The normalisation of ‘plus-size’ body shapes: How healthy is your weight?

Is it offensive to tell people they are overweight or obese even when it’s hurting their health? Physicians say replacing body-shaming words like “obese” and “overweight” in clinics with politically-correct weight-neutral phrases such as “healthier weight” often interferes with health messaging and the treatment outcomes of common obesity-related disorders, such as diabetes and heart disease.

There’s no doubt that body-shaming is rude and but in clinical settings where disease management must get priority, using weight-sensitive terminology is not enough to convince people make an effort to lose weight for optimal disease management.

The normalisation of ‘plus-size’ body shapes to lower stigma and promote body positivity is unintentionally leading to more and more people in the UK underestimating their weight and not recognising health risks of being overweight, reported a study from UK and Austria this week. Those underestimating their weight were 85% less likely to try to lose weight compared with people who accurately identified their weight status, said the study, published in the journal Obesity.

It found that the number of overweight persons with misperceptions about their weight in the UK went up from 48.4% to 57.9% in men and 24.5% to 30.6% in women between 1997 and 2015, found the study. People with lower education and income were more likely to think their weight was healthier than it was, as were people from ethnic minorities, including south Asians. Ethnic minorities in the UK, though, were more likely to make an effort to lose weight than white populations.

Around 180 million people are overweight in India, including14.4 million children and teenagers between the ages of 2 and 19, reported The New England Journal of Medicine last summer. The numbers are rising rapidly. Over the past decade, number of overweight people almost doubled from 10.5% adults in 2006 to 19.6 in 2016, shows data India’s National Family Health Surveys, the most comprehensive report card on the nation’s health.

Obesity raises the risk of several diseases, such as diabetes, hypertension (chronic high blood pressure), heart disease, kidney ailments, low back pain, joint problems, and several cancers, including of the uterus, breast, gall bladder, colon, rectum and kidneys.

Healthy weight is defined as body mass index (BMI), calculated by weight in kilograms divided by height in metres squared. According to the international BMI range, a BMI of less than 18.5 is underweight, 18.5 to 24.9 is normal, 25 to 29.9 is overweight and 30 or more is obese.

South Asians, however, develop these health risks at lower body weight because they have more body fat and fatty deposits in liver and muscles than Caucasian populations, so they need to have a lower weight-to-height ratio.

Instead of 24.9 being the cut-off for a healthy body weight, south Asians need to keep their BMI less than 23, recommended an expert committee in Journal of Association of Physicians in India in 2009, which have since then been adopted by the American Diabetes Association for all Asians, and in the UK for South Asians.

Foods low in sugar, processed carbohydrates, saturated fat (oils that solidify at room temperature found in animal, dairy and processed products) and high in unsaturated fats (mustard, olive, canola oils), fruit, vegetables, pulses, whole grains and nuts, along with one hour of moderate-intensity activity seven days a week, keeps weight healthy and lowers disease risk.

In the absence of policies that support public transport, urban planning to create pavements and open spaces, improved food labelling, higher taxes on foods high in sugar, salt and saturated fats and banning marketing junk food to children, each of us must ensure our weights are within the healthy range.

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