The Health Risks of Being Overweight or Underweight

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More than half of all American men are overweight, and a third of all American men are obese (weigh more than 20 percent more than their ideal body weight). Being overweight is a major risk factor for a number of chronic diseases, including heart disease, high blood pressure, stroke, diabetes, and certain forms of cancer. Even a small reduction—as little as 10 percent—in body weight can decrease your chances of developing the most common chronic disorders as you get older. If you already have a health problem, losing weight can help you manage your condition. In some disorders, such as diabetes, weight loss can help reduce and even eliminate the need for medication.

Heart disease is the number one cause of death in American men. High blood pressure is a major risk factor for stroke, which can lead to permanent disability and death. You can reduce your risk of developing heart disease, high blood

70 pressure, and stroke if you keep your weight within a healthy range. However,

Staying the number of pounds you weigh is not the whole story. You also need to know

Healthy where your body stores fat. If you are like most men, your body stores fat around the abdomen, and a large amount of abdominal fat raises your likelihood of developing heart disease and diabetes. Regular aerobic exercise (see page 56) is the best way to get rid of abdominal fat. Also, if your waist measures more than 40 inches, you are more likely to develop heart disease, high blood pressure, or diabetes. Your body mass index (BMI; see page 18) is another important indicator of heart disease risk. Strive to maintain your BMI between 18.5 and 24.9 for optimal health.

Obesity is the top contributing factor to high blood pressure. Losing a modest amount of weight—even just 10 pounds—could return blood pressure levels to normal in many of the millions of men who have high blood pressure. Men who take blood pressure medication could substantially reduce or even eliminate their need for the drugs if they lost a modest amount of weight. Blood pressure readings go down within the first 2 or 3 weeks of such a weight loss. The percentage of your body weight made up of fat seems to affect your blood pressure more than total body weight, so exercise that builds muscle, such as strength-conditioning exercises (see page 57), also can help keep your blood pressure lower.

More than 16 million Americans have type 2 diabetes (see page 367); one third of them do not know that they have the disease because it has no symptoms in the early stages. Type 2 diabetes is characterized by increased levels of sugar in the blood because the body does not respond adequately to the effects of the hormone insulin, which regulates blood sugar levels. Diabetes can eventually produce serious complications, such as blindness, kidney disease, and poor circulation (which sometimes leads to amputation of the lower limbs). Men who have diabetes also have higher rates of heart disease, stroke, and high blood pressure than do men who do not have the disease. Uncontrolled diabetes also can cause life-threatening events such as diabetic coma.

Type 2 diabetes tends to run in families, so if you have relatives who have diabetes, your own risk of developing the disease rises. But being overweight is an even stronger risk factor than heredity. Regardless of family history, overweight men are twice as likely to develop diabetes as men who are not overweight. This means that, even if you have a family history of diabetes, you can prevent or at least delay the onset of the disorder by keeping your weight within a healthy range and by increasing your level of physical activity. If you already have diabetes, losing weight and exercising regularly can help control your blood sugar levels and could make it possible for your doctor to decrease the amount of medication you need to control your diabetes.

Colorectal cancer is the second most common cause of death from cancer in the United States, and being overweight increases your risk of developing the disease. Although some risk factors, such as family history, are beyond your control, being overweight is not one of them. If you have a family history of colorectal cancer, you should be especially careful about maintaining a reasonable weight. And be sure to limit your consumption of red meat and animal fat; a high-fat diet that includes large amounts of meat also increases your risk for this type of cancer.

Being overweight puts extra pressure on your joints, especially those in your knees, hips, and lower back. Because of this extra pressure, the cartilage (the tissue that cushions and protects the joints) gradually wears away, causing a form of arthritis known as osteoarthritis (see page 308). Over the years, the damage to the joint may be so extensive that the joint must be replaced surgically. This damage is permanent and cannot be reversed. Inflammation of the tendons, called tendinitis (see page 306), is another common problem in overweight people. Tendons can become irritated and inflamed (especially the Achilles tendon, which stretches from your calf to your heel) from simple, everyday activities such as walking. Losing weight decreases the stress on your joints and tendons and reduces wear and tear. Weight loss also may reduce the pain and inflammation of osteoarthritis.

