Prudent clinicians do not push overweight patients to lose weight unless
they have evidence of health risks. Percent of body fat, which can be
estimated based on skinfold thickness and distribution of fat rather than
weight, may be more critical factors in determining medical risk than
weight alone. Risk may increase when body fat exceeds 26-28% in women
and men.
Distribution of body fat is also important. Concentration of fat in the
abdomen in men, and in the upper torso especially around the shoulders
in women, is linked to earlier onset of coronary artery disease and noninsulin-dependent
(type II) diabetes mellitus. For example, risk for cardiovascular disease
increases when the ratio of waist circumference to hip circumference exceeds
0.95 in men and 0.80 in women. However, little is known about what hormonal
and other factors determine body fat distribution, how to alter it, and
how much the associated cardiovascular risks can be reversed. While recent
enthusiasns have surfaced for using growth hormone or testosterone in
men in their 50's - 70's to decrease fat, and to increase muscle mass,
conclusive studies of enduring risks and benefits are not completed. Although
women may not like a gynoid ("pear") distribution of weight, it is safer
in the long run than the android ("apple") distribution. Exercise has
been demonstrated in convincing studies to be an independent health -promoting
factor, especially in formally sedentary people who now regularly maintain
about 4-6 hours of moderate exercise per week. For those people with a
BMI of 26-30 (19-25 is normal), becoming fitter (↑ lean muscle mass
and exercise capacity) appears to be as important as losing weight.
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