Contour control, survival, and quality of life

Ideal body weight is far lower than average

Body weight is the archetypal risk factor for morbidity and mortality. It is repeatedly measured without going away. It figures voluminously in the press, supporting an inflated consumer industry in dietary and other products. It was adopted early by life insurance companies when little else was measurable. Medical science is bankrupt of effective treatments for obesity, it confuses the public as to whether being overweight is determined by fate or free will, and it keeps changing the units of measurement imperial to metric, body mass index,1 waist to hip ratio,2 and waist circumference3 resulting in familiarity by few British doctors and even fewer patients. The government decrees, Canute-like, that the tide of obesity is to go out4 when, as elsewhere, it is coming in,5 with Britain accumulating, I estimate, some 10 000 metric tonnes of blubber a year. Into this sombre picture comes the paper in this week's BMJ by Shaper and colleagues (p 1311).6 Using data from the British regional heart study, the authors report 15 years' follow up of mortality and cardiovascular morbidity in relation to the body mass index of middle aged British men seen in the late …