Posted by: isaaph | October 29, 2007

A Follow Up To “Fat and fit, lean but unfit?”

Here’s the latest from Dr. Rafael Castillo

A rejoinder on being fat yet fit, lean but unfit

By Rafael Castillo, MD

MANILA, Philippines—We received a good number of feedback and questions regarding last week’s column on being fat yet fit, and lean but unfit. A rejoinder is in order.

Firstly, we inadvertently exchanged the values for the waist circumference (WC) measurement for Asian men and women. The ideal values should be less than 90 centimeters (35.5 inches) in men and less than 80 centimeters (31.5 inches) in women. Caucasian cut-off values are higher: approximately 40 inches for men, and 35.5 inches for women.

Different values

Why different values for Asians and Caucasians? It’s not arbitrary and definitely nothing verging on racism. It’s borne out of hard research data that ethnic differences exist with regard to the relationship of the waist circumference and cardiovascular risk, such that measurements above these identified cut-off values are associated with a significant increase in the risk of developing stroke, heart attack and other cardiovascular complications.

Researchers have shown this initially in Asians living in America. If they used the accepted cut-off values for Caucasians in those with Asian ethnicity, what would appear to be a marginally increased waist circumference of 37-39 inches in men and 32-35 inches in women were already associated with greater risk. This finding has been validated by other studies conducted in Asia.

The reason for this is that Asians are inherently predisposed to be more insulin resistant than Caucasians. Insulin is not only responsible for sugar metabolism but it also governs fat metabolism and distribution. Many believe that significant abdominal obesity is one of the tell-tale signs of insulin resistance, which is identified as the culprit leading to hypertension, diabetes, cholesterol problems and obesity.

Identifying high-risk patients

Galo Barrios texted his question if a normal waist circumference (WC) will rule out the metabolic syndrome. Increased WC is just one of five criteria for identifying high-risk patients with the metabolic syndrome. The other four criteria are the blood pressure (higher than 130/85 mmHg), blood sugar level (higher than 100 mg/dl), a low high-density cholesterol or the good cholesterol (lower than 40 mg/dl in men and less than 50 mg/dl in women) and high triglycerides (more than 150 mg/dl). Three out of five make a diagnosis of metabolic syndrome.

Although one big international medical organization is proposing that the syndrome should never be diagnosed without obesity, indicated by increased WC, the prevailing opinion is that any three of the five criteria can already strongly identify patients with metabolic syndrome.

Body fat indicators

Marissa Reyes from Merville Park, Parañaque, asked about the waist-hip ratio (WHR) and the body mass index (BMI).

The WHR and BMI are also indicators of body fat, but most clinicians now prefer to use the waist circumference for practical reasons. It’s easier to determine, requiring only one measurement and not entailing any computation, as the WHR and the BMI do.

To determine the WHR, divide the WC by the hip measurement. It should not be more than 1 (preferably 0.9) in men and not more than 0.8 (preferably 0.7) in women. So one may still be overweight but if his/her proportions are still okay, as shown by the WHR, then the associated risk may still be not significant. Conversely, the seemingly normal-weight individual with bulging belly—hence, higher WCR—may be at a higher risk.

The BMI, expressed as kg/m2, is computed by dividing the weight in kilogram by the height in meter squared. In Caucasians, a BMI higher than 25 is considered overweight, while in Filipinos and other Asians, a BMI higher than 23 is already considered overweight.

There are some inherent limitations in using the BMI to evaluate fatness and leanness. As the term implies, it measures total body mass which not only includes fat but muscle and bone as well. Hence, it can be easily distorted by such factors as fitness level, muscle mass, bone structure, gender and again, ethnicity.

In athletes, for example, the muscle is heavier than fat. So they may seem overweight based on their BMI measurement. Hence, the BMI may overestimate fatness in those with more lean body mass like the athletes, while underestimating fatness in those with less lean body mass such as in the elderly.

Healthy lifestyle

Singapore-based Alex Lip, a manager at Omron Singapore Pte Ltd., gave me an interesting feedback. He calls seemingly lean individuals with increased fat mass as having “hidden obesity.” This is why his company has developed modern sensitive devices to detect BMI and abdominal obesity accurately.

So how do we remain fat yet fit and prevent becoming lean but unfit? Nothing beats the good old healthy lifestyle. Eating a high-fiber low-fat diet, avoiding fast foods like the plague, avoiding being sedentary especially after retirement, doing regular exercise on most days of the week (preferably daily), nonsmoking and avoiding those who do, drinking no more than an ounce of alcohol a day, and managing stress effectively all go a long way to ensure a healthy direction far away from the emergency room or the morgue.

