Diploma in Weight Management Consultancy · DIPLOMA IN WEIGHT MANAGEMENT CONSULTANCY 2 associated with many severe and minor ailments and impediments. This may narrow down with some

Diploma

in Weight Management

Consultancy

Section 2

courses@plaske ‐interna onal.com www.plaske ‐interna onal.com

THE PLASKETT INTERNATIONAL COLLEGE © Dr Lawrence Plaskett

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DIPLOMA IN WEIGHT MANAGEMENT CONSULTANCY

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CONTENTS

Topic Nos Topic Page No

SECTION 2 PART 1—UNDERSTANDING THE FIELD

PART 2—THE NATURE OF THE PROBLEM

1 Introduc on to Part One 3

2 The Aims of the Work 4

3 The Clients’ Mo ves 4

4 The Clients Themselves 5

5 The Clients’ Knowledge of Nutri on 5

6 The Place of Psychology 6

6.1 A First Look 6

6.2 Emo onal A achment to Foods 6

6.3 Peer Pressures 6

6.4 Family Pressures 7

6.5 What Makes One Feel Well or Ill 8

6.6 Importance of the Client’s Blood Sugar Level 9

7 The Arithme cal Equa on of Body Weight 10

7.1 The Nature of the Equa on 10

7.2 You Cannot Destroy Neither Energy Nor Ma er 11

7.3 Translate the Equa on in Prac cal Ma ers 11

7.4 The Orthodox and Alterna ve Almost Agree 11

8 8 Ways of Working 12

8.1 Variety of Approach 12

8.2 Use Combina ons of Different Approaches 12

8.3 The Consultant’s Exper se Manipulates the Available Methods 13

9 Ge ng Fat is all too Easy—We Review how it Happens 14

9.1 Introduc on to Part 2 14

9.2 Most of us have a Declining Food Intake 14

9.3 Energy Intake Reduc on has Spanned Decades 15

10 Defini on and Classifica on: Criteria for Weight Normality 16

10.1 We all Know What Obesity Looks Like 16

10.2 Where Should One Draw the Line to say Who is Obese? 16

10.3 Using the Criterion of Body Mass Index (QI) 18

10.4 Standards of Normality according to USA Figures 20

10,5 Prevalence 21

10.6 Obesity in Children 22

10.7 Mortality and Morbidity and the Yards cks for Op mum Weight 23

10.8 Indica on of Op mum Weights 24

References 26

Checkpoint 27


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SECTION 2

PART 1 ‐ UNDERSTANDING THE FIELD

PART 2 ‐ THE NATURE OF THE PROBLEM

1 Introduc on

This first sec on simply introduces the basic ideas of the training. It is quite highly

simplified for the sake of those who have not touched this subject before. We make li le

apology for this, since these basic ideas are essen al and if you have done any study within

the field before, we ask you to be pa ent but s ll take note, please, of the essen al

principles that we set out below.

The purpose of this course of training is to enable you, the student, to help others who are

overweight or obese to lose weight and to do so in a professional manner. At the same

me, it aims to mo vate you and empower you to set up a prac ce as a Weight

Management Consultant that will lead to your gaining a good reputa on in this field,

developing a panel of sa sfied clients and bringing you both status and income. These

things would not be possible if losing weight were easy. If it were, then most people would

be of normal weight and there would be no prospects of se ng up a good and thriving

business as a “Slimming Consultant”. Since losing weight is not easy, one has to be aware of

all the different methods and ramifica ons that are a part of this intriguing subject. The

professionalism comes from knowing a number of different “ways in” to help the clients

and also from being able to develop awareness of the individuality of each client. This will

put you in a posi on to find the best and most successful route to weight loss for each

person who consults you. This will mean giving individual advice, not just the same advice

to everyone. By recognising individuality we earn the client’s trust and apprecia on and we

also increase the chances of achieving the fullest possible success by being in a posi on to

find individual solu ons to each client’s problem.

Introduc on


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2 The Aims Of The Work

As in any professional service, the client is king. It is he or she, the client, who is paying you

and in so doing making you a living. Let us trust that it is going to be a good one. However,

the professional person is one with a professional a tude. The professional must think

“how can I render the greatest service to this client and help him or her to reach his or her

goals, and generate sa sfac on with my services?” There is another aspect also. The

professional Weight Management Consultant should go well beyond merely achieving the

client’s slimming goals. The Weight Management Consultant needs to be able to achieve

these while also having a very clear view about protec ng the client’s wider interests. Not

all methods of slimming are health‐giving and some of the available methods are not even

compa ble with the best of health. Above all the Weight Management Consultant needs to

be able to enable the client to achieve his or her slimming goals while also suppor ng,

protec ng and, indeed, improving the client’s general health. Most people who have put

themselves into the posi on of advising on slimming are not very well informed about

improving the underlying health status of the client. Most have not been trained properly

to do so. You are going to be different and your clients should for the most part end up

with a greater prospect of future freedom from chronic illness, not only as a result of their

reduc on in weight, but also generally, through be er cellular and ssue health

throughout the body. As a professional you will definitely owe your clients a duty of care

that rejects the idea of a aining slimming goals at the cost of undermining (to any degree)

the client’s general health.

