Changing perceptions of obesity
I’m going to start this post with a few questions that I want you to seriously consider before you answer and read on. Are you overweight? If so, how much overweight? What do you think your ideal weight should be?
Think about these questions seriously and answer them before moving on. You don’t have to tell anyone the answers, but the answers to these questions will focus your attention more on the subject at hand.
It’s been my experience, gained from almost three decades of caring for overweight patients, that most overweight people seriously underestimate the amount of excess fat they’re carrying. This was really brought home to me a few years ago when I was involved in a lawsuit (a business lawsuit, not a malpractice lawsuit, in case you’re wondering) and hired arguably the best attorney I’ve ever worked with. This guy was a real magician. It was almost as if he had a spy in the courthouse and in the opposing lawyer’s camp. He knew everything that was going to happen before it happened; he predicted every ruling from the judge before it ever came down. He was truly amazing. And he was truly fat.
He was one of those guys who carries most of his excess weight in the abdominal area. And he had a world-class abdomen that cantilevered over his belt. He actually would move it around with his hands when he turned. Based on many years of observing overweight people and developing a real knack at guessing their weights, I figured that this guy was toting around at least an extra 100 pounds. Although this lawsuit had nothing to do with my practice of medicine or our books, this lawyer knew what I did, and we talked about it on a number of occasions. Several times during these discussions we had about obesity, he remarked that he, himself, needed to lose about 30 pounds. Thirty pounds?!?!?! If he lost 30 pounds it would have been a step in the right direction, but he would have had a long, long way to go to get where he needed to be. This guy could outsmart everyone he dealt with in the legal community in a large metropolitan area, but didn’t have a clue as to how obese he was.
I use this lawyer as an example because he was so observant and so able to pick up on nuances and subtleties in the legal world around him, but couldn’t pick up on his own excess belly fat, which was far from nuanced or subtle. And he isn’t alone. When patients come to see me about weight loss, I always ask them how much they want to lose. Invariably it’s a lot less than my expertise would tell me they need to lose. People just don’t view themselves as being as overweight as they really are.
A recent paper in the British Medical Journal (full text here) confirms my own findings. Although this study didn’t evaluate the amount subjects thought they were overweight (i.e., they weren’t asked how much they thought they should lose), they were asked whether they were overweight or not. And as the obesity epidemic has worsened, the number of obese people considering themselves obese has fallen. Why is this? Why, when more people are overweight than ever, would fewer people consider themselves overweight?
Another recently published paper may help us with the answer. The June issue of the International Journal of Obesity (IJO) contains an enlightening paper titled “Do you see what I see? Weight status misperception and exposure to obesity among children and adolescents” showing that children and adolescents who live and/or spend considerable time in environments in which there is a lot of obesity, tend to consider the obese state more ‘normal’ than those who spend time in environments without so much obesity. Why shouldn’t the same hold true for all of us who spend our time surrounded by people in various stages of overweight come to the same conclusion? In my youth, obesity was the exception – now it’s the rule. When I was a kid almost all kids were thin and so were most adults. Overweight people stood out. Now it’s the lean and healthy people who stand out.
In the IJO study, children and adolescents were measured to determine their weight status (using, unfortunately but as expected, BMI as a measure of overweight) then the researchers asked these kids to pick out their own profiles from a standardized series of body shapes of boys and girls. (The body shapes used are at the top of this post.) Obese kids growing up in homes with obese parents or who have many obese friends tended to point out the silhouettes of thinner children (the ones in the middle of the series) as being the most similar to themselves. The reality was that these children looked much more like the children at the right side of the series. Those kids with normal-weight parents and friends were much more accurate in their selection of their own body shapes.
All of which confirms the idea that people tend to view as normal that which they see all the time regardless of whether it is really normal or not. In today’s society obesity is rampant, and not just in the people we see wandering around the malls and at the fast food places. We see obesity on television in the form of John Goodman, Rosie O’Donald, Roseann Barr, Cedric the Entertainer, and a host of others including Oprah now. Television commercials are now filled with ‘normal’ looking overweight people of both sexes. I intended to roam through YouTube and find a number of them to put up to demonstrate the point I’m making. But instead, I decided to do something a little different and a lot more fun.
As I said before, when I was a kid, obese people stood out and were noticed. I thought back about television when I was a kid and tried to remember who were the fat people on TV then. There weren’t many, but there were a few. I was a huge Three Stooges fan as a kid and a sort of Laurel and Hardy fan. (The Three Stooges and Laurel and Hardy films were all shot long before I was born, but in my youth, they were always shown on Saturday morning kid TV.) I found a few clips on YouTube, and it’s really enlightening to look at these in view of what we consider obese today.
Oliver Hardy was considered grotesquely obese in his time. When you watch the following short film, look at how obese he really was in terms of today’s obesity epidemic. he’s obese, of course, but you could walk through any mall in America and see dozens of people much more obese than Hardy…but not in his day.
Another obese character from my youth was Curly Howard (Jerome Lester Horwitz), the zany, manic, overweight butt of all the Three Stooges jokes. I remember Curly as being enormously obese, but looking at him in the clip below, he wouldn’t stand out in a crowd today. In fact, he looks almost normal (as compared to today’s citizens, of course).
Although I was never much of a fan as a kid, my folks loved the Jackie Gleason show. Jackie reveled in his obesity, and even went by the monicker The Fat Man. He was thought of at the time as incredibly obese. Take a look.
Amazing, isn’t it? Again, you wouldn’t notice him in a crowd today.
I’ve gone on this trip down memory lane just to show you how the perception of obesity has changed over the years. What was obese 50 years ago is kind of normal now. Consequently, it’s easy to see how it would be easier to consider oneself normal when one is really overweight. And it’s easy to see why a lot of people would think they have only a few pounds to shed when they’ve really got a few dozen.
