Are There Really 59 Types of Obesity?

How Understanding the Types Can Improve Weight-Loss Approaches

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The difference between the medical definitions of “overweight” and “obesity” hinges solely on body mass index (BMI), but are there different kinds of obesity as well? Experts are beginning to think so, and, if true, this could help explain why some weight-loss approaches work for some people and not for others.

Difference Between Obesity and Overweight

As noted above, there is a basic difference between obesity and overweight if you use the medical definition based on BMI only.

Overweight is defined as a BMI of 25.0 to 29.9 kg/m2. To be classified as obese, a patient must have a BMI of 30.0 or greater. (Normal BMI is between 18.5 and 24.9.)

A BMI of 40.0 or greater is often referred to as “morbid obesity,” and is recommended by national guidelines as the cutpoint for identifying patients who may be eligible for bariatric surgery.

You’ll note that these differences, while important for medical purposes, don’t take into account anything other than BMI. But many experts are now looking beyond the BMI for insights into defining obesity—and how to treat it.

59 Types of Obesity?

Obesity experts seem to vary in their counts of how many different kinds of obesity there are, but one thing on which they do agree is that there isn’t just one kind of obesity.

One researcher, Dr. Lee Kaplan, Director of the Obesity, Metabolism and Nutrition Institute at Massachusetts General Hospital, told the New York Times in 2016 that he has counted 59 types of obesity so far.

Given that over 25 genes with links to obesity have now been uncovered, it is perhaps not surprising that there would be many different types of obesity with which to contend. Famously, the FTO gene has been identified in recent years as having a definite association with obesity, but others appear to be playing a role as well.

There has even been a genetic link to binge eating that has been identified.

One study, published in the Journal of Public Health in 2015, reported that there are at least six different types of obesity. In this study, investigators looked at data collected from the Yorkshire Health Study between the years 2010 and 2012.

Study participants had been sent survey questionnaires by their general practitioners, and, in all, data on 27,806 people were collected, of whom 4,144 met the medical definition of obesity with a BMI of 30 or more.

The survey asked questions regarding age, sex, socioeconomic status, ethnicity, and health conditions. Health-related quality of life was also assessed. Participants were also queried on topics such as smoking status, physical activity, and alcohol consumption.

The researchers used this information to define groups of individuals with obesity who shared common characteristics beyond BMI alone. In doing so, they concluded that there was enough evidence to identify the following six subgroups, all with a BMI of 30 or more:

  • “Heavy drinking” males
  • Young, healthy females
  • Affluent, healthy elderly
  • Physically ill but happy elderly
  • Unhappy, anxious middle aged
  • Those with the poorest health

    So what did these study investigators finally conclude? That there are many different groups of people with obesity, and that “it is important to account” for these differences “within individuals who are obese.” They went on to suggest that recognizing these differences can have important implications for clinical interventions and policy decisions intended to target and treat obesity, since a “one-size-fits-all” approach is not likely to work.

    Maybe, for instance, the presence of heavy drinking (of alcohol) is the key reason for the development of obesity in the first subgroup of males noted above; if that is the case, the drinking should be targeted and intervened upon as part of any effort to treat obesity.

    That same approach wouldn’t apply to the second subgroup of young, healthy females, who likely have a very different reason (or reasons) for having obesity, and so they would need a different kind of intervention, and so forth on down the list.

    It is worth noting, by the way, that the largest of the six subgroups was the second one, that of the young, healthy females. These were women who drank a bit less alcohol than the people in the other groups and had fairly good quality-of-life scores.

    Need for Different Approaches to Weight Loss

    If nothing else, knowing that there are different types of obesity should lead to the development of different approaches to weight loss.

    If you have obesity, you may have already found this to be the case for yourself: you may have tried a few or several different methods of losing weight already. If you’re like most people, one or more of these methods was recommended to you by a friend or a physician, because it worked for them or for their other patients. But maybe you found it didn’t work for you, even though you gave it your best shot.

    Well, instead of feeling shame that you “can’t” lose weight, now you can take comfort in knowing that, with all the different types of obesity that may be out there, what worked for someone else may not work for you, and it isn’t your fault that it doesn’t work.

    The point is to keep trying until you do find what works for you, because the vast majority of people, regardless of the type of obesity, can, in fact, lose weight—again, given that they find the right weight-loss approach that works for them.

    These weight-loss approaches come in a large variety, with everything from the various dietary approaches to medications to bariatric surgery.

    All of them start and end with a healthy diet, though, so make sure you don’t leave that out. By following some very basic principles of healthy eating, not only will you be on the road to tackling obesity, but, regardless of how much weight you lose, you will also reduce your risk for other chronic diseases like heart disease, diabetes, and cancer. So healthy eating is all-important.

    Similarly, getting regular physical activity, regardless of how much weight is lost, gets your entire body—and your mind—in much better condition, and you will reap the benefits in the long run, in the form of reduced risk of the same bad players: heart disease, diabetes, cancer, and other chronic illnesses.

    Also don’t forget the importance of getting a good night’s sleep, which has increasingly been recognized as key to a whole host of health-preserving benefits. Not only can getting enough sleep on a regular basis help with weight loss and prevent further weight gain, but it enables you to cope better with stress. Adequate sleep is also important, we now know, for preventing heart disease.

    So all of this boils down to taking good care of yourself. Do that, and the rest will come.

    Sources:

    Green MA, Strong M, Razak F, Subramanian SV, et al. Who are the obese? A cluster analysis exploring subgroups of the obese. Journal of Public Health 2015.

    Lordan G, Pakrashi D. Do all activities “weigh” equally? How different physical activities differ as predictors of weight. Risk Anal. 2015 May 20.

    Smemo S, Tena JJ, Kim KH, Gamazon ER, et al. Obesity-associated variants within FTO form long-range functional connections with IRX3. Nature 2014;507:371-5.

    St-Onge M, O’Keeffe M, Roberts AL, RoyChoudhury A, et al. Short sleep duration, glucose dysregulation and hormonal regulation of appetite in men and women. Sleep. 2012;35:1503-10.

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