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BEING OVERWEIGHT MAY NOT BE ASSOCIATED WITH EARLY DEATH, STUDY SAYS

By Sandee LaMotte, CNN
Updated 2:36 PM EDT, Wed July 5, 2023
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Being overweight as defined by the body mass index rating scale is not linked to
an increase in death when considered separately from other health issues, a new
study found.

A doctor takes a patient's weight at during an appointment.
Frazao Studio Latino/Getty Images

The good, bad and ugly about BMI

Also known as BMI, the calculation measures a person’s body fat based on height
and weight. As currently used, the BMI scale divides adult populations
into various degrees of body fat.

An adult is considered “overweight” if their BMI falls between 25 and 29.9,
while a “healthy” or “normal” weight is defined as a BMI between 18.5 and 24.9,
according to the US Centers for Disease Control and Prevention. A BMI of 30 or
higher is considered obese.

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“The real message of this study is that overweight as defined by BMI is a poor
indicator of mortality risk, and that BMI in general is a poor indicator of
health risk and should be supplemented with information such as waist
circumference, other measures of adiposity (fat), and weight trajectory,” said
study first author Dr. Aayush Visaria, an internal medicine resident
physician at the Rutgers Robert Wood Johnson Medical School in New Brunswick,
New Jersey.

However, limitations of the study make it hard to determine if the findings are
due to BMI or other factors, according to experts not involved with the new
research.

“The use of the word ‘overweight’ is misleading here, as it excludes anyone with
a BMI above 30. In lay language ‘overweight’ would usually be interpreted as
anyone with a weight above ‘normal’ and would include obese patients,” said Dr.
Baptiste Leurent, a lecturer in medical statistics at University College London,
in a statement.

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“This paper found an unequivocal association between BMI and mortality, before
and after adjustment for risk factors,” said Leurent, who was not involved in
the study.

In addition, observational studies can only show an association, not causation,
said Dr. Robert H. Shmerling, senior faculty editor for Harvard Health
Publishing, a subsidiary of Harvard Medical School in Boston.

“They looked at death rates, but there are other outcomes that are also
important that they didn’t look at, such as quality of life or the development
of new comorbidities such as new cases of diabetes or heart disease,” said
Shmerling, who was not involved in the study.


DEATH VS. DISEASE

In the new study, published Wednesday in the journal PLOS ONE, researchers
analyzed data gathered on over 554,000 non-pregnant Americans older than age 20
from the 1999-2018 National Health Interview Survey and the 2019 US National
Death Index. 

Eli Lilly & Co. corporate headquarters stand in Indianapolis on May 21, 2012.
Victor J. Blue/Bloomberg/Getty Images

Next-generation drug from Eli Lilly boosts weight loss to 24%, highest yet seen
in trials

Visaria and his coauthor, Dr. Soko Setoguchi, a professor of medicine and
epidemiology at the Rutgers Robert Wood Johnson Medical School and Rutgers
School of Public Health, then compared BMI levels with deaths that occurred over
the next 20 years.

The risk of death did rise by 18% to 108% for most people with BMI levels higher
than 27.5, Visaria said, with risk rising as weight increased in a U-shaped
curve.

There was one exception: adults older than age 65. There was no significant
increase in mortality for any older adult with a BMI of between 22.5 and 34.9 —
a range that included those with normal weight, overweight and obesity.

“This paper does not add anything new,” said Naveed Sattar, a professor of
cardiovascular and metabolic health at the University of Glasgow in Scotland,
who was not involved in the study.

“We know that BMI often displays a U shaped curve with mortality, but this is
due to many people (particularly older) at lower end of the BMI range having
unintentional weight loss due to illness,” Sattar said in a statement.

Weight loss often goes hand in hand with development of dementia, cancer and
accompanying loss of appetite in an older population. Prior research has found
losing as little as 5% of body mass increased the risk of premature death among
adults 65 and older, especially for men.

