Overfat and Underfat: New Terms and Definitions Long Overdue

Abstract

For the first time in human history, the number of obese people worldwide now exceeds those who are underweight. However, it is possible that there is an even more serious problem-an overfat pandemic comprised of people who exhibit metabolic health impairments associated with excess fat mass relative to lean body mass. Many overfat individuals, however, are not necessarily classified clinically as overweight or obese, despite the common use of body mass index as the clinical classifier of obesity and overweight. The well-documented obesity epidemic may merely be the tip of the overfat iceberg. The counterpart to the overfat condition is the underfat state, also a common and dangerous health circumstance associated with chronic illness and starvation. Currently (and paradoxically), high rates of obesity and overweight development coexist with undernutrition in developing countries. Studies in cognitive linguistics suggest that accurate, useful, and unintimidating terminology regarding abnormal body fat conditions could help increase a person's awareness of their situation, helping the process of implementing prevention and simple remedies. Our contention is that promoting the terms "overfat" and "underfat" to describe body composition states to the point where they enter into common usage may help in creating substantive improvements in world health.

Keywords: World Health Organization; body mass index; cachexia; chronic illness; mortality; obesity; overweight; waist circumference.

Figure 1

The overfat–underfat progression. The common spectrum of deteriorating health during the lifespan from the overfat to underfat state.

Figure 2

Estimated number and percentage of overfat and underfat adults and children worldwide (based on 2014 world population numbers of 7.2 billion). ¹Includes obese and overweight and other populations listed above (items 1–5). The 62% number does not include item 6 (children). ²Includes 666 million adults due to starvation, plus 10.8 million chronically ill people who were cachexic at time of death in 2008 (with the high range including 70 million with eating disorders). ³World population of 7.2 billion minus overfat plus underfat.

Figure 3

Increase in death rates from cachexia. Number of people from cachexia at time of death. If we hypothesize that 60 million deaths from all causes will occur in 2020, WHO extrapolations predict that 21.3% of people (12.8 million) would have cachexia at time of death.

Figure 4

Changing terminology.