Do You Really Need to Lose Weight?

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7 questions that can help you decide

By Dulce Zamora
WebMD Weight Loss Clinic - Feature

Reviewed By Charlotte Grayson, MD

So your favorite jeans have gotten a bit too close-fitting for comfort. Maybe you don't cut quite the figure in your bathing suit that you did a few years ago.

But do you really need to lose weight? Are you putting your health in danger -- or just carrying around a little harmless extra padding?

The standard answer is that you're overweight if your body mass index (BMI) is 25 or higher and obese if your BMI is 30 or higher. But some new research is confusing the weight-and-health issue a bit.

A study published in the April 20 issue of The Journal of the American Medical Association (JAMA) found that people whose BMIs put them into the overweight category actually had a lower risk of death than people in the normal-weight group. (People who were considered obese still had an increased risk of death.)

"When we looked at the overweight group we found that that group was associated with fewer than the expected number of deaths," says study author David F. Williamson, PhD, senior epidemiologist at the Diabetes Division of the CDC. Does that mean that if you're overweight, but not obese, you should quit worrying about dropping the extra pounds? Experts who spoke to WebMD gave us some answers -- along with seven questions you should ask yourself.

• What is your lifestyle? Regular physical activity and healthy eating are important, no matter what your weight or your BMI.
• What is your family history? If a close relative has a history of high blood pressure, heart disease, diabetes, or other weight-related ailment, it's crucial to be mindful of your weight.
• What is your weight history? People who have consistently gained weight over the years need be careful. Experts say your BMI should not increase dramatically, even as you age. Even moderate weight gain in adulthood can increase your risk of diabetes.
• How is your weight distributed? Weight gained above the hips -- the so-called "apple" shape -- can be problematic. In both men and women, bigger abdomens can signal trouble.
• What is your waist size? The National Institutes of Health has determined that a waist circumference of over 40 inches in men and over 35 inches in women signifies a health risk, particularly in people with BMIs of 25-34.9 (the overweight category). Clothing size is not a good indicator of weight or health, since sizes vary with different manufacturers. But you can use your own clothing -- maybe a favorite pair of pants -- as a personal gauge of your weight.
• What is your health profile? If your cholesterol and blood pressure levels are high and your BMI falls into the overweight or obese category, it's important to lose weight. If your BMI is in the high end of healthy or in the low overweight range, it's a good idea to talk to your doctor about whether weight loss is right for you.
• How do you feel? Seriously consider weight loss if you are overweight and have joint problems, shortness of breath, or other health troubles that limit your day-to-day living.

The Body Mass Index

To understand the issue of weight and wellness, you first need to understand the BMI, the common measure of fatness that is at the heart of the debate.

To find your BMI, you multiply your weight (in pounds) by 705, then divide twice by your height (in inches). A BMI of:

• 18.5 or less is considered underweight
• 18.5-24.9 is considered ideal weight
• 25-29.9 is considered overweight
• 30 or higher is considered obese

Many doctors and researchers say the BMI is a useful tool to determine whether someone is overweight or obese, though they concede it has limitations. But critics say the BMI is an inaccurate gauge of wellness.

"This overweight category of body mass index of 25 to 29.9 is a phony category. It doesn't have medical justification," says Paul Campos, JD, a law professor and author of The Diet Myth: Why America's Obsession with Weight Is Hazardous to Your Health.

Campos says the BMI was developed as a statistical sorting tool for researchers and was never meant as a gauge for weight loss.

"It just doesn't make sense," he says, pointing to muscular celebrities such as Matthew McConaughey and Brad Pitt, who he says would be considered too heavy based on their BMI numbers.

The well-muscled and the big-boned have often found themselves in the BMI's overweight or obese categories, a frequent criticism of the body fat measurement. Indeed, one recent study found that more than half of National Football League (NFL) players were obese according to their BMIs.

Patrick M. O'Neil, PhD, director of the Weight Management Center at the Medical University of South Carolina, agrees that BMI numbers alone should not be used to determine whether someone needs to lose weight. It's important to believe one's eyes, he says.