3 The Clients’ Mo ves

The clients who come to you for help are likely to range from those who are just slightly

overweight to those who are colossally obese. Their range of mo ves for seeking help will

be wide but all of these mo ves are generally well known. They may seek to improve their

appearance generally in order to advance their social contacts and friendships, or their

chances of mee ng members of the opposite sex and hence improving prospects of close,

sexual and/or life partnerships. Some may a end on account of a demand from their

partners, who are fed up with seeing them in their overweight or obese condi on. Others

may have health as their primary goal, being aware that overweight and obesity are

Aims of the Work The Clients’ Mo ves


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associated with many severe and minor ailments and impediments. This may narrow down

with some clients, so that the goal may be improving mobility, perhaps by reducing the

wear and tear of the skeletal structures in arthri s. Some may have athle c aspira ons and

overweight can be a great impediment for them. In some cases employment opportuni es

may be at the root of the client’s goals, either because weight reduc on is needed to

perform manual work to a good enough standard or simply for reasons of presenta on, i.e.

the job applicant, and a erwards the job‐holder needs to look lithe and ac ve! The

Weight Management Consultant needs to appreciate the clients’ mo ves and needs in

order to do the job properly. This will enable you to develop yards cks of success, not only

in terms of pounds or kilos of weight lost but also in terms of results and outcomes in the

drama of the clients’ lives.

4 The Clients Themselves

The Weight Management Consultant must expect to be consulted by clients of all ages and

both sexes. It is usual for women to predominate among them, showing a propor onately

greater concern about overweight among women than among men. To some extent help is

sought more during the years when “a rac veness” is a cri cal issue, but nonetheless you

must expect to be consulted by people in the very young and very old age groups. The very

young are usually brought by their worried parents, for obvious reasons, and may or may

not have been referred by medical prac oners or other types of health consultants.

5 The Clients’ Knowledge of Nutri on

A good propor on of the clients will be found to already possess quite full knowledge of

which foods are fa ening and which foods are not. They may even be able to put together

quite good diets and menus for themselves. These clients are obviously in rela vely li le

need of what we might call “technical” consultancy from you and the emphasis during the

me you spend with them will have to be on why it is that they have not converted their

knowledge into effec ve ac on. This is a very common type of situa on. In other cases,

there will be a sizeable gap in the client’s educa on where calories and food types are

concerned and he or she may have very li le idea of basic concepts of designing a diet and

a rou ne that would be conducive to weight loss. Inevitably, there will also be

The Clients Themselves The Clients’ Knowledge of Nutri on


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intermediate situa ons in which the client possesses at least some scanty outlines of good

nutri on in rela on to weight loss.

6 The Place of Psychology

6.1 A First Look

Probably it will not surprise our students to learn that, in slimming, the psychological

approach of the client is of the utmost importance. With reference to 1‐5 above, clients

who have an understanding of basic nutri onal principles will, in effect, already know the

main things that they need to do to lose weight. For these people, your role as consultant

will not be primarily to inform them about what they need to do about food choices

(although you may, of course, help them to hone and improve the knowledge they have)

but rather, you will be concerned with enabling these clients to apply what they already

know successfully. This is not a ra onal posi on. Ra onally one should be able to apply

what one knows (so long as it is not technically difficult to do). Choosing foods is not

technically difficult, but rather, it may be emo onally difficult. With these more

knowledgeable clients, your main role will be to help to overcome this emo onal difficulty

and hence enable them to overcome the essen ally emo onal block to becoming slimmer.

6.2 Emo onal A achment to Foods

One will also have to understand what lies behind these emo onal difficul es. The causes

of the problem are partly cultural. The foods with which one was brought up are usually

foods to which one has an emo onal a achment and changing them becomes, therefore,

an emo onal wrench. Another aspect of the cultural block is concerned with the image

that certain foods have in one’s society.

6.3 Peer Pressures

Some foods may be thought of as being the ‘right’ things to eat and hence they are the

source of peer pressure to eat those foods. This does not mean that one’s peers

The Place of Psychology


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necessarily believe that these par cular foods are the healthiest. One’s peers may know

be er than that. However, the foods in ques on may be thought of as ‘OK’ foods from a

social viewpoint. Indeed, socially acceptable foods are very o en not par cularly healthy at

all – o en quite the opposite. Very o en these foods are what we call “calorie‐dense”,

meaning that they have high calorie content per unit weight, e.g. a high content of calories

per gram, per 100 gram etc. Hence, they may promote over‐weight rather than weight

loss. Where social acceptability conflicts with slimming priori es, it is the slimming

priori es that tend to lose out. The client opts to be socially ‘OK’ rather than to be slim.

The conflict involves an emo onal conflict that is played out in the client’s mind, but o en

on a subconscious level, so that the client, when ques oned, appears not to understand

even that this specific conflict has been going on.

6.4 Family Pressures

Other areas of difficulty include family ones. Family members can apply pressures all too

easily. In par cular, over‐weight family members may well apply pressures to disregard

good ea ng habits for fear of having their own nega ve ea ng habits shown up. They

prefer to have company in persis ng with bad ea ng habits that promote overweight, so,

as a result, the en re family becomes and stays over‐weight. Again, some of the

difficul es can be prac cal ones, but no less difficult for that. For example, the person who

does the shopping and prepares food in the family may be unaware of the precau ons

needed to avoid being or becoming over‐weight or, if not unaware, may be deliberately

avoiding making any changes to improve the family diet. There are people who adopt a self

‐defensive posi on with regard to food, diet and weight issues. These are the people of

whom we say that they “have their head in the sand” – reminiscent of the ostrich! If there

is a person or persons like this in the client’s family, then slimming is going to be hard for

them. Moreover, if one of these people happens to be in charge of buying and preparing

the family’s food, then the ma er becomes doubly difficult. Even though some of the

above family situa ons are of a prac cal nature, they give rise to emo onal consequences

and produce an emo onally difficult situa on from which it is hard for the client to escape.



