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- Tables are formulated on specific populations; they may not be applicable to the entire population, particularly those of lower socioeconomic and some ethnic groups.
- The mortality and morbidity related risks of obesity are influenced by concurrent risk factors such as smoking.
- Tables do not provide information on body fat distribution or degree of obesity.
- Frame size as used for estimation of lean (fat-free) body mass is subjectively determined in the 1959 tables. The use of elbow width to judge frame size, as suggested in the 1983 tables, may or may not eliminate the problem.
- Age is not taken into account.
For What Medical Conditions Can Weight Reduction Be Recommended?
Weight reduction may be lifesaving for patients with extreme obesity, arbitrarily defined as weight twice the desirable weight or 45 kg (100 pounds) over desirable weight. When obesity is accompanied by severe cardiopulmonary manifestations, as in the Pickwickian syndrome, weight reduction should be part of the treatment for this medical emergency.
In view of the excess mortality and morbidity associated with obesity (as discussed above), weight reduction should be recommended to persons with excess body weight of 20 percent or more above desirable weights in the Metropolitan Life Insurance Company tables (using the midpoint of the range for a medium-build person). In the 1983 tables, 20 percent over desirable weight is a higher weight than would be obtained by the use of the 1959 tables. The maximum increase is found in those of short stature and does not exceed 17 percent for men or 13 percent for women. Although not a specific recommendation of the panel, use of the lower weights as goals would be advisable in the presence of any of the complications or risk factors summarized below. The body mass index values, which correspond to 20 percent above desirable weight, are 27.2 and 26.9 for men and women, respectively, using the 1983 tables and 26.4 and 25.8 for men and women, respectively, using the 1959 tables. These values are not substantially different from the BMI values for men and women identified with the lower cutoff point for overweight as determined by the National Center for Health Statistics--27.8 and 27.3 for men and women, respectively (NHANES II population, bare feet, no clothes).
Weight reduction is also highly desirable, even in patients with lesser degrees of obesity, in many other circumstances, including the following:
- Noninsulin-dependent diabetes mellitus, a family history of diabetes mellitus, women with a history of gestational diabetes or history of birth of an infant large for gestational age.
- Hypertension (hypertension due to specific, identifiable causes such as renal artery stenosis or pheochromocytoma should be treated for those specific causes).
- Hypertriglyceridemia or hypercholesterolemia.
Weight reduction is likely to be helpful, although the benefits may not be as clear as in the circumstances listed above, in other circumstances, including:
- Coronary artery heart disease.
In any circumstance in which excessive weight imposes functional burdens, weight reduction may improve functioning of the affected system, organ, or region. Such conditions include many common disorders, for example:
- Heart disease of other types.
- Chronic obstructive pulmonary disease.
- Osteoarthritis of the spine, hips, or knees.
Weight reduction in the treatment of these conditions should be under the direction of a physician because accurate diagnosis is needed before treatment is started, and weight reduction may have to be accompanied by other treatments. In addition to physicians, the assistance of other health professionals is critical for treatment in any weight-reduction program. When exercise is prescribed as an adjunct to other methods of weight-reduction, assessment by a physician of the cardiopulmonary risk of exercise is especially important.
The panel views with concern the increasing frequency of obesity in children and adolescents. Obese children should be encouraged to bring their weight to within normal limits. Although childhood obesity does not necessarily lead to obesity in adulthood, there is evidence that it is a significant risk factor for adult obesity. Because dietary restriction can adversely affect parent-child relationships, eating behavior, and growth and maturation, physicians must carefully monitor any dietary restrictions.
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