Editorial: Overweight, Obesity, or Overfat

ChuckH

Oct 30

A Challenge of Terminology: Overweight or Overfat

Overfat

One of the problems with our current state of diet, weight loss, and obesity in the United States is the language we use. Every article I read refers to weight loss when they mean fat loss. I am no different because I interchange the worse at will. Although I am not as adamant to make a change as the writers of two articles a read preparing for the post, I agree that we need to change our mindset.

Obesity is a pandemic in the world. Based on conservative numbers from the World Health Organization (WHO) 39% of adults are overweight, and 13% are obese worldwide[1]. According to the National Institute of Health (NIH), nearly 70% of United States citizens are either overweight or obese[2]. Clearly, this is a problem that needs to be addressed immediately.

The first article I reviewed was on Science Daily[3] based on a journal article in Frontiers Public Health[4] which puts forward the notion that needs to expand the terminology and add the term overfat. "Overfat" is simply what the word implies. Overfat is the condition of having excess fat in comparison to the person's lean body mass[5]. The body weight may be too high or normal or even low. Normal body weight and elevated body fat have been referred to as normal weight obesity in the past[6],[7],[8]. This article estimated that 76% of the world's population is overfat[9].

Obesity and Complications

Why should we add this term? Overfat is an excellent addition to the terminology because if you have excess body fat, you are more likely to develop central obesity, metabolic syndrome, and the many obesity-related illnesses that come with it (high blood pressure, insulin resistance, diabetes for example). It is also important for us to shift our focus from losing weight to losing fat.

As we age, our bodies adapt our metabolism and we become increasingly less muscular and add central body fat or obesity. This is called sarcopenic obesity[10]. It is a risk factor for metabolic syndrome and insulin resistance.

So why don't we just ditch the term overweight for overfat? It seems like a simple swap but it is not. Weight is more complicated than just being overweight. My muscle-bound friends would like me to skip this one, but I can't. Being overweight even if the BMI is low and body fat percentage is below 18% has its risks. You can't upgrade your chassis so putting a battle tank on a WV Beetle chassis will result in the chassis wearing out. Look at the knee replacement rate for retired NFL players and you will that being overweight has its risks even without excess fat. That being said, higher levels of muscle mass have been shown to lower the risk of diabetes and metabolic syndrome as long as body fat is not also increased[11]. In fact, muscle strength is inversely associated with a risk of all causes of mortality[12].

The importance of this article:

Body fat not weight. This publication acknowledges a need to refocus health changes on body fat loss and not weight loss.
Body Mass Index is a poor measure of obesity or body fat. The article explains the shortcomings of BMI and indicates that waist circumference is a better and more practical measure of overfat or obesity[13],[14],[15].
Overfat Awareness. The change in terminology may alter the focus in individuals and medical providers away from body weight and heaviness to body fat reduction. I have an even easier one to use – pants size.

Recommendation: reduction in body fat and weight is important to a healthy active lifestyle, but body fat loss is more important for health and longevity. Use waist circumference or pants size to follow your progress.

Footnotes

[1]"Obesity and Overweight."

[2]"Overweight and Obesity Statistics."

[3]"Science Daily."

[4]Maffetone, Rivera-Dominguez, and Laursen, "Overfat and Underfat: New Terms and Definitions Long Overdue."

[5]St-Onge, "Are Normal-Weight Americans over-Fat?"

[6]Oliveros et al., "The Concept of Normal Weight Obesity."

[7]Ruderman, Schneider, and Berchtold, "The 'metabolically-Obese,' normal-Weight Individual."

[8]Ruderman et al., "The Metabolically Obese, Normal-Weight Individual Revisited."

[9]"Science Daily."

[10]Sakuma and Yamaguchi, "Sarcopenic Obesity and Endocrinal Adaptation with Age."

[11]Srikanthan and Karlamangla, "Relative Muscle Mass Is Inversely Associated with Insulin Resistance and Prediabetes. Findings from the Third National Health and Nutrition Examination Survey."

[12]Ruiz et al., "Association between Muscular Strength and Mortality in Men: Prospective Cohort Study."