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6.5 What Makes One Feel Well or Ill?

Another category of difficulty may arise from the client’s own experience of “how he or she

feels” a er ea ng par cular foods. If the client feels good a er ea ng a food, he or she will

naturally tend to want to eat that food o en. Yet this may give rise to, and prolong, habits

that run contrary to the aim of losing weight. We all know, only too well from experience,

that in these circumstances the weight‐loss objec ve tends to come second place to the

“feeling good” objec ve. Hence, a client who feels markedly be er a er ea ng bread, for

example, is likely to con nue to eat bread even though bread is a carbohydrate food that

tends to make one desire more of it. With bread, it is not so much the calories per unit

weight that ma ers, because oats and rice have similar calorie content, but rather that

bread is a food that easily sets up the desire for more of it. Habitual bread eaters can easily

eat their way through half a loaf of bread before they have thought about the

consequences. Of course, this situa on is not peculiar to bread only, and several other

foods can exhibit a similar phenomenon. This “feeling good” effect may arise from all sorts

of different reasons.

It may have a purely psychological basis wherein the image that the food produces in the

client’s mind gets translated into the desire to eat the food. In Western countries, or

countries with a Westernised lifestyle that includes much meat and dairy produce, this can

o en happen with meat or milk consump on. These are the emo onal a achments

referred to already. The desire for the food then arises, perhaps, from the food’s image as

being high protein (even though that is not necessarily a good thing) and as being

nurturing and rich and, in the case of milk and milk products, associated with infant and

childhood nutri on. The idea here seems to be that food that is good for infants must also

be good for everyone else. Some mes wheat can also be linked to a similar psychology,

being seen in the West as “the staff of life” and being associated with a religious authority

(i.e. biblical references to bread).

Some mes people feel good a er ea ng a par cular food for a physiological reason. For

example, if the client is prone to producing too much stomach acid and hence suffer from

and over‐acidic stomach, then ea ng a food that neutralises or buffers the excess acid will

produce a lessening of the diges ve discomfort that the sufferer experiences. That will be



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translated into the “feeling good” factor and the client will tend to con nue to eat that

food. If this happens to be a highly calorific dairy product like cheese, for example, then

this will be another habit that promotes over‐weight rather than weight reduc on.

O en the “feeling good” factor a er ea ng a par cular food is connected with allergy. It is

a strange phenomenon that ea ng a food to which one is allergic can o en produces a

“feeling be er” situa on. This very easily leads to habitual use of the food involved and

hence another nega ve factor that militates against loss of weight or against the simple

control of bodyweight at a normal level. This par cular ma er is so important that we

must always be alert to the effects of allergies and the way that these may impede our

client’s progress.

6.6 Importance of the Client’s Blood Sugar Level

A very special case of a client “feeling good” a er a food is one that occurs when the food

produces a raised blood sugar level. To do this, a food generally needs to be a

carbohydrate food so that it acts as a source of sugar directly. Hence the foods that

produce these effects most directly are sugars, or else foods that are rich in sugar.

Confec onery bars cons tute one of the best examples. These very sugary products

produce very rapid increase in the blood sugar level as a result of sugar being absorbed

directly into the blood stream. The client may have been feeling low before ea ng it

because his or her blood sugar was low. When it is raised quickly, there are almost

immediate effects of a type that render the client more alert and more brain‐ac ve than

before. Hence there is a feeling of well‐being. Naturally people enjoy this feeling and many

of us eat such bars (or other foods that deliver sugars) again and again to the detriment of

maintaining normal body weight. The same thing may happen with starchy foods that

break down easily to yield sugars.

All these situa ons that lead to “feeling good” or “feeling be er” a er ea ng a par cular

food for primarily physiological reasons, easily get translated into the client’s emo ons.

“Feeling good” is so important to people that the sensa on becomes emo onally charged.

The client wants to “feel good” again and again. Hence the ea ng of the food is both

habitual and emo onally linked.



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Returning now to more directly psychological factors, we must note that many people find

ea ng relieves tensions, worries and unhappiness (perhaps their blood sugar is again a

factor here, but there are unavoidable links between the physiology and the psychology of

clients).

Then there are also more bizarre situa ons such as those that involve the client ea ng

whilst sleepwalking and hence being unaware of the ea ng that is making them

overweight.

7 The Arithme cal Equa on of Body Weight

7.1 The Nature of the Equa on

The student is asked to note that in the orthodox field of obesity control and treatment,

the reasons for over‐weight are seen to be very easily understood. There is, contained

within this orthodox situa on, both a good founda on of truth and at the same me a

number of mysteries that the orthodox do not readily recognise. It takes “Alterna ve and

Complementary” medicine to iden fy some of these mysteries and to pinpoint their

significance. What determines whether people put on weight or not is nothing like as

simple a ma er as the orthodoxy has always believed.

The orthodox posi on states clearly that there is one unavoidable equa on that relates the

intake of food energy (calories) to the body’s energy output and to body weight change.

