The Pandemic of Excess Fat Metabolic Health
Updated: May 11
Why overfat, not obesity, is the real concern By Christopher J. Stadtherr, MD
Excess body fat is associated with a wide range of cardiometabolic disorders, as well as most non-infectious chronic diseases.
The traditional measure of body composition, Body Mass Index (obesity defined as BMI > 30), however, is notoriously unreliable, as 30 percent of individuals with “healthy” BMIs are found to be metabolically unhealthy. BMI typically underestimates body fat content, and individuals with large muscle mass are often inappropriately categorized as obese.
What is “overfat”? The presence of excess body fat is more properly defined as “overfat,” which includes the presence of at least one additional risk factor of impaired cardiometabolic or physical health. Excess body fat is measured by increased body fat percentage or waist circumference.
Downstream metabolic consequences of excess body fat are related to chronic inflammation and insulin resistance, such as abnormal glucose, high blood pressure, cardiovascular disease, cancer, and dementia. Some of the negative effects on physical health include low back pain, osteoarthritis, osteoporosis, and reduced productivity. On the other extreme, underfat is also a relevant problem. In addition to starvation-related malnutrition, underfat is also prevalent in chronic illness and in eating disorders.
The majority of people are overfat. It was estimated in 2017 that 91 percent of American adults could be classified as overfat, along with 69 percent of children. Excess body fat in childhood also is a significant risk for overfat status later in life and development of chronic disease. Sadly, and largely due to this overfat pandemic, children now have a lower life expectancy than their parents.
Is “overfat” insensitive? With the negative stigma in our culture over terminology about excess body fat, in recent years, the health care community has avoided using the term “obese” in favor of euphemisms such as “unhealthy weight.” It turns out, however, that the term “obese” is only more upsetting for non-obese patients, whereas obese patients find the euphemism more upsetting.
Focus on the real issue. Terminology such as “overweight” can be misleading, due to the fact that it draws attention away from the real cause of disease, focusing on weight rather than fat. Thus, people may believe that weight loss, rather than specifically fat loss, will improve their health.
In order to solve a problem, one must first understand what matters. Weight is mostly irrelevant, whereas fat content is what’s driving chronic disease. Bottom line: Measure what matters.