Thin might be in, but damning evidence suggests that those below a healthy weight range may be at more of a disadvantage than their overweight comrades. 

Indeed, weight management tends to focus on obesity and extra weight, with heart disease, high cholesterol, and Type 2 diabetes recognized as preventable diseases too often caused by poor diet and exercise habits. However, new evidence suggests otherwise, with people on the underweight range of the Body Mass Index (BMI) 1.8 times higher chance of early death than those in the healthy weight range. That number also trumps the risk factor of obesity in early death, which is amplified 1.2 times, with morbidly obese people risk elevating 1.3 times.  

"Excess thinness is not the road to health, and not the road to robustness," said Dr. Joel Ray, the study's leader. "Think of health robustness as decent muscle structure, reasonable fat, and good bone structure -- all generated by moderate eating. That's sufficient eating, not overeating or undereating."

The findings reported that low weight was often the result of myriad unhealthy habits, including smoking, alcohol abuse, and drug use. Other factors included mental illness, malnourishment, and low socio-economic status.

The BMI has also proved controversial, though is still periodically used as a measure of health. The index looks at weight in relation to height, with a healthy weight range ranking between 18.5 to 24.9 on the index. The underweight range is anything below 18.5, while overweight falls between 25 and 29.9. A BMI of 30 or over constitutes obesity. Ray urged caution when using the BMI, though maintained that the index's calculation method was a sound basis for the study. "BMI reflects not only body fat, but also muscle mass," he said. "If we want to continue to use BMI in health care and public health initiatives, we must realize that a robust and healthy individual is someone who has a reasonable amount of body fat and also sufficient bone and muscle. If our focus is more on the ills of excess body fat, then we need to replace BMI with a proper measure, like waist circumference."

The findings were published in the Journal of Epidemiology and Public Health

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