This equa on is:

Monthly body weight change = body food energy intake per month minus

body food energy output per month.

In the simple form wri en above there are no units of measurement, but we are only

se ng out the general idea here. We shall look at the units of measurement more closely

in Sec on 3a of this Course.

The Arithme cal Equa on of Body Weight


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7.2 You Cannot Destroy Neither Energy nor Ma er

This idea is based upon the basic physical law known as the Law of Conserva on of Mass‐

Energy. You cannot destroy Mass‐Energy, though it may be possible to convert mass into

energy and energy into mass. However, so far as we know the human body does not

interconvert mass and energy to any measurable extent. Therefore, for us, there are

separate Laws: the “Law of Conserva on of Mass” and the “Law of Conserva on of

Energy”. This means quite simply that energy that we take in must either leave the body,

or be stored within it. It cannot be destroyed.

7.3 Translate the Equa on in Prac cal Ma ers

The weight of food entering the alimentary system has a poten al to provide a certain

amount of energy when transformed by the body’s enzymes. Say, we eat food having a

calorie content of, for example, 2000 calories per day. Let us say that, by the basic

func oning of our body systems, plus the energy we use in life ac vi es, we use 2000

calories per day. Then we shall neither gain weight nor lose weight. If we now alter the

situa on so as to be ea ng more food, this may contain 2200 calories per day. If we

con nue to use up only 2000 calories per day, then we shall “store” in the body 200 extra

calories per day. There will be no outlet for these extra calories and hence the food

material that contained them must remain in our body and must increase each day un l

the input or output changes. If, on the other hand, we cut down our daily food intake to

food that contains only 1800 calories per day whilst keeping our energy usage unchanged

at 2000 calories, we shall then be on “nega ve calorie balance” and we shall be losing

weight. The weight we shall lose will be the weight of body ssue that contains 200

calories per day.

7.4 The Orthodox and the Alterna ve Almost Agree

There is inevitability about these figures. In alterna ve and complementary medicine we

do not challenge them. However, whilst the orthodox posi on produces a very fixed and

rigid set of conclusions, the whole situa on can be altered if the body usage of energy

becomes raised (in which case weight gain may be avoided) or if the absorp on of the

The Arithme cal Equa on of Body Weight


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ingested food can become less efficient (in which case the increase in weight may also be

avoided). Alterna ve and complementary medicine has concentrated upon altering these

two variables in a variety of lifestyle ways or technological ways that can produce realis c

solu ons to people’s weight problems.

8 Ways Of Working

8.1 Variety of Approach

So, the objec ves in the prac ce of “Alterna ve and Complementary” medicine for weight

control has focussed upon “nibbling at the edges” of this unavoidable orthodox equa on.

We may:

Work hard on ge ng people to control their diets by pa ent and careful

consulta on techniques (there are sub‐techniques within the category)

Work hard on increasing people’s usage of energy by methods we all know about.

Usually these involve exercise.

Find new ways to increase energy output.

Find new ways to deliberately “waste” body energy so that excessive bulk nutrients

are no longer stored in the body crea ng excess weight.

In prac ce, the techniques we have for increasing energy output or “was ng” nutrients

comprise not only exercise, but also so‐called “supplements”. We shall study these closely

in a later sec on.

8.2 Use Combina ons of Different Approaches

What we need to achieve more than anything else is a successful combina on of

approaches. It may be hard to do all that you need to do via diet alone. It may be hard to

do all that you need to do via exercise alone – this is usually asking too much. You might

have to run six miles every day, for example, to achieve your objec ve. Most of us, living

Ways of Working


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busy lives with a myriad of responsibili es, will be unable to do this. O en, if asked to do

some of each, people will be more successful.

The techniques that “waste energy” or “waste food” provide us with addi onal outlets for

ingested food. They prevent the body from ge ng access to all of the food one eats. There

are real advantages to be had here, even if it some mes involves a li le controversy. These

are research studies that show the advantages of these methods.

8.3 The Consultant’s Exper se Manipulates the Available Methods

Given these methods, one may have as many as four different avenues to explore for

balancing the “unavoidable equa on”. This may be a great deal easier to do than working

without special techniques. Moreover, given these techniques and given the help of a well‐

trained and understanding Weight Management Consultant, far more clients can be

successful in reaching their slimming goals and hence become proud possessors of body

size and shape that both pleases them and enhances their health status.

Ways of Working


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PART TWO

9 Ge ng Fat is all too Easy – We Review how it Happens

9.1 Introduc on to Part Two

Based upon what we have said in Part One of this Sec on, ge ng fat is just a ma er of

taking in more food energy than you use. Even animals and birds become obese if offered

unlimited, very palatable food. The combina on of very a rac ve food and no need to

hunt for it, which cuts down exercise, seems to lead very readily to obesity. This appears

to match the modern human situa on. The supermarkets are full of easily accessible

foods, many of which are low‐fibre concentrates of sugar and/or fat. Those foods are

especially a rac ve to the palates of many of us and they play a great role in promo ng

obesity. If one eats a diet based mainly upon these things, then it is hard to sa sfy one’s

hunger without over‐ea ng. Individuals take on excess fat as soon as this situa on

develops in a society. Furthermore, where much leisure is also available in a society, the

energy expenditure of individuals decreases, causing an imbalance between energy intake

and energy expenditure. Although there has been disagreement as to which side of this

energy equa on is more important in the epidemic of obesity (excess intake or inadequate

energy expenditure), both aspects are certainly involved.