[13]Dagan et al., "Waist Circumference vs Body Mass Index in Association with Cardiorespiratory Fitness in Healthy Men and Women: A Cross Sectional Analysis of 403 Subjects."

[14]Patry-Parisien, Shields, and Bryan, "Comparison of Waist Circumference Using the World Health Organization and National Institutes of Health Protocols."

[15]Shen et al., "Waist Circumference Correlates with Metabolic Syndrome Indicators Better Than Percentage Fat*."

References:

Dagan, Shiri Sherf, Shlomo Segev, Ilya Novikov, and Rachel Dankner. "Waist Circumference vs Body Mass Index in Association with Cardiorespiratory Fitness in Healthy Men and Women: A Cross Sectional Analysis of 403 Subjects." Nutrition Journal. Springer Nature, January 15, 2013. doi: 10.1186/1475-2891-12-12
Maffetone, Philip B., Ivan Rivera-Dominguez, and Paul B. Laursen. "Overfat and Underfat: New Terms and Definitions Long Overdue." Frontiers in Public Health. Frontiers Media SA, January 3, 2017. doi: 10.3389/fpubh.2016.00279
Oliveros, E, VK Somers, O Sochor, K Goel, and F Lopez-Jimenez. "The Concept of Normal Weight Obesity." Progress in Cardiovascular Diseases 56, no. 4 (January 1, 2014): 426–33. [PubMed]
Patry-Parisien, J, M Shields, and S Bryan. "Comparison of Waist Circumference Using the World Health Organization and National Institutes of Health Protocols." Health Reports 23, no. 3 (September 1, 2012): 53–60. [PubMed]
Ruderman, N, D Chisholm, X Pi-Sunyer, and S Schneider. "The Metabolically Obese, Normal-Weight Individual Revisited." Diabetes 47, no. 5 (May 1, 1998): 699–713. [PubMed]
Ruderman, NB, SH Schneider, and P Berchtold. "The 'metabolically-Obese,' normal-Weight Individual." The American Journal of Clinical Nutrition 34, no. 8 (August 1, 1981): 1617–21. [PubMed]
Ruiz, J. R, X. Sui, F. Lobelo, J. R Morrow, A. W Jackson, M. Sjostrom, and S. N Blair. "Association between Muscular Strength and Mortality in Men: Prospective Cohort Study." BMJ. BMJ, August 13, 2008. doi: 10.1136/bmj.a439
Sakuma, Kunihiro, and Akihiko Yamaguchi. "Sarcopenic Obesity and Endocrinal Adaptation with Age." International Journal of Endocrinology. Hindawi Publishing Corporation, 2013. doi: 10.1155/2013/204164
Shen, Wei, Mark Punyanitya, Jun Chen, Dympna Gallagher, Jeanine Albu, Xavier Pi-Sunyer, Cora E. Lewis, Carl Grunfeld, Stanley Heshka, and Steven B. Heymsfield. "Waist Circumference Correlates with Metabolic Syndrome Indicators Better Than Percentage Fat*." Obesity. Wiley-Blackwell, April 2006. doi: 10.1038/oby.2006.83
Srikanthan, P, and AS Karlamangla. "Relative Muscle Mass Is Inversely Associated with Insulin Resistance and Prediabetes. Findings from the Third National Health and Nutrition Examination Survey." The Journal of Clinical Endocrinology and Metabolism 96, no. 9 (September 1, 2011): 2898–2903. [PubMed]
St-Onge, MP. "Are Normal-Weight Americans over-Fat?" Obesity (Silver Spring, Md.) 18, no. 11 (November 1, 2010): 2067–68. [PubMed]
"Obesity and Overweight." Work Health Organization: Obesity and Overweight. Accessed January 7, 2017. http://www.who.int/mediacentre/factsheets/fs311/en/.
"Overweight and Obesity Statistics." National Institute of Health: Overweight and Obesity Statistics, January 6, 2017. https://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx.
"Science Daily." Deeper than Obesity: A Majority of People Is Now Overfat, January 3, 2017. https://www.sciencedaily.com/releases/2017/01/170103122342.htm.