Now, let’s go back to the question at the start of this post. Are you overweight? And if so, by how much?
In my years of taking care of patients, I’ve noticed that when asked what they would really like to weigh, men seem to go for their weight when they graduated from high school. Women usually pick something they think is more realistic, say, for example, 120 pounds. The one thing men and women have in common, though, is that they both usually off the mark.
In my opinion the very best way to determine one’s degree of overweight and one’s ideal weight is to determine body composition and go from there. And, in most cases, the ideal weight is a moving target. Let me explain.
Ideally, men should carry around 15 percent of their weight as fat, and women should carry about 20 percent. So, the first step in determining one’s degree of overweight is to determine the amount of body fat and lean mass that composes one’s body. This can be done using numerous methods, each with it’s own degree of accuracy and pain-in-the-buttness to do. In our clinic we used a bioimpedence analyzer that was pretty accurate, but it had to be calibrated often, and the subjects had to be at a certain level of hydration to get an accurate reading. The one we used cost about a thousand bucks back then – now there are a zillion available for anywhere from twenty dollars to a few hundred. I’ve tried the less expensive ones just to check them out, and they don’t work for squat–i.e., their results are not accurate and reproducible.
When I wrote my first book Thin So Fast, I presented a set of tables and instructions for measurement of body fat percentage that were derived from a set of equations developed by Penrose, Nelson and Fisher. Barry Sears picked up these charts from me and used them in his book The Zone. MD and I used them again in Protein Power, so if you have a copy of that book, you can find them there. We found these charts to be spectacularly accurate. In fact, we used them whenever we thought our bioimpedence analyzer was out of whack. We would have used them all the time, but they would have been to cumbersome with the patient load we had.
I need to make these equations to they can be in an online form, but I just haven’t gotten around to it yet. In the meantime, if you don’t have a copy of one of the above books at hand, you can find a couple of reasonably accurate body composition analyzers here.
Once you’ve calculated your body fat percentage, you come up with your first ideal weight target. Let’s say you are a female, you weight 195 pounds, and you’ve determined that you are carrying 35 percent body fat. You do the following calculation (0.35 X 195 = 68.25) and learn that you are hauling around 68.25 pounds of body fat. If you subtract this fat weight from your total weight (195-68.25 = 126.75) you find that your lean weight (everything that isn’t fat) is 126.75 pounds.
Since, as a female, you should ideally have only 20 percent body fat, you can divide your lean weight by 0.8 (100 percent minus the ideal 20 percent body fat) to determine that your first ideal weight target should be (126.75/0.8) about 158 pounds. Whoa there Nellie, you say, that’s way too high. I want to weigh a lot less than 158 pounds. I want to weight more like the 120 pounds I weighed when I got married.
Well, in order to weight 120 pounds, you’re going to have to lose some lean body mass, which you will as you lose fat. But wait, I don’t want to lose lean mass, you say. If you want to weight 120 pounds and your lean body mass all by itself weighs 126.75 as we calculated above, then it’s going to be real tough to get to 120 pounds without losing some lean mass. At least 6.75 pounds’ worth. But you’ve got to have some fat – around 20 percent, in fact, which is going to add more weight. But don’t despair, because this first target weight is just that: the first target.
As you lose fat on your low-carb diet you will lose some lean mass as well. Since your going to be lighter, you won’t need the same amount of muscle mass to support you, so you will naturally lose a little muscle mass. You’ll also lose some weight from excess fluid and even some organ weight – all of which counts as lean body mass. You’ll lose organ weight because for the most part a smaller body requires smaller organs. After you’ve lost 20 pounds or so, it’s time to recalculate. When you do you may well find that of the 20 pounds you’ve lost 14 have been fat and 6 have been lean (and by lean we mean anything that’s not fat). Recalculating shows that now at your lower 175 pound weight (195 minus the 20 you lost), your lean body mass is 120.75 pounds. When recalculated for ideal body weight (that weight at which you are at 20 percent body fat), you find that your ideal weight has gone down from 158 pounds to about 151 pounds. When you lose another 20 pounds and recalculate, you may find your lean mass has dropped to 114, giving you a new ideal weight of (114/0.8) of 142 pounds. Since you’ve lost 40 pounds since starting, your actual weight at this time will be (195-40) 155 pounds, so you’re not that far off. If you lose another 15 pounds, and 8 of that is fat and 7 is lean, you’ll have a lean mass of (114-7) 107 pounds. Recalculating for ideal (107/0.8) will mean your new ideal weight is about 134 pounds. And you’ll weigh (195-20-20-15) 140 pounds so you will be very close. You’ll have only 6 pounds left to lose. But if you lose those 6 and 2 of them are lean, it’s recalc time. Now your lean weight is (107-2) 105 pounds. Dividing 105 by 0.8 gives you your new ideal weight, which is now 131 pounds. And you’ll weigh 134, so you are really close now. You’ll probably end up at about 130 pounds and 20 percent body fat, which will be perfect. But you won’t know at the very start what this will be because, as I said, your ideal weight is a moving target.
The same works with men. Just use the 15 percent body fat as ideal instead of the 20 percent I used in the example for a female above. Go through the calculations and come up with your first ideal weight and go from there.
So, go back to the questions I asked at the start of this post and get to work. Find out where you really stand in the obesity spectrum and start inching your way down. And don’t think that just because everyone else is no fatter than you that you’re normal. You may be normal in the statistical sense as compared to the rest of your countrymen or women, but it’s not normal you should be striving for. You should be making a run at ideal.