Sleep apnea is a serious condition that is closely linked to being overweight. The condition can cause you to snore heavily and to stop breathing for short periods during sleep. Breathing can halt for 20 seconds or more, sometimes causing the skin to turn blue. Sleep apnea often causes daytime sleepiness and can be a factor in heart failure because of chronically low oxygen levels in the blood. Weight loss usually improves the condition.

Another health risk of being overweight is gallbladder disease and gallstones. The risk of gallbladder disease rises as your weight increases, although doctors do not yet fully understand the connection between the two. Ironically, weight loss itself, especially if it is too rapid, can actually increase your chances of developing gallstones. A modest weight loss of about 2 pounds a week is less likely to cause gallstones.

Although less common than in women, eating disorders such as anorexia nervosa and bulimia nervosa affect men, too. Estimating the number of men affected can be difficult because men don't often talk about such problems or seek help for them. However, the incidence seems to be increasing as a new generation of men becomes more concerned about body image. Of the people being treated for eating disorders, about 10 percent of those with anorexia and about 20 percent of those with bulimia are men. Eating disorders are most common in men who are distance runners, wrestlers, and football players.

The symptoms of anorexia (self-starvation, an irrational fear of being fat, compulsive exercise) and of bulimia (binge eating followed by self-induced vomiting or laxative abuse) are the same in both men and women. However, men often develop an eating disorder as a result of a desire to enhance sports

Maintaining a Healthy Weight

72 performance or to overcome past weight problems, whereas women often

Staying develop an eating disorder as a result of an unrealistic body image. Also, body

Healthy building and weight lifting have a much larger part in the excessive exercising that men with an eating disorder undertake than they do for women. Some men with an eating disorder use anabolic steroids (see page 14) to increase muscle tone and to improve strength. The affected man can become so obsessed with exercise that he begins to display exercise addiction, characterized by acute anxiety when he misses a workout and preferring exercise over time spent with family or friends.

The underlying causes of an eating disorder include a lack of self-esteem, an inability to handle stress, and sometimes sexual abuse in childhood. The man feels that controlling his intake of food gives him more control over his life in general. Most men with an eating disorder first develop it in adolescence. Although homosexual men often face pressure to be thin and attractive, placing them at a higher risk for developing an eating disorder than heterosexual men, homosexual men make up only about 20 percent of all men who have an eating disorder.

In addition to severe weight loss, anorexia can produce decreased blood levels of the hormone testosterone. The problem can become so serious that the body's major organ systems are affected. As many as 10 percent of all people with anorexia die of the disorder. The binge-purge behavior that is characteristic of bulimia can interfere with the delicate balance of chemicals in the body. Fatigue, seizures, and an irregular heartbeat can result. Stomach acid contained in vomit can damage the lining of the esophagus (the muscular passage that connects the mouth and the stomach) and corrode tooth enamel.

A relatively new type of eating disorder, called muscle dysmorphia, has emerged. This condition appears mainly in body builders who, in spite of being very muscular, fear that they look thin and out of shape. The disorder arises from the same body-image issues as those contributing to anorexia and bulimia in women.

If you think you may have an eating disorder, see your doctor right away. The doctor will conduct a thorough examination to find out how severely you are affected. He or she will assess your weight and ask you a number of questions, including whether you binge and then purge yourself of food and if you use laxatives, diuretics (drugs that cause the body to pass water), diet pills, or anabolic steroids. The doctor will perform a comprehensive physical examination, including laboratory testing to find out if any hormonal imbalances are present. If your doctor determines that you have an eating disorder, he or she will probably recommend a combination of psychotherapy, nutritional education, and counseling to treat your condition. Hospitalization may be required in severe cases.

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