interventions for clients with weight-related concerns are currently based.

The Relationship between Weight and All-Cause Morbidity/Mortality

The Relationship between Weight and Cardiovascular Disease

The Relationship between Weight and Hypertension

The Relationship between Weight and Type 2 Diabetes

The Relationship between Weight and Cancer

The Relationship between Weight and Bone Disorders

The Relationship between Weight and Gallbladder Disease

The Relationship between Research and the Decision to Treat High BMI as a Disease

Conclusions

• The scientific community is divided on the role of weight in the development of cardiovascular disease, hypertension, type 2 diabetes, breast, endometrial, and colon cancers, osteoarthritis, osteoporosis, and all-cause morbidity/mortality.
• Well designed studies utilizing true random samples are desperately needed to clarify the true nature of the relationship between weight and health, but it is unlikely that conclusive evidence will be available soon, given the failure of over 30 years of research to end this debate.
• Despite the lack of scientific agreement within the weight/health related research, the media and many scientists, and medical professionals tend to support the concept that high BMI (termed obesity) is a disease requiring treatment and the scientific evidence that supports this opinion is frequently selectively overemphasized.

Perhaps the our knowledge regarding the relationship between weight and health is best summed up by two senior editors of the prestigious New England Journal of Medicine in a 1998 editorial entitled "Losing Weight-An Ill-Fated New Year's Resolution" when they state:

"the data linking overweight and death as well as the data showing the beneficial effects of weight loss, are limited,fragmentary and often ambiguous."30

References

Back to Unit 1 C: The Relationship Between Weight and Health

© Fall 2001