9.2 Most of us have a Declining Food Intake

In the UK the records of the Na onal Food Survey (Ministry of Agriculture, Fisheries and

Food, 1991) show that on average the calorie intake of the popula on is decreasing with

me, even though food is more and more available. Obviously there is much less physical

ac vity since the introduc on of cars, power tools and domes c appliances. Occupa ons

have altered enormously, with those formerly based on physical effort, such as lumber

jacking, mining and navvying are now done by machines. The same is true of labour‐

intensive housework where human muscle power has been substan ally replaced by

electrical appliances. The scale of the effect is impressive. In the decade of 1979‐1989 the

energy consump on per person per day (over all groups) fell from around 1750 calories in

Ge ng Fat is All Too Easy. We review how it Happens


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1979 to 1500 in 1989, a drop of 14%. However, different groups were affected differently.

The largest effect was seen in males in the age bracket 18‐34 years. This was a drop from

2500 calories in 1979 to 1950 calories in 1989, a reduc on of 22%.

This means that we now have to extract our requirements of micronutrients from a

progressively lower bulk of food. Hence the importance of choosing nutrient‐dense foods

becomes obvious. Our micronutrient requirements have not changed but our energy

requirements have greatly reduced. That however, is a health issue, not a weight issue.

Almost certainly our micronutrient supply has decreased to the detriment of our health.

That is a very important change, though one that is not directly related to weight.

Apart from that, the creeping inac vity affec ng most of the popula on has reduced our

true physiological energy requirement down to a level that fails to sa sfy, in many cases,

our desire to eat. We have decreased our intakes, but we have not decreased them

sufficiently to offset our reduc ons in effort.

9.3 Energy Intake Reduc on has Spanned Decades

Of course the reduc on of energy intake has not been restricted to a single decade.

Sinclair & Hollingsworth (1969) es mated the energy requirement of the male 18‐34 year

age group to be 2900 calories. Twenty years earlier Lova Evans (1949), in textbook of

physiology, quoted the daily energy requirement of the adult male as 3400 calories. His

authority was a BMA report by Cathcart and Murray (1933) for which we do not have the

full reference. The drop between 1949 and 1989 therefore appears to have been as large

as 40%. This very large figure may be exaggerated, however, because the UK Na onal

Food Survey only deals with household food consump on, whereas we know that ea ng

out now plays a much larger role in calorie supply than it did in 1933.

There is every reason to suspect that similar situa ons exist in most countries that follow a

lifestyle with a high living standard. If you are studying this Course in a different country

(as many students are), then you will be able, we think, to locate similar sta s cal sources

if you choose to look.

Ge ng Fat is All Too Easy. We review how it Happens


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But the same tendency is present almost everywhere. Food energy intakes are found to be

declining in line with reduc ons in exercise and physical work, but the reduc ons are not

enough to offset a significant rise in obesity in the popula on.

10 Defini on and Classifica on: Criteria for Weight Normality

10.1 We Know What Obesity Looks Like

The characteris cs of obesity are all too familiar, comprising not only large increases in

weight, but also specifically a large increase in body fat. In most cases the weight increase

is reflected in the weight of added adipose ssues, of which a high percentage is fat itself.

Obviously, waist measurements suffer, and there are losses in the a rac veness of the

person’s appearance. Clothes, even if they are made to the new size, do not look good any

more. This condi on is detrimental to good health and well‐being. The quality of life is

affected progressively as the weight goes s ll higher. Eventually subjects suffer from

restric on of movement and exercise, poor self‐image and social difficul es. These may

o en loom larger in the subjects’ mind than the issues purely to do with health prospects

in the future, including the issue of longevity.

Longevity is an issue, even though it may not worry people as much as symptoms that are

being suffered now. Longevity has long been used as something of an index of op mum

weight. The idea here is that the op mum weight must be the one that gives one the

longest mean life expectancy. These figures are also very important to insurance

companies, who have come to judge risk of death at certain ages according to both

lifestyle (e.g. to do with smoking and alcohol use) and body weight.

10.2 Where Should One Draw the Line to say Who is Obese?

One cannot precisely divide a popula on into normal and obese except in a rather

arbitrary way. A er all, if you take the commonest weight in the popula on for people of

a given height, you might think that you would come up with “normality”. Yet that does

not have to be correct. It is possible for an en re popula on to have a strong tendency

Defini on and Classifica on: Criteria for Weight Normality


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towards heaviness, so that the most commonly occurring weights are themselves too

heavy.

Then again, the distribu on of weights in the popula on is always widely spread. You have

people who are about average and others who are clearly obese. In these cases no one

would want to argue about it. However, there will always be plenty of people who are

more heavy than average but who would be insulted to be called obese. The distribu on

of weight in the popula on, if plo ed on a graph of bodyweight against frequency of

occurrence, always shows a skew distribu on, with some excep onally high weights

trailing out at the upper end. These people at the upper end have got to be termed

“obese”. But where is the dividing line?

We shall deal in the next Sec on with the effect of gene cs upon obesity. Even if one had

a popula on that was gene cally homogenous (a very improbable situa on), weight would

be variable. In the modern world, with the great intermixing of ethnic and racial groups,

wide gene c heterogeneity exists. The heterogeneity is manifested by differing heights,

body circumference (chest, waist, hips), and heaviness of frame. It is undesirable to focus

on a single number of kilograms for any given height as being the "normal" weight. This is

par cularly evident since it is not clear what the criterion for "normal" weight should be.

