So there’s a story in today’s Boston Globe, which reports that slightly more than half of overweight adults are healthy, as measured by their cholesterol levels and blood pressure (and a few other things, basically measuring ‘metabolic health’). And not a few (about one quarter) of people of ‘normal’ weight were unhealthy by those measures.

Well, that’ll set the fox in the henhouse, won’t it?

Let’s have a look at the original, shall we? It does say about what is reported (have a look), but is interesting for what else it says:

“The independent correlates of 0 or 1 cardiometabolic abnormalities among overweight and obese individuals were younger age, non-Hispanic black race/ethnicity, higher physical activity levels, and smaller waist circumference.”

So, young white people who exercise and have smaller waists than hips are healthier than you might expect based on their body mass index. What does this tell us? Mostly, it tells us that BMI is a blunt instrument with respect to measuring cardiovascular health. If you’re paying attention at all, this is not news, although it is nice to have it confirmed by a data set as large as NHANES (National Health and Nutrition Examination Survey-it’s a Really Big, Really Good data set). Basically, obesity is not as big a problem as fat distribution. To quote the paper: “There is not yet a standardized definition of body size phenotype”. Perhaps we should work on that, because where the fat is, and whether you are ‘physically active’, may mean more in terms of health than BMI alone. So, now wither obesity prevention? Because it’s going to be hard to base any kind of health intervention on BMI, which is what we’ve been doing for a while now.

This matters for a couple of reasons. If you’re going to design an intervention with respect to obesity (and believe, me, a lot of money is going to be spent on this in the upcoming few years), you need to point the money at the right problem. And BMI is looking like the wrong problem. So what is the right problem? We’re getting a grip on it, but we need a ‘standardized definition of body size phenotype’. We also need to get a grip on activity. How do activity and ‘body size phenotype’, whatever we decide that is, interact? Which is more important, or are they interacting terms?

And this matters right now. I interviewed today for a position at a local health care think tank, which has a sizable initiative on obesity intervention. What is the future of that initiative, in light of these findings? It’s not dead, but it might need significant reworking in light of this paper. The nice part is, if I get the job (it’s an internship, but hey, still a job as far as I’m concerned), I might get to do some of the rework.

Ain’t science grand?