How much do you weigh?

Barts-MS rose-tinted-odometer  ★

When last have you weighed yourself and calculated your BMI (body mass index)? 

BMI = body mass (kg) / the square of the body height (m) [kg/m2]; to save you time and effort you can simply use the NHS BMI calculator, which takes imperial measurements as well. 

I am not sure if you are aware that childhood and adolescent obesity is an important risk factor for developing MS. We estimate that smoking and obesity could account for 1 in 5 new cases of MS. Obesity is a complex disorder that tends to run in families. The familial link is not only due to the effect of genes but cultural and social factors. If you are obese, or very obese, you need to do something at a personal level that may inform what the next generation does about it; good habits are infectious. 

I have little doubt that obesity impacts on MS outcomes. Obesity affects mobility and is associated with deconditioning and poorer outcomes. I recall a patient of mine with primary progressive MS losing over 30 kg in weight, with his BMI dropping from over 30 to less than 24, and in parallel, his EDSS improved from 6.5 to 5.5. The latter improvement was from him getting fit from his 5-day per week exercise programme and making the effort. 

As you are aware obesity is associated with a metabolic shitstorm that impacts on many disease processes. Obesity causes metabolic syndrome (hypertension, insulin resistance, glucose intolerance, diabetes and dyslipidaemia) and a systemic inflammatory syndrome that may worsen MS. Therefore, there is a good reason why, if you are obese you should consider doing something about it. This is easier said than done. To start I would recommend you read “Why we get fat and what to do about it”, by Gary Taubes or you can watch his lecture on YouTube. Understanding the metabolic issues that underlie obesity will allow you to understand what to do about it. The latest science behind obesity is not rocket science.

Why this post just before Christmas? Christmas is a time of excess and maybe this post will make you mindful of what and how you eat. I was horrified when I read the forecast in this week’s New England Journal of Medicine that by 2030 1 in 2 US adults will be obese. The conclusion of the paper says it all. 

“We project that given current trends, nearly 1 in 2 U.S. adults will have obesity (BMI>30) by 2030, and the prevalence will be higher than 50% in 29 states and not below 35% in any state — a level currently considered high. Furthermore, our projections show that severe obesity (BMI>35) will affect nearly 1 in 4 adults by 2030 and become the most common BMI category among women, black non-Hispanic adults, and low-income adults.”

 Estimated Prevalence of Overall Obesity and Severe Obesity in Each US State, from 1990 through 2030. Image from the NEJM.

I suspect the UK is not far behind the US. What we need to realise that underlying this epidemic in obesity is an MS epidemic. Don’t you think we should do something about it?

Ward et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med, 381 (25), 2440-2450 2019 Dec 19.

Background: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity.

Methods: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes.

Results: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2).

Conclusions: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).

CoI: multiple

10 thoughts on “How much do you weigh?”

  1. I have slow/stable PPMS, have always had an healthy BMI, tending if anything towards underweight. I also have normal blood pressure. So weight issues were not a factor for me in developing MS. Perhaps this is why I didn’t/don’t show relapse activity though, i.e. no strong, damaging reaction by my immune system to the underlying, smouldering disease.

  2. I’ve had MS for donkeys years. I have never seen an obese MS patient in the clinic waiting room, or ward. Obesity may come after EDSS kicks in, but not prior to diagnosis. Growing up in the 50s and 60s in East London, people walked to school didn’t eat fast food unless it was fish and chips as a treat. We were also taught to cook in school and be frugal as many pupils lived in poverty. There was still a waiting list to see a neurologist.

  3. Prof G….
    You’ve just set a precedent for blaming MS as being caused by being over weight……
    I’ve never been over weight my life.
    Before MS played its hand I could run a mile and half in 9min at the age of 40.
    So please don’t blame it osolely on being overweight.

    1. Obesity is only a risk factor, i.e being overweight increases your risk of getting MS. The corollary doesn’t apply, i.e. being normal or underweight doesn’t prevent you from getting MS. Although some claim obesity is causal this may not be the case. At the moment the link between obesity and MS is an association and may be due to another factor that is also associated with obesity.

  4. I understand the comments already submitted. No chance of being an obese child in the 60s. So much outdoor play. I was super fit at diagnosis and running strong for first few years. I’d say I’m about 6 on disability scale now. Use scooters, chairs out and about, hands getting affected etc. However, I keep on exercising as I did gain weight with the slowing down. I realised I had to reduce portions and still do as much as possible. So I aim to keep in my size 12 at age 58 and 5ft 8 not too bad. Previously a bean pole. I know the more weight I have to lug about the slower I will be. Common sense really. I want to enjoy my remaining years, not heave myself about. We ALL MS or not need to realise the toll over eating has on the health service. It’s not an illness to start with, it’s “eyes bigger than your belly” as I would tell my children when wasting food 🙂 And I have to say greed. Mindful eating helps so much. Changing habits and yes they are catching. Happy Healthy Christmas to You All

  5. Since MS kicked in i have been forever hungry, I could be physically full but still have the feeling of being hungry. The curse of damage to the hypothalamus. Add that to vascular necrosis in hip due to steroids fighting weight gain is so difficult!

  6. Prof G, I know I am n=1 and fall into the pot of people offering up their anecdotalhave evidence.

    I was an obese child, lost weight, played a decent level of rugby, Fell ill and have since put on significant weight since my symptoms began.

    I’ve tried to lose weight, but the thought of working out now fills me with despair, now that I had to quit rugby and can no longer run. I’ve simply lost my passion for exercise as I am confronted with what I can no longer do.

    I think depression and apathy take over many of us, I feel I can’t enjoy exercise anymore.

    Food on the other hand is one of the few pleasures I have left.

  7. ‘The latest science behind obesity is not rocket science.’ But how the brain controls the body IS rocket science. An overweight body is more difficult to control than a normal healthy body, adapted by evolution over thousands of years. Survival of the fittest means the brain has to force the overweight body to move. This leads to becoming manic – in over simplified terms. Manic Mode Brain versus Normal Mode Brain. An enabling state for MS to develop?

  8. I’ve taken up exercise in the last year. I’ve never been obese, but have some extra weight and cannot imagine that my previously sedentary lifestyle would allow me to maintain the good health I’ve genetically lucked into as the years pile on. I feel better, sleep better, move better (even on my weaker side), etc. None of that is a shock, but it’s still encouragement to keep on moving.

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