Should it be low mortality, low morbidity (i.e. low disease incidence), a combina on of the

two, or should it be the longest extended "op mal health" or "well‐being" of the individual

lifespan, a measure of either the person’s produc ve lifespan or their “enjoyable”

lifespan?

Arbitrary defini ons of obesity (such as, for example, falling into the top 15% of weights)

have been set. The flaw of working like that is that if the popula on as a whole is heavier

than desirable, you could easily have, say, 25% of the popula on being obviously obese

according to an everyday understanding of the word.

Sex differences in percentage total body fat also occur early in life, so that by 5 years of

age, different standards are necessary for males and females. In adults, sex differences are

marked. Subcutaneous fat is about 11% of body weight in men and 18% in women if you

take average figures.



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The life insurance industry has developed sta s cs that have been used widely to provide

tables of “normal” weights. These tables give weight ranges for height and frame size and

are the weights associated with the greatest longevity in individuals who were healthy at

the me of ini al examina on when their heights and weights were measured. These may

well be the best data now available but they suffer from a number of drawbacks. They

predominantly reflect data from upper middle class Europeans. They take no account of

the varia ons of weight that occur among average people of different ages. They provide

predic ons of the longevity of young persons weighed in their early twen es followed

through to their eventual death. The tables have been used on the assump on that

whatever weight is desirable at age 21 years, is also desirable at age 45 or 65. Yet, in

Western society, weight changes with age in a normal popula on, with a gradual increase

in women from 20 to 60 and a more gradual increase for men from 20 to 50, with a fall

a er that for men. In addi on, body composi on changes with age, with the gradual

accre on of fat and loss of lean body mass. Therefore, it is unclear whether the "normal"

weight should be the same as age advances or whether it should rise as percent body

adipose ssue increases. In an effort to clarify the confusion about how to classify

overweight, a classifica on was proposed that is useful clinically. It is based on two simple

measurements: height without shoes and weight with minimal clothing.

10.3 Using the Criterion of Body Mass Index (QI)

The weight/height2 (W/H2), called the Body Mass Index (BMI), (also called “Quetelet’s

Index” and abbreviated “QI”), is then calculated, with weight expressed in kilograms and

height in meters. The popula on, whether male or female, can be divided for degree of

obesity as follows. Here there are three degrees of obesity.

Grade of Obesity W/H2

III >40

II 30 to 40

I 25 to 29.9

U 20 to 24.9



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These classes have since been modified by World Health Organisa on WHO (1998) to the

following format with three degrees of obesity plus a “Pre‐obese” category.:

Grade of Obesity W/H2

III >40

II 35.0 to 39.9

I 30.0 to 34.9

Pre-obese 25.0 to 29.9

Normal 18.5 to 24.9

The validity of BMI is common to both sexes. The major weakness of using BMI is that

some very muscular individuals may be classified as obese when they are not. This is

because the weight of muscle (over and above the average) cannot be dis nguished from

fat deposits. The number of people affected in this way will be small, however. BMI is the

rela ve weight index that shows the highest correla on with independent measures of

body fat. The BMI range of 20 to 24.9, originally classified as normal, coincides well with

the normal mortality ra o derived from life insurance tables. The mortality ra o begins to

increase at BMI levels above 25, and it is here that health professionals should be

concerned. The extra risk of early death increases only slowly at first and then starts to

become serious as more weight is added.

Although the increase in mortality in the new pre‐obese category (W/H2 = 25 to 29.9) is

not great, it is of importance because of the large numbers of people in this class and

because it is transi onal to Obesity Grades I, II and III, which truly create major health

risks for the individual.

The Figure below presents a diagram of this classifica on by height and weight based upon

Garrow’s original system that worked upon three categories of overweight.



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Rela on of weight to height defining the desirable range (0), and grades I, II and III obesity,

marked by the boundaries W/H2 = 25 to 29.9, 30 to 40 respec vely (pre‐1998).

10.4 Standards of Normality according to USA Figures

In the USA, efforts to produce standards of obesity for the popula on against which

individuals can be compared have generally concentrated on weight and have taken two

forms. The first is the use of "desirable" weight, which is the weight (adjusted for sex,

height and frame size) that is correlated to the greatest longevity. These figures come

from the life insurance data as described above. The second is the use of average weights

of sub‐samples of a general popula on stra fied by sex, age, and height. Obesity then is



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defined as some specific degree of devia on from these averages (with the disadvantages

to which we have referred already).

As a rule, the desirable weights of the insurance tables are lower than the average weights

descrip ve of the United States popula on. That should cause no surprise, since it merely

shows that the average weights of the popula on are higher than ideal. The data show an

increase of weight by age from 18 years to 54 years with a plateau and then a fall a er

that. Hence, weight is not sta c with age once maturity is reached, but actually varies with

age.

There is a number of more or less sophis cated techniques for objec ve measurement of

obesity. They are not usually a part of the necessary work of the Weight Management

Consultant (who can work from height, weight and build) they are interes ng and

informa ve.