Source: Philippine Daily Inquirer

Posted by: isaaph | October 29, 2007

Fat and fit, lean but unfit?

Finally! A Filipino doctor acknowledges that a fat person can be healthy.

Fat and fit, lean but unfit?

By Rafael Castillo, MD

BOSTON, Massachusetts―We keep on saying that being fat is a risk factor for heart disease and stroke, but it may be better to be fat and fit, than lean but unfit.

So says Dr. Frank Hu, associate professor of Nutrition and Epidemiology at the Harvard School of Public Health here in Boston. Dr. Hu however stresses: “It’s best to be lean and fit.”

Dr. Hu was part of an impressive faculty of world experts which discussed insulin resistance, which is now believed to be the common denominator of many medical conditions, from obesity to diabetes to cancer, liver disease, HIV infections and a long list of diseases of the modern world.

Now back to overweight and obesity. Many may confuse body weight and body fat. Most people don’t distinguish between the two, but they are actually two different things and knowing the difference is essential to determine whether or not one needs to lose weight to remain healthy.

Body weight

What we refer to as our body weight is the number we see on the weighing scale, either in pounds or kilograms. Technically, our body weight is actually a function of our body mass multiplied by the acceleration of gravity. But to simplify matters, let’s just concentrate on the reading on the weighing scale. That’s our weight.

To assess whether one is overweight or not, a standard formula has been used by many clinicians to determine what one’s ideal body weight is based on one’s height. Roughly, one’s ideal body weight in kilograms is one’s height in centimeters minus 100. One inch is 2.54 centimeters, and one kilogram is 2.2 pounds.

“Overweight” therefore connotes excessive weight for one’s height, based on the formula or some predetermined “average” standards outlined in height-weight charts. An important fact however is missed in the computation. The weight is only an indication of heaviness, but inadequately factors in the body composition, consisting of bones, muscles and fat. Muscles and bones are called lean body mass and weigh more than fat.

Body fat

Fat comes in two types: essential fat and storage fat. Essential fat is needed by the body to remain alive and function well. We can’t survive long if we’re completely devoid of fats. In fact, every cell of the body has some amount of fats. So essential fats are stored in practically all tissues and organs of the body.

Storage fat is that we find beneath the skin (subcutaneous) which serves as a reservoir for energy during times of fasting or famine.

Over the last few years, research has shown that storage fat in the abdomen―also called visceral fat―is the vicious type of fat associated with all sorts of cardiovascular complications. Although it protects internal organs from trauma, it also secretes hormones which can constrict the arteries and make the blood clot easily.


Health experts are now saying it’s okay to have fats anywhere else except in the abdomen. Belly fat is risky. Pear-shaped type of obesity (more fats on the hips) is not so bad; but an apple type of obesity (abdominal or visceral fatness) can lead one to the emergency room, or the morgue.

Women, because of their hormones and child-bearing, have three to four times more essential fat than men. The amount of storage fat is similar in both men and women.

Total body fat (essential and storage) is approximately 10 to 18 percent in men, and 16 to 25 percent in women. True obesity is defined as excessive fats, or greater than 25 percent body fat for men and 30 percent for women.

An old way of measuring body fat is through skinfold measurements, where the thickness of fat tissue just under the skin at various sites on the body is measured. Another old way, admittedly tedious, is by underwater weighing, which uses special equipment to calculate body fat. Nowadays, special scales are available that determine body fat just by standing on them.

Waist circumference

A practical and very easy way to determine if one has a little too much of the bad type of fat (visceral or abdominal fat) is by simply measuring the waist circumference at the level of the navel or umbilicus. In Asians, more than 90 centimeters (35.5 inches) in women or more than 80 centimeters (31.5 inches) in men strongly suggest a visceral type of obesity.

In the presence of other risk factors such as diabetes, hypertension and cholesterol problems, increased waist circumference indicates that the individual has the “Metabolic Syndrome” which increases the risk of heart attack and stroke four to five-fold.

Read More…

Posted by: isaaph | October 17, 2007


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Posted by: isaaph | October 17, 2007

Rep. Guinigundo Seeks Ban On Trans Fat

Manila, Philippines (AHN) – A congressman has filed a bill before the Philippine House of Representatives which seeks to ban storage, distribution and use of trans- fatty acids being utilized in the preparation of food, drinks, and beverages in restaurants, food chains, and other similar food service facilities or establishments, including manufacturers of food products.

