The Right Coast

April 25, 2005
David Brooks is fat
By Tom Smith

Fisking Brooks.

My guess is that that new study out in the JAMA would look different if it looked at body fat percentage instead of BMI. And I doubt it would find packing around extra fat does you any good at all.

That study has caused just an eensy beetsy bit of tension around my household. My lovely wife Jeanne has it in for fat. She is an endocrinologist. Spurning my suggestion that she put the umlaut (that little sideways colon thing over some o's and u's in German) back over the o in her name, pull her blonde hair back tightly, wear a tight, starched white doctor coat, and set up as a sex doctor to the rich and horny in Palm Springs (talk about a cash machine!), she ministers to a couple thousand ordinary San Diegans, and sees the ravages of fat every day. Even a mere 15 or twenty pounds of fat makes you more vulnerable to diabetes; LWJ has lots of patients like that. And many more a lot heavier than that. Not to mention coronary complications, etc. etc. She's going to get bad journalistic summaries of this study quoted to her hundreds of times, I predict. And she is not going to like it. She especially resents the spin some journalists are putting on it -- "doctors are selling us a bill of goods again."

Whatever the bloggers are saying, the study really doesn't say you're better off being a little chunky. It could be picking up on a lot of things. First, the lameness of BMI's. Also, as the study itself notes, on the aggressive care you get in this country for various maladies of overweightitude, such as a bad lipid profile, high blood pressure, and so on and on. It may be folks in the slightly overweight class are getting better care for problems people in the upper end of the "not overweight" class ought to be getting. Also, if you have to take drugs (like I do!) for not great lipids, that's hardly an endorsement for fat (as that doughboy Brooks suggests). If you could lose weight, and lose the Lipitor, that would be better, and cheaper.

Fat is very hard to measure, as any Fitness 24 employee can fail to tell you in ten minutes of astonishingly inarticulate babble. The only reliable measure involves putting you in a big vat and seeing how much water you displace, then weighing you and finding your density. (BTW if you notice the water starting to boil, or any dancing going on around the vat, get out immediately.) A surprisingly good measure is waist size. If yours is getting bigger, that's a bad sign. No, gaining muscle will not do that. And yes, it is unfair. Very.

My guess is the JAMA study is picking up on a lot of Americans who get some exercise, at work or for recreation, and are carrying around a bit of muscle that pushes them over into the technically overweight BMI classification, when in terms of fat percentage, they actually are not. (I, for example, am right on the border in terms of fat percentage between acceptable and overweight, at least according to my probably unreliable electronic scale. In terms of BMI, however, I am way into obese, which I ain't.) That would give you the modest longevity advantage the slightly overweight have in the JAMA study, especially given that the actually overweight are getting 40 mg or whatever of statins dropped into their greasy bloodstreams every day, so that in the modestly overweight category, they don't bring their team down very much. That is a far, far cry from saying, being 20 or 30 or 40 pounds overweight is not that big a deal. So put that Big Mac down, you disgusting tub 'o' lard. And pick up a nice glass of red wine instead.