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NEW YORK (Reuters Health) - Obesity's health effects could have more to do with feeling bad about being fat than actually being overweight, a new study shows.
Researchers who looked at a nationally representative group of more than 170,000 US adults found the difference actual weight and perceived ideal weight was a better indicator of mental and physical health than body mass index (BMI).
"The obesity 'epidemic' might have a lot more to do with our collective preoccupation with obesity than obesity itself," the study's lead author, Dr. Peter Muennig of Columbia University in New York City, told Reuters Health. "We still need to focus on healthy diet and exercise as public health officials, but we need to take fatness out of the equation. Were we to stop looking at body fat as a problem, the problem may well disappear."
Some researchers have suggested that stress due to stigmatization could be a factor in the health problems obese people have, such as high blood pressure and diabetes, he and his colleagues note in the March issue of the American Journal of Public Health.
To investigate, they examined data on 170,577 people participating in a study of behavioral risk factors. All had reported their actual weight, perceived ideal weight, and the number of days in the past 30 days when they felt that their physical or mental health was not good.
When the researchers used statistical techniques to control for the influence of age and body mass index, they found that the more dissatisfied a person was with his or her weight, the more "bad days" he or she had. The relationship was strongest in non-Hispanic whites and women.
For example, people who felt they had to lose just 1 percent of their body weight had 0.1 more unhealthy days a month than those who thought their weight was ideal. But women who wanted to lose 10 percent of their body weight reported 1.6 healthy days a month, and those who wanted to pare off 20 percent reported 4.3 unhealthy days.
Men who thought they were 10 percent overweight lost 0.9 days to poor mental or physical health, while those who felt they needed to lose 20 percent of their body weight reported 2.7 unhealthy days each month.
Women experience more stigma for being fat than men, and excess weight may be less acceptable among white people than among African-Americans or Hispanics, the researchers note.
In a study now under review, Muennig said his group found that being overweight doesn't increase mortality in ethnic groups that are more accepting of heavy people. "For instance, African-Americans as a group experience almost no excess mortality, even for women who are 5'5" and 250 pounds," he noted in an e-mail interview.
"There needs to be a realization among public health officials and medical professionals that the messages we are giving the public could be doing more harm than good," Muennig said.
"It has long been recognized that "fat" does not necessarily equal unhealthy. Nonetheless, we doctors often have a very visceral reaction when we see an obese person in our office. This visceral reaction sets off a red light that says, 'tell this person to lose weight.' That is not the right way to approach obesity."
SOURCE: American Journal of Public Health, March 2008.