Being overweight may not lead to an early death, but may add to the risk of
chronic disease, experts say.
urbazon/E+/Getty Images

The most significant finding, Visaria said, was for people between ages 20 and
65 whose BMI was between 24.5 and 27.5 — the lower end of the overweight scale.
There was no significant increase in the risk for death.

However, the risk of future disease is “probably a more important measure of
health than all cause mortality,” said Tom Sanders, professor emeritus of
nutrition and dietetics at King’s College London, who was not involved in the
study.

“The main hazard of overweight (BMI 25 - 29.9) and moderate obesity (BMI 30-35)
is a three times greater risk of developing diabetes which contributes to
cardiovascular disease, renal failure and blindness,” he said in a statement.

While the study did control for smoking and a variety of other diseases linked
to early death, that information was only gathered once for each person in the
survey. Therefore, the study could not follow that person to see if he or she
later developed conditions such as hypertension or diabetes that might
contribute to death — a limitation of the study, Visaria told CNN in an email.


nortonrsx/Getty Images

Don’t use sugar substitutes for weight loss, World Health Organization advises

“They also didn’t look at the cause of death — it might have been from a car
accident or something not health-related,” said Shmerling, who is the former
clinical chief of the division of rheumatology at Beth Israel Deaconess Medical
Center in Boston.

“In addition, if you look at the big picture findings, they did find an increase
of mortality with obesity — so it’s not as if they’ve refuted the usefulness of
BMI for all purposes,” he said.

It’s also possible, said Shmerling, that people in the overweight category visit
the doctor more often, make lifestyle changes — such as increasing exercise or
adopting a healthier diet — and get medical care so they don’t develop diabetes,
heart disease or other comorbidities.

“Death due to obesity may be due to development of morbidities like heart
disease, but obesity is also its own independent disease that we know can
independently increase risk of death,” Visaria said. “The issue is how we
diagnose obesity which may not be representative of the risks.”


WAIST CIRCUMFERENCE IS A KEY MEASURE

In addition to BMI, Visaria said the study also looked at data that measured
waist circumference, or the thickest part of the stomach. Results showed using
waist circumference “significantly modifies the association between BMI and
all-cause mortality,” he said.

“People with elevated waist circumference had higher risk of mortality compared
to normal waist circumference within the same BMI groups,” Visaria said in an
email. “In the overweight BMI range (25-29.9), the risk of mortality was 17-27%
higher among people with elevated waist circumference compared to lower waist
circumference.”

FILE- This April 3, 2018 file photo shows a closeup of a beam scale in New York.
U.S. health officials have updated a tool to track rising cases of severe
obesity among children who were previously off the charts. Expanded growth
charts released Thursday, Dec. 15, 2022 by the Centers for Disease Control and
Prevention now include a body mass index of 60 — up from previous charts that
stopped at a BMI of 37. (AP Photo/Patrick Sison, File)
Patrick Sison/AP

Doctors urged to move beyond BMI alone as a health measure

That type of deep fat that surrounds the body’s organs, often called belly or
visceral fat, has been linked to a 39% higher risk for dementia in older women
and heart disease, frailty and early death in both sexes.

Measuring waist circumference should be paired with stepping on a scale as part
of any health assessment, according to guidelines published in April 2021 by the
American Heart Association. Abdominal obesity, as it is known, is defined as a
waist circumference of 40 inches (102 centimeters) or above for men, and 35
inches (88 centimeters) or above for women.

The American Medical Association also recently adopted new guidelines calling
for physicians to use more than BMI when evaluating an individual’s health.

“BMI is based primarily on data collected from previous generations of
non-Hispanic white populations,” the AMA wrote. While it’s “significantly
correlated with the amount of fat mass in the general population, (it) loses
predictability when applied on the individual level.”

The use of BMI as a measure of potential health risk may not disappear from
clinical practice as it does have a place in a thorough workup — but it should
not be the only measure, Visaria said.

