Normal weight or obese? Both!

Philip J. Goscienski, M.D.

January 2008

Now that obesity has pushed its way onto the political stage with cities and states and eventually the federal government getting into the act to try to control it, it's about time that we figured out what obesity — fatness — really is.

If you've been browsing through health magazines over the past few years you have learned that your BMI (Body Mass Index: weight in kilograms divided by height in meters squared) should be less than 25. If it's between 25 and 30 you're overweight and a BMI of 30 or more is considered obese.

Aside from presenting a problem to the mathematically challenged, the BMI is not a practical way to evaluate an individual. It doesn't take into account the difference between fat and muscle. If a well-trained athlete with a good physique and little body fat weighs as much as a person of the identical height who has become overweight they will have identical BMIs. They will, of course, have very different body shapes.

Realistic nutritionists know that the percentage of body fat, not weight, is what matters and that not all fat is the same. Thigh fat in women is not associated with heart disease but abdominal fat in both men and women is. Worse still is the fat that hides within the walls of the abdomen, so-called visceral fat. Accumulating around coils of intestine, visceral fat is linked to heart attack and stroke even in persons who appear otherwise to have only a slightly enlarged waist.

That large waist is a giveaway to an excess of visceral fat. The scale might lie but the tape measure doesn't. It reveals what scientists refer to as normal weight obese, a condition in which a person's weight appears to be normal for his or her height but whose body fat is greater than 30 percent. These persons usually have a too-large mid-section.

There are lots of ways to measure body fat but all of them are subject to error, some are expensive and others are only available in research facilities. None of that really matters for the average person seeking good health. In order to minimize the risk of heart disease, men should aim for a waist size no greater than 35 inches and women, 33 inches. Men whose waist exceeds 39 inches and women whose waist size is more than 37 inches have a considerably higher risk of heart disease.

Trimming your tummy is not rocket science; it's a matter of sensible substitutions. Replace daily dessert with a piece of fresh fruit; have a colored vegetable in place of pasta, potato or rice just 3 or 4 days a week; add an extra 30 minutes of walking 4 days a week. These measures won't make you feel deprived and they certainly won't leave you feeling hungry. Yet they add up to losing about one pound every 10 days — 35 pounds in a year. And if you never step on that lying scale again it won't matter, because the tape measure always tells the truth.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at