The overweight debate: Healthy and heavy?

By Sarah Mahoney

updated 12:14 p.m. ET Oct. 12, 2008

Eight months ago, while traveling on business, I went to see a doctor for a minor issue. After taking care of it, she scanned my chart. "Have you considered going on a diet?" she asked. "Your weight puts you at a higher risk of heart disease and diabetes." Ouch!

Blushing, I promised to follow up with my doc at home and hightailed it to my hotel, where I spent the rest of the day pacing between the full-length mirror and the jumbo bag of cashews in my purse.

It's not that I hadn't considered losing weight. I was sure I was too fat when I went to college at 113 pounds, and in my mid-30s when I weighed 140. What's different is that now, at 158, I'm clinically overweight. Experts define it as having a body mass index (BMI) between 25 and 29.9, and at 5-foot-4, mine is 27 — not even borderline.

On the brighter side, I live a healthier life than the average Jane. I exercise almost every day — walks, weights, yoga. My diet is packed with fruit, vegetables, and whole grains — albeit in larger portions than a dietitian might advise. I traded the high stress of New York City for rural Maine, where rush hour involves dogs, family, and wild turkeys outside my window. I knit. I garden. Heck, I even meditate.

Doesn't any of this count? Or is that darned scale the only thing anyone cares about?

Beyond the BMI
Turns out, I'm not the only one asking these questions. In fact, in light of several new studies, experts are divided on the danger posed by excess weight, especially if the person is, like me, generally healthy and fit. Much of the research linking excess weight and an increased risk of diabetes, heart disease, and cancer, among other chronic diseases (the list goes on and on), has been done on people who are obese, with a BMI of 30 or more. When the merely overweight folks are separated out, the health risks drop and sometimes even disappear.

"Being overweight may not be associated with any risk of heart disease," says Robert Eckel, MD, a professor of medicine at the University of Colorado and past president of the American Heart Association.

Recently, researchers from the CDC and the National Cancer Institute (NCI) caused waves in the medical community with a report analyzing the death records of 37,000 adults. Although obese folks had a greater risk of dying from cancer or heart disease, those who were simply overweight had, surprisingly, no greater risk than normal-weight people. Even more amazing, the findings suggested that being overweight may actually protect against death from a multitude of diseases other than cancer and heart disease. The research made headlines ("Is That Spare Tire a Lifesaver?"). Critics quickly responded that the study failed to consider quality-of-life issues caused by excess pounds and didn't appropriately control for unhealthy habits like smoking, which can keep people lean but undeniably raise cancer risk. Still, it added fuel to the ongoing debate of whether losing weight is absolutely necessary to reduce disease risk if you're not obese.

However, no one's debating that weight loss can be one part of an overall disease prevention plan. But is it the most essential first step? That depends on how many other disease risk factors you have, says Eckel. Among them:

Age: Anyone 45 or older is at a higher risk of diabetes, and a woman's risk of heart disease begins to rise at 55. Cancer risk also increases with age. (Talk about a midlife crisis.)

Family history: I always assumed that because many in my family had died from heart disease, I was in trouble. But it turns out that what really matters is early heart disease — for men that means a heart attack before age 55 and for women, age 65. Even then, only first-degree relatives — parents, children, and siblings — are considered red flags. And while it's true that type 2 diabetes rarely occurs in people who aren't overweight or obese, the risk of developing the disease is 5 to 10 times higher if a first-degree relative has it — regardless of your weight.

As far as the big C is concerned, only about 5 percent to 10 percent of cancers are inherited, and those that are typically occur earlier in life. According to the American Cancer Society (ACS), most cancers are caused by gene mutations brought on by age, lifestyle, and environmental factors, like inactivity, smoking, excessive alcohol consumption, and increased exposure to radiation or carcinogenic chemicals, among others. In fact, researchers from Britain's Million Women Study found that 5 percent of all cancers affecting postmenopausal women in the United Kingdom are associated solely with excess body weight. Indeed, the ACS and the NCI acknowledge that while being overweight and obese are linked to an increased risk of cancer, there is limited evidence that losing pounds will reduce that risk.

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