However, any discussion over how fat mass is measured does not change what
science knows about the impact of excess weight upon the body, experts say.

“We know from other evidence that the higher our weight, the greater the risks
of developing multiple conditions,” said the University of Glasgow’s Sattar.

“These conditions in turn adversely influence people’s quality of life and their
happiness,” Sattar said in a statement. “It is these ‘quality of life’ metrics
we need to focus more on, and, if possible, try to improve with relevant
interventions at multiple stages of life.”


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vendor level in the “Vendors” link. These settings are accessible on a site or
app specific basis, at any time through the ‘Manage Cookies+’ link located at
the footer of webpages or in application settings. We work in coordination with
an industry framework which will signal your preferences to our participating
vendors. Vendors

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MANAGE COOKIES+

We process your personal data to personalize content and ads, measure the
delivery of such content and ads, to provide social media features, to extract
insights about our properties and as otherwise specified in our Privacy Policy.
We share this information with our Affiliates and Vendors on the basis of
consent. You may exercise your right to consent to a specific purpose below.
Additionally, you may exercise your preferences for consent at a vendor level in
the “Vendors” link under each purpose. These choices will be signalled to our
vendors participating in the Transparency and Consent Framework.
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PLEASE NOTE: CONSENT TO STORE AND/OR ACCESS INFORMATION ON A DEVICE IS REQUIRED
TO CUSTOMIZE AND IMPROVE YOUR EXPERIENCE

STORE AND/OR ACCESS INFORMATION ON A DEVICE

Store and/or access information on a device

Cookies, device identifiers, or other information can be stored or accessed on
your device for the purposes presented to you.

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SELECT BASIC ADS

Select basic ads

Ads can be shown to you based on the content you’re viewing, the app you’re
using, your approximate location, or your device type.

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SELECT PERSONALISED ADS

Select personalised ads

Personalised ads can be shown to you based on a profile about you.

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CREATE A PERSONALISED ADS PROFILE

Create a personalised ads profile

A profile can be built about you and your interests to show you personalised ads
that are relevant to you.

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SELECT PERSONALISED CONTENT

Select personalised content

Personalised content can be shown to you based on a profile about you.

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CREATE A PERSONALISED CONTENT PROFILE

Create a personalised content profile

A profile can be built about you and your interests to show you personalised
content that is relevant to you.

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MEASURE AD PERFORMANCE

Measure ad performance

The performance and effectiveness of ads that you see or interact with can be
measured.

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MEASURE CONTENT PERFORMANCE

Measure content performance

The performance and effectiveness of content that you see or interact with can
be measured.

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APPLY MARKET RESEARCH TO GENERATE AUDIENCE INSIGHTS

Apply market research to generate audience insights

Market research can be used to learn more about the audiences who visit
sites/apps and view ads.

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DEVELOP AND IMPROVE PRODUCTS

Develop and improve products

Your data can be used to improve existing systems and software, and to develop
new products

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ENSURE SECURITY, PREVENT FRAUD, AND DEBUG

Always Active

Your data can be used to monitor for and prevent fraudulent activity, and ensure
systems and processes work properly and securely.

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TECHNICALLY DELIVER ADS OR CONTENT

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Your device can receive and send information that allows you to see and interact
with ads and content.

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MATCH AND COMBINE OFFLINE DATA SOURCES

Always Active

Data from offline data sources can be combined with your online activity in
support of one or more purposes

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LINK DIFFERENT DEVICES

Always Active

Different devices can be determined as belonging to you or your household in
support of one or more of purposes.

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RECEIVE AND USE AUTOMATICALLY-SENT DEVICE CHARACTERISTICS FOR IDENTIFICATION

Always Active

Your device might be distinguished from other devices based on information it
automatically sends, such as IP address or browser type.

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STRICTLY NECESSARY COOKIES

Always Active

These cookies are necessary for the website to function and cannot be switched
off in our systems. You can set your browser to block or alert you about these
cookies, but some parts of the site will not work.

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