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Is Fat the New Normal?

A rise in average body weight may be changing how we see ourselves.

From the WebMD Archives

If you're tall enough to stand out in a crowd, you're probably aware of your tallness – maybe even self-conscious about it. But imagine that you're in a room full of basketball players. Suddenly, you don't seem so tall anymore. Your above-average height feels normal.

The same scenario -- but with weight, not height -- may be happening throughout the U.S.

According to the CDC, two-thirds of Americans are overweight or obese. Now that the average body weight tends toward plump rather than svelte, the perception of what's normal may be sliding. And that may have health consequences that are flying under your radar.

The New Normal

The average American is 23 pounds heavier than his or her ideal body weight. If we equate "normal" with average, it's not much of a stretch to say it's normal to be fat.

"For children and for many adults who are overweight, they are starting to perceive themselves as the new normal," says obesity expert Robert F. Kushner, MD, MS. Overweight people may dismiss their weight, he tells WebMD, because they feel "everyone else looks exactly the same." Kushner is a professor at Northwestern University's Feinberg School of Medicine and clinical director of the Northwestern Comprehensive Center on Obesity.

"It's quite clear that people are changing their idea of what an acceptable body size is," says Nicholas Christakis, MD, PhD, of Harvard Medical School. As the average body weight goes up, there's more acceptance of heavier body types. This, in turn, clears the path for even more people to put on weight, says Christakis, who is the co-author of Connected: The Surprising Power of Our Social Networks and How They Change Lives.

Are Americans Really Getting Fatter?

The rate of obesity has climbed dramatically in the past 20 years: A third of adults are obese today, compared to 23% in the late 1980s. But this trend may have reached a plateau. According to a new study in the Journal of the American Medical Association, the obesity rate has not changed significantly in the past few years.

That's no reason to become complacent, Kushner says. "The prevalence of obesity is leveling off, but it's leveling off at flood stage. So we need to turn that around."


Is Weight Gain Contagious?

How did we get to that "flood stage" of obesity? Maybe you should look around you.

"Our work suggests that weight gain spreads in social networks," says Christakis, who has researched the spread of obesity.

His findings, published in The New England Journal of Medicine in 2009, show that your odds of becoming obese rise by 57% if you have a friend who becomes obese and by 40% if your sibling becomes obese."We're social animals," Christakis says. "We're influenced by the choices and actions and appearance and behaviors of those around us."

In short, our social contacts -- the people in our lives -- have a big influence on what we eat, how much we exercise, and how we judge our own appearance. This may help explain why obesity rates are not the same throughout the country. In fact, there are what might be called obesity hotspots.

Obesity Hotspots

Jana Gordon Bunsic, DO, has seen evidence of this first-hand in her practice. She's a board-certified family physician and clinical nutritionist in Morristown, Tenn. – a town in a state with one of America's highest obesity rates.

"Upon moving my family and my medical practice to east Tennessee, I was immediately surprised by the prevalence of obesity in the area," says Bunsic, who used to live in south Florida. She cites a culture that's fond of "biscuits and gravy," as well as too little exercise. "The society is quite rural, and few people walk or ride bikes from place to place."

With obesity being so common, Bunsic finds her patients have a skewed idea of what's normal. "A 16-year-old patient came in with his mother the other day," she recalls. "By following my recommendation, he had lost 45 pounds… His mother was very concerned he was starting to become too thin" even though he was still overweight by medical standards.

Changing Perceptions

Skewed perceptions are not confined to Tennessee.

"It's taking more and more weight as time goes by for people to judge themselves heavy," Christakis says. In a study using government data, he found that obese people generally knew they were obese 20 years ago. That's not necessarily the case anymore. In 2007, a National Consumers League survey showed that although 34% of adult survey participants were obese, only 12% said they had ever been told that by a health care professional.

Contributing to these changing perceptions is a fashion trend known as vanity sizing. Manufacturers have made clothing sizes more forgiving over the years. "This is making women feel good about themselves," Kushner says, "but the bad thing is it's supporting the weight increase in the population."


Pros and Cons of a New Normal

Kushner sees two positives in society's changing views of weight. One is that overweight people "don't tag so much of their self-esteem to weight," Kushner says. The other is that women of a healthy weight are less likely to see themselves as fat. With so much more of the population being truly overweight, those in the healthy category may feel slim by comparison.

But Kushner cautions that there is a downside, particularly for the obese. If people don't recognize that they have a problem, they'll be less motivated to lose weight, he says. And although the social norms may be changing, the health risks of obesity are not.

Health Risks of Obesity

"It's clear that being overweight is bad for your health," Christakis says. This does not mean that everyone who is overweight will develop health problems, but the risks are well documented. Excess weight has been linked to diabetes, arthritis, heart disease, and some forms of cancer. And last year, a study found that weighing a third more than your ideal weight could take three years off your life.

"Many [patients] intuitively know their weight is a big part of their diabetes, hypertension, lower extremity swelling, and feeling poorly," Bunsic says, "but they have never had a doctor tell them that their weight was a root cause." To turn the situation around, she says doctors should counsel patients about the dangers of being overweight and help them develop accurate perceptions of what is normal.

Christakis agrees, but he says health professionals must handle the issue of weight delicately. "People could tell their patients, ‘When you make an effort to lose weight, it doesn't just benefit you.'" The bottom line: Healthy habits tend to spread among social contacts. So when you make a positive change in your life, it may also affect the people you care about.

WebMD Feature Reviewed by Louise Chang, MD on 6/, 010



News Release,CDC.

Robert F. Kushner, MD, MS, professor, Northwestern University Feinberg School of Medicine; clinical director, Northwestern Comprehensive Center on Obesity.

Nicholas Christakis, MD, PhD, professor, Harvard Medical School; co-author, Connected: The Surprising Power of Our Social Networks and How They Change Our Lives.  

CDC: "U.S. Obesity Trends."

CDC: "Prevalence of overweight, obesity and extreme obesity among adults: United States, trends 1960-62 through 2005-2006."

Flegal, K. Journal of the American Medical Association, January 2010; vol 303: pp 235-241.

Christakis, N. TheNew EnglandJournal of Medicine, July 2009; vol 357: pp 370-379.

Jana Gordon Bunsic, DO, board-certified family physician and clinical nutritionist in Morristown, Tenn.

Chang, V. American Journal of Preventive Medicine, May 2003; vol 24: pp 332-339.

News release, National Consumers League.

WebMD Health News: "Being Overweight Shortens Life Span."

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