10.5 Prevalence

We look briefly here at the prevalence of obesity because this can give you an idea of the

importance of the task upon which you are now embarking. Of course, one has to use

some suitable defini on of obesity before you can think of measuring it and discussing its

prevalence.

The USA insurance companies use the terms "ideal weight" or "desirable weight" to

describe weights that actuarially were associated with the least mortality. One defini on

of overweight has been widely accepted as 10% above an ideal or desirable weight and of

obesity as 20% or more above this point. Using such cri‐teria, researchers found a high

incidence of over‐weight. Indeed, an alarming per‐centage of Americans are overweight.

This percentage increases with age, par cularly among women.

The table below gives the prevalence of overweight (i.e. 20% above desirable weight) in

the USA according to two studies in the past (Abraham & Johnson). This is history now and

we know that ma ers have got a great deal worse than this since 1974.



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Of course the above data is now old, but the situa on has not improved. Much more

recent data show that one in three of the US popula on is now obese according to the

same defini on (Kuczmarski et al, 1994). The situa on has become a lot worse in the UK

also and according to a 1995 study it stood then at 15% obesity in men and 16.5% in

women (Presco ‐Clarke & Primatesta 1997).

The incidence of obesity is affected not only by age and sex but also by socio‐economic

factors. People in different classes of society have different incidence of obesity. You do

not need necessarily to a end to this sociological aspect, as you will be dealing with single

individuals and advising on their par cular degree of overweight or obesity.

10.6 Obesity in Children

The prevalence of obesity in the Western world begins with infancy. Studies available,

though imperfect, suggest that one third or more of infants in the Western industrialized

world are too heavy. Data for schoolchildren are less available and es mates have varied

between 6 and 15%. Adolescent obesity rates have been calculated at the 20 to 30 % rate

in the USA. The studies suggest that young women are more likely to be obese than are

young men. The prevalence of obesity seems to be rela vely constant throughout

childhood.

Whether obesity in childhood leads to obesity in the adult has been widely debated. Some

retrospec ve studies have suggested that there is a direct progression from a fat child to a

Men % Men % Women % Women %

Age 1960-1962 1971-1974 1960-1962 1971-1974

20-74 14.5 14.0 25.1 23.8

20-24 9.6 7.4 9.1 9.6

25-34 13.3 13.6 14.8 17.1

35-44 14.9 17.0 23.2 24.3

45-54 16.7 15.8 28.9 27.8

55-64 15.8 15.1 38.6 34.7

65-74 14.6 13.4 38.8 31.5



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fat adult. Rimm and Rimm (1976) report that 50% of adult women in every age group with

weights greater than 18% of ideal body weight had been obese adolescents. In addi on, it

has been stated that 30% of adults who are obese become obese during childhood. About

80% of obese adolescents become obese adults, and they tend to be fa er than those who

become obese as adults. Although a recent workshop concluded that there is no evidence

that the obese child becomes an obese adult, a s ll newer study showed that 26.5% of

ini ally obese infants and children were s ll obese two decades later, compared with the

15% expected by chance.

10.7 Mortality and Morbidity and the Yards cks for Op mum Weight

Overweight leads to being more vulnerable to dying early (mortality) and to being more

vulnerable than average to developing chronic illnesses (morbidity). Knowing that should

be a real incen ve to anyone who is having difficulty with loosing weight but it does not

always appear to work in that way. It is logical to strive hard to avoid suffering chronic

ailments earlier in life than would otherwise happen. But that is logical and a tudes to

overweight o en are not logical at all. We shall look much more closely in Sec on 4 at the

extent to which people die sooner than they should when they are overweight or obese. In

that sec on we shall also examine the range of illnesses that are known to increase when

subjects are overweight or obese.

Meanwhile our aim is to arrive at an idea of what would be an ideal weight for men and

women. “Ideal” could mean many things. To one person it might mean the weight at

which they would have op mum athle c performance. That might be one weight for a

runner and quite another for a wrestler or weightli er. Indeed, those people who have an

excep on amount of muscle (as opposed to excep on fat) do upset the figures, because,

so far as we know, being a bit heavier through possessing extra muscle does not down rate

your life expectancy and does not call for weight reduc on. To another it might mean a

par cular size in dresses. To another it might mean the weight at which they look the most

a rac ve, and that is just a ma er of opinion, of course. But perhaps a wide appeal is to

define the op mum weight as being that weight at which people can expect to live the

longest.



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That idea coincides with the priori es of life insurance companies who need to know

which individuals are free from higher than normal risk of dying young when they are

selling life insurance policies and also need to know who might die younger than average

when selling life‐long annui es. In the first case, having more people dying young is bad

for their business, while in the second case, having too many people living longer is bad for

their business. But in either case they certainly need to know so to avoid taking on

inadvisable risks.