Rep. Magtanggol Gunigundo (2nd District, Valenzuela), author of House Bill 2232, said French fries, fried chicken, cookies, pop-corns, processed junk foods, pastries, among others, which are being served in many food chains, contain trans-fatty acids.

Citing recent studies, Gunigundo warned that “excessive intake of trans fat by more than 0.5 percent everyday is fatal.”

Gunigundo added trans-fat might not only cause serious heart ailments and diabetes in adults but also cause obesity, hypertension and heart diseases.

He said children fond of patronizing fast-food chains are also being exposed to diabetes.

“The immediate phase out of trans fat must be immediately done and should not be put off since a great number of Filipinos are now fond of fast-food meals,” Gunigundo said.

The bill stated that artificial trans-fat refers to an unsaturated or fatty acid that is produced by partial hydrogenation of plant oils. This contains one or more instances of atoms bonded in a trans-configuration.

The trans-fatty acids are usually being used in processed foods such as margarine and fried foods and puddings and commercially baked goods and partially hydrogenated vegetable oils.

The bill provides that it shall be unlawful for Food Service Facilities (FSF’s) or Food Service Establishments (FSE’s) and manufacturers to use trans-fat in the preparation of food for storage, distribution or for selling.

The bill also provides further for penal provision on the person or any business entity, establishment storing or using trans-fatty acids in preparation of food products they serve and sell to the public.

The first offense is penalized with fine of P300,000.00 or imprisonment of not more than one year or both, while second offense, a fine of P400,000.00 or imprisonment of not more than two (2) years or both; For the third offense, in addition to a fine of not more than P500,000.00 or imprisonment of not more than three (3) years or both, the business permits and licenses, in the case of business entity or establishments shall be revoked or cancelled.

This is good news for the Philippine populace. Let us all hope that this bill will be passed.

Source: All Headline News

Posted by: isaaph | October 12, 2007

Fat Rant 2

Another great installment by Joy Nash to the Fat Rant series!

Posted by: isaaph | October 10, 2007

Karl Lagerfelt Rejected 3 Size 0 Models

I suppose this is good considering how he kept on saying that he dislikes fashion for overweight people and that he only sees “skinny bones”, not anorexic models.

“It is the first time I have ever done something like this,” he said.

“I have nothing against skinny girls. But these were terrible. They looked as if they had grown up in a Third World country with no food to eat.”

Well it’s about time!

Posted by: isaaph | October 4, 2007


Check out the size-positive contibution to today’s Philippine Daily Inquirer. It’s called Fat But Happy and written by Chinky Dane Seraspi.

Posted by: isaaph | September 7, 2007

The Malu Fernandez Issue

A few people may have wondered why ISAA Philippines didn’t try to put a stop to the personal attacks aimed at Malu Fernandez’s size when the issue first came out. I might have made a wrong decision but I chose the organization not to join the fray because of the sheer number of hateful comments her articles generated. I decided to comment on the issue personally and through my personal blog because I was intimidated by the hate out there. Comments such as

u fuckin hippo! go to hell! who u think u are? u look half beast half balloon! why they allowed this crap to feature in n.paper? i mean that was a foul statement to our OFW. as far as i know they are the modern heroes, no one have the rights to do that especially them, this racist malu is babaeng kupal? pinagsamang sebo at tuyong modtaks! in english go to hell where all of ur fats burn along with ur soul. greece ur ass!!!!

is very alarming and scary. I didn’t want to involve the organization because of the raw feelings of the people out there and how it might be seen that we are condoning what Malu Fernandez wrote. Now that the issue is dying down and people are starting to think rationally, I have a couple of things to say.

First, the articles of Ms. Fernandez are in no way agreeable with us. Her words are insulting not only to OFW’s but to every Filipino. She is so detached from reality, it’s no wonder that she was shocked with how the ordinary Filipino took her words.

Second, even if Malu Fernandez is at fault, it doesn’t mean that she deserves death threats. NOBODY deserves that, not even Osama Bin Laden I suppose.

Third, saying that insulting her size is justifiable because she insulted OFW’s is foul. Her size doesn’t have anything to do with her brain and her actions. The fat comments about her just goes to show how negatively fat is seen by most Filipinos.

Well that’s it for now.

