As nation gains, 'overweight' is relative
By Elizabeth Landau
CNN

(CNN) -- The little number on the tag on a pair of pants that indicates size can mean a lot to a person, and retailers know it.

The probability of people describing themselves as overweight is decreasing, researchers find.

That's why, in recent years, as the American population has become generally more overweight, brands from the luxury names to the mass retail chains have scaled down the size labels on their clothing.

"You may actually be a size 14 and, according to whatever particular store you're in, you come out a size 10," said Natalie Nixon, associate professor of fashion industry management at Philadelphia University. "It's definitely to make the consumer feel good."

Research shows that, when it comes to self-perception, the concept of "overweight" may be relative.

A working paper from a group led by Mary Burke, senior economist at the Federal Reserve Bank of Boston, Massachusetts, suggested that people's perceptions of overweight have shifted, and "normal" is now heavier than it used to be.

Researchers used data from the National Health and Nutrition Examination Surveys, nationally representative surveys run by the Centers for Disease Control and Prevention. The first group was surveyed in 1988-1994, and the second was surveyed in 1999-2004. Because there were different people in each survey, it is not possible to tell if the perceptions of individuals shifted over time, the authors said.

Participants were asked whether they consider themselves "underweight," "about right," or "overweight," and reported their body mass index, a measure of the health risks associated with weight.

Are people more complacent, or better educated?

Although the BMI of the general population increased from the earlier survey period to the later one, the probability of people describing themselves as overweight decreased in the later survey, researchers found.

They found that weight misperception tended to decrease among women -- meaning women with normal BMI who were surveyed in 1999-2004 were less likely to say that they're "overweight" than women with normal BMI in 1988-1994, especially among 17 to 19-year-olds. For men, it was about the same.

"For women, this was good news," Burke said. "Women seem to get a more realistic perception of themselves."

Although the study authors said this trend may reflect healthy body image campaigns, physician nutrition specialist Dr. Melina Jampolis, who was not involved in this research, said she doubts that positive messages had this much influence.

Rather, it is the relative increase in weight of the general population that makes people with normal BMI feel more normal, she said.

On the flip side, feeling normal but being overweight may decrease a person's motivation to lose weight, Burke said.

Still, while the BMI scale reflects disease risks associated with being overweight, it does not reflect the whole story of a person's health, experts said.

There have been reports that being somewhat overweight, but not obese, is associated with decreased mortality, such as a 2005 study in the Journal of the American Medical Association that looked at deaths from a variety of causes.

Innovations such as treatments for high cholesterol have lowered the death risks for overweight people, Burke said. Especially for older adults, being slightly overweight may increase bone density, cushioning bones against falls, she said.

But the JAMA paper shows associations, not causes. People should not take this information as an excuse to gain weight, Jampolis said.

There are, however, other reasons that BMI isn't the whole story -- for instance, it does not reflect the distribution of a person's weight, Jampolis said.

"You could have really skinny arms and legs and just carry your weight in the middle, and it could be only 10 pounds, but belly fat, the visceral adiposity, it could very significantly increase your risk of disease," she said.

Experts noted that plumpness has been in style during some historical periods, especially as an indicator of prosperity when food was scarce. But the ideal of controlling one's food isn't new either. The book "Fat History: Bodies and Beauty in the Modern West" by historian Peter Stearns points out that fasting was a religious virtue seen throughout the Middle Ages, and continuing into the Puritan version of Protestantism. Christianity also espoused the idea of restricting food to fight sin.

The artistic and literary movement known as Romanticism, beginning in the late 18th century, stressed "slender, ethereal" ideals, Stearns wrote. The 1830s brought a prominent New York fashion style of a "willowy" look for young women, and there were many reports of anorexia nervosa during this time, the book said. But for older women, plumpness remained fashionable, and women on stage were expected to be voluptuous.

The meaning of the word "diet" came to include the goal of weight loss as early as 1910, Stearns wrote. "Middle-class America began its ongoing battle against body fat" between 1890 and 1910, Stearns wrote. The main factors that contributed to this shift were the advent of fat-control devices, the rise of public conversation about fat, and changes in fashion for both men and women, he wrote.

The culture of beauty that shaped up around the turn of the last century, promoting slimness as beautiful and fatness as ugly, has intensified since then, Stearns wrote.

Despite the widespread notion of dieting, obesity has risen dramatically over the last 20 years in America, according to the Centers for Disease Control and Prevention. A recent survey by the Robert Wood Johnson Foundation and the Trust for America's Health found that the percentage of adults classified as obese went up in 23 states in the last year.