10.8 Indica ons of Op mum Weights It is instruc ve to compare these tables with the results that you get via the BMI. For

example, a man of 6 feet tall and medium frame weighing 162 pounds (11 stones 6

pounds), which is in the middle of his range, (= 73.6 kg) has a BMI of 73.6 / 1.85 x 1.85 =

21.52. Because this is within the BMI range of 20.0 – 24.9 it is in the well‐accepted normal

range. However, a man of this height weighing only 73.6 kilos really looks quite lean. The

Optimum Weights in pounds for Men of Varying Height and Frame (Divide these weights by 2.2 to get weights in kilograms)

HEIGHT HEIGHT

feet & inches meters Small Medium Large

5'01" 1.56 105-113 111-122 119-134

5'02" 1.59 108-116 114-126 122-137

5'03" 1.62 111-119 117-129 125-141

5'04" 1.64 114-122 120-132 128-145

5'05" 1.67 117-126 123-136 131-149

5'06" 1.69 121-130 127-140 135-154

5'07" 1.72 125-134 131-145 140-159

5'08" 1.74 129-138 135-149 144-163

5'09" 1.77 133-143 139-153 148-167

5'10" 1.79 137-147 143-158 152-172

5'11" 1.82 141-151 147-163 157-177

6'00" 1.85 145-155 151-173 166-187

6'01" 1.87 149-160 155-173 166-187

6'02" 1.89 153-164 160-178 171-192

6'03" 1.92 157-168 165-183 175-197

FRAME



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Optimum Weights in pounds for Women of Varying Height and Frame (Divide these weights by 2.2 to get weights in kilograms)

HEIGHT (feet & inches)

FRAME

Small Medium Large

4’08” 1.44 90-97 94-105 103-117

4’09” 1.46 92-100 97-108 106-120

4’10” 1.49 95-103 100-112 109-123

4’11” 1.51 98-106 103-115 112-127

5’00” 1.54 101-109 106-119 115-130

5'01" 1.56 104-112 110-122 118-134

5'02" 1.59 107-116 113-126 122-138

5'03" 1.62 110-119 117-130 125-142

5'04" 1.64 114-123 120-134 129-146

5'05" 1.67 118-127 124-138 133-150

5'06" 1.69 122-131 128-142 136-154

5'07" 1.72 126-136 132-147 140-159

5'08" 1.74 130-140 136-151 145-164

5'09" 1.77 134-145 140-156 149-168

5'10" 1.79 139-150 144-160 153-173

5'11" 1.82 144-155 148-165 158-178

6'00" 1.85 149-161 153-170 162-184

HEIGHT (meters)

above table would allow him to weight up to 173 pounds or 78.6 kilos. His BMI would then

be 78.6 / 1.85 x 1.85 = 2.30. This is s ll a li le on the strict side. The BMI category 20.0 –

24.9 would permit his weight to go to just over 85.1 kilos; 187 pounds or 13 stone 4

pounds. These tables are, therefore, a li le strict and demanding compared to the dictates

of the BMI. A very large American study found that the best BMI values for longevity for

men was from 22 to 24.9. If you take a mean of these you get 23.45. At this BMI, our 6’

man would weight 80.2 kilos, 176.4 stones or 12 stones six pounds.



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The op mum BMI value for women was found to be 22 – 23.4. Therefore, clearly, BMIs of

the order of 20 or 21 are unnecessarily low whether for men or women.

We have presented these figures so that you can use them in your future work but there

will probably be plenty of occasions when you and your clients decide to se le for slightly

higher target weights so as to avoid skinniness or a wizened or slightly haggard look in

older people. Hollow cheeks and a scrawny body will not be part of the objec ve. In other

words one is likely to find that the very slight difference in longevity from just a few extra

pounds is some mes not a bad trade‐off against be er personal appearance.

References

Abraham, S. & Johnson, C.L., “Overweight adults 20‐74 years of age: United States 1971‐74. Vital and Health Sta s cs, Advance Data No. 51, Hya sville, Md. Na onal Center for Health Sta s cs, Public Health Service, DHEW.

Garrow, J.S. & James, W.P.T., (1993) “Human Nutri on and Diete cs”, Churchill Livingstone.

Garrow, J.S., James, W.P.T. & Ralph, A (2000), ) “Human Nutri on and Diete cs”, Churchill Livingstone.

Kuczmarski, R. et al, (1994) “Increasing prevalence of overweight among US adults” JAMA 272 205‐11.

Lova Evans, C., “Principles of Human Physiology”, Tenth Edi on, J & A Churchill, London (1949) (p833).

Rimm, I.J. & Rimm, A.A., (1976), Am J. Public Health 66 479‐481.

Sinclair, H.M. & Hollingsworth, D.F., “Hutchinson’s Food and the Principles of Nutri on”, Edward Arnold Ltd., London (1969).

Van Itallie, T.B., Am. J. Clin. Nutr. 32 2723‐2733 (1979).

References


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Checkpoint for Sec on 2 CHECKPOINT FOR

SECTION 2

Please write out your answers and check them against those given in the answers sec on at the rear of the course. Checkpoints are included to help you assess your own understanding of the course. Please do not submit them to the office. 1. Name two factors that have influenced soaring levels of overweight and

obesity

2. How does exercise help people to lose weight?

3. What have (a) cars and (b) washing machines to do with people’s weight?

4. Are most of the popula on ea ng more or less than 50 years ago?

5. Are most people ge ng more or less micronutrients than 50 years ago?

6. Define Body Mass Index

7. How much difference is there between the average subcutaneous fat per‐centage in men and women?

8. What is the meaning of “pre‐obese”?

9. Work out the value of your own BMI and that of one other person close to you.

10. Is it true or false to say that the excess mortality of overweight and obese people increases progressively with degree of overweight?

11. On average both men and women get heavier con nuously, as they get older – true or false?

Documents

Diploma in Weight Management Consultancy · DIPLOMA IN WEIGHT MANAGEMENT CONSULTANCY 2 associated with many severe and minor ailments and impediments. This may narrow down with some