Posted by: isaaph | September 4, 2007

The Fat Report

I read this great blog entry a few days ago and I’m posting it here with permission from Kuya Kevin. He is a foreigner who is doing ministry work in the Philippines.

Tumaba ka (you’ve gotten fat). Pumayat ka (you’ve gotten skinny). Live in the Philippines for a while and you will hear these words. My missionary mentor noticed that his Filipino friends/associates would frequently update him on the perceived status of his weight (especially after returning from furlough in the States). He affectionately called this the “fat report.”

This is an interesting dichotomy in Filipino culture. I’ll explain.

Filipinos are incredibly polite–so polite that they are often indirect in their communication. Filipinos, for example, are unlikely to give you a direct “no” if you invite them to something. You may hear something like “we’ll try,” which really means “we’ll come if there’s a snowball fight in Manila.” A Filipino might not show you a mistake that you’ve made—he/she would rather not embarrass you, and would hope that you realize it on your own. Being too direct can be interpreted as rude here.

The opposite, however, seems to be true when it comes to comments on one’s physical appearance. A few years back I developed a pimple on my forehead. It seemed that everyone I met felt the need to call my attention to the blemish, as if I needed to have emergency plastic surgery to have it removed. After a few comments I was ready print my own t-shirt logo: I KNOW I HAVE A PIMPLE. DON’T PANIC, IT WILL BE GONE IN A FEW DAYS.

This is particularly evident when it comes to the words “fat” and “skinny.” It has taken me some time to get used to hearing these words used so loosely. In America, you just don’t call someone “fat,” especially a woman. Calling a woman fat is essentially a declaration of war. Here in the Philippines it is completely different—commenting on someone’s weight is done just as casually as one would comment on a new set of earrings.

I’ve learned a couple of things that have helped me better understand the “fat” and “skinny” labels.

First, the “fat” term is a bit ambiguous. Any type of perceived increase in body mass is called “fat,” even if the individual has not gained bodyfat. I spent my first summer break (April/May) in Antipolo for language school. There was plenty of food around and I had some good weightlifting sessions. I put on a few pounds of “good weight” (mostly muscle) as a result. I frequently heard “tumaba ka” (you’ve gotten fat) when I returned to campus. Some of the students made gestures to imply that I had gotten “fat” through my chest and shoulders.

Secondly, the “fat report” is very subjective. A couple of weeks ago a friend told me I looked thinner. A couple of days ago someone told me I’ve gotten fat. Call me crazy, but I don’t think I’ve gained weight in two weeks. It seems there is a strong cultural compulsion to comment on a friend’s physical appearance, regardless of how accurate or inaccurate the perception may be.

I feel very blessed with the body that God has given me, so I’m not sensitive about this issue. I do, however, take a closer look in the mirror if I start hearing several “fat” comments. I don’t mind having a little extra encouragement to avoid developing the “Baptist preacher midsection.” That “encouragement” will always be present here. As long as I live in Manila, I can count on hearing the “fat report” on a regular basis.

This is how it is in the Philippines. Many foreigners who stay here for a long time are taken aback by “fat comments” said to them by ther Filipino friends.

Posted by: isaaph | August 1, 2007

Fat and Thin

I want to share this great article which appeared on today’s Philippine Daily Inquirer.

Fat and thin
By Michael Tan

Back in the 1980s when I was working with a nongovernmental organization, we had a British volunteer who would occasionally come into the office sulking. We’d speculate, often correctly, that someone had again greeted her, “Uy, Rose, ang taba-taba mo ngayon ah.” [“Hey, Rose, you’re become so fat.”]

Sounds brutal, doesn’t it? Rose would always point out that in Britain and in many Western countries, such a remark was rude and offensive.

With time, she did come to accept that such statements, including the converse “Uy, ang payat mo ngayon ah” [“Hey, you’re so thin”] are meant as greetings, said only when you’ve acquired some familiarity with the person. It’s a versatile greeting, with different meanings, depending on who says it and in what context. Sometimes it’s just an expression of endearment, usually said by grandparents when they see their favorite “apo” [grandchild]. Other times the statements can be a form of scolding, as when parents (and in our nosey extended family system, uncles and aunts and grandparents) want a child to put on (or take off) weight.

There will be times, too, when it is said in jest, like tricycle drivers would do to Rose, who was well liked in her community, especially because she was so “Kana” and yet could speak Filipino. The tricycle drivers, Filipino-style, would greet her and then rub it in by asking passengers, “Urong nga” [“Move over”], even if there was enough space. Read More…

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