As clothing size numbers scale down in an era when bodies are getting more overweight, portion sizes have been increasing, Jampolis said. Photographs of fast food hamburgers from 50 years ago reveal that the serving size back then would seem like a "joke portion," now, she said.

"The same thing has happened with our body sizes. We're perceiving them as totally normal," she said.

As far as vanity sizing, Nixon called it a "temporary fix" that reflects a larger problem of people looking for quick solutions for losing weight, she said.

"It doesn't really deal with the root of the problem," she said. "It's really a lifestyle issue. It's not about a temporary diet, it's not about being pleasantly surprised because you're a size 12 instead of a size 16," she said.

Why Are Southerners So Fat?
By CLAIRE SUDDATH Thursday, Jul. 09, 2009

People from Mississippi are fat. With an adult obesity rate of 33%, Mississippi has gobbled its way to the "chubbiest state" crown for the fifth year in a row, according to a new joint report by Trust for America's Health and the Robert Wood Johnson Foundation. Alabama, West Virginia and Tennessee aren't far behind, with obesity rates over 30%. In fact, eight of the 10 fattest states are in the South. The region famous for its biscuits, barbecue and pecan pies has been struggling with its weight for years — but then again, so has the rest of the country. Wisconsin loves cheese, New Yorkers scarf pizza, and New Englanders have been known to enjoy a crab cake or two. So why is the South so portly?

For one thing, it's poor. Mississippi is not only the fattest state in the nation, but also the poorest, with 21% of its residents living below the poverty line, according to the U.S. Census Bureau. Alabama and West Virginia, the second and third fattest states, are tied for fifth poorest. With a poverty rate of 14%, the South is easily the most impoverished region in the country. "When you're poor, you tend to eat more calorie-dense foods because they're cheaper than fruits and vegetables," explains Jeff Levi, executive director of Trust for America. Poor neighborhoods also have fewer grocery stores, even in the rural South. A 2004 study by the University of South Carolina found that most food-shopping options in rural areas fall into the convenience-store category because grocery stores are located too far away. But although poverty puts people at risk for obesity, it doesn't determine their fate. A number of impoverished states — including Montana, Texas and New Mexico — have relatively low levels of obesity. There must be something else.

Maybe it's the culture. Southerners definitely enjoy their fried chicken (not to mention fried steak, fried onions, fried green tomatoes, fried pickles and fried corn bread). Even when their food isn't fried, they like to smother it in gravy. But while nutritionists frequently blame Southerners' large guts on their regional food choices, the accusation is a little unfair. Just as Californians don't actually live on wheat grass and tofu, Southerners don't really sit around eating fried chicken every day. "I've not come across anything that says the diet in the Southeast is worse than the rest of the country," says David Bassett, co-director of the University of Tennessee's Obesity Research Center. "We're definitely in what I like to call the 'Stroke Belt,' " he says, referring to Southeastern states' high percentage of heart disease and hypertension, "but I think that has more to do with Southerners' lack of physical activity rather than the food."

Bassett isn't just talking about neglected gym memberships and people who sit on the couch all day. Physical activity can be something as simple as walking to the bus stop. That's another problem, by the way: the South doesn't have many bus stops. Public transportation is paltry, and for most people, the best way to get around is by car. "You don't really think of riding the train as exercise, but at least you have to walk a few blocks to get to the stop," says Bassett. States like Mississippi and Tennessee also have a surprising lack of sidewalks, discouraging even the most eager pedestrians. Many roads are narrower than those in the North — where streets have wider shoulders to accommodate winter snow — and people who want to bike or jog find themselves uncomfortably close to traffic.

But who wants to exercise when it's 100 degrees outside? The South is really hot and humid. Nobody in Mississippi goes running in the summer — at least, nobody sane. Bassett points out that Colorado, the state with the lowest obesity rate (18.9%), is relatively affluent and has a temperate climate and plenty of trails that lend themselves to outdoor activities.

So there you have it. Southerners have little access to healthy food and limited means with which to purchase it. It's hard for them to exercise outdoors, and even when they do have the opportunity, it's so hot, they don't want to. To combat this affliction, some Southern states have adopted programs to fight rising obesity. In 2003, Arkansas passed a school body mass index–screening program that assesses weight and sends the results home to parents. Tennessee encourages its schools to buy fresh ingredients from local growers. And in 2007, Mississippi adopted nutritional standards for school lunches. Most of these programs are relatively new, so it will be a few years before experts can determine their efficacy. "I think there's reason for optimism," says Barrett. "But it's likely that the Southeast will lag behind the rest of the country for some time to come."