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Recently Lori, a client of mine, called me angry, upset and discouraged. She had just returned from her yearly physical, which she had been eagerly anticipating. Though she hadn't reached her weight-loss goal, Lori had made many lifestyle changes to promote good health. She had begun exercising on a regular basis, made some subtle shifts in her dietary habits that made her feel better, and had even begun a weekly yoga/meditation class to manage stress. The results of the physical demonstrated her efforts had been paying off. Her blood pressure was in the normal level for the first time in years, her blood sugars had dropped, and her cholesterol profile had greatly improved. However, once the exam was complete and she was sitting with her physician in his office, rather than commenting on the improvements, he stated, "Lori, I was really hoping you would have dropped a lot more weight since our last visit. If you don't get serious about taking off the extra pounds, your risk of early disease will continue. Have you tried dieting?" There is an overwhelming presumption in our country that if an individual is overweight they are also unhealthy. Research clearly supports that being overweight is a major health risk factor, contributing to an increase in cardiovascular disease, diabetes, stroke, and many types of cancer. So can we assume that if you are hauling around extra pounds that classify you as overweight or obese, it will destine you to a future filled with illness and disease? Not necessarily. An intense debate has emerged in the last few years amongst obesity researchers, asking the question, "Can people be overweight but still be healthy?" Is the number on the scale the only thing that counts, or should we take other factors into consideration? Scientists are now dueling over the relative importance of "fatness vs. fitness" when it comes to determining the health of an overweight individual. A small but vocal group of researchers have been challenging conventional wisdom. They argue that not only is it possible to be both fat and fit, but fitness is actually a more significant measure of health than body weight. The first major fatness versus fitness study was conducted by researchers at the Cooper Institute, a nonprofit fitness organization in Dallas. In a study of 22,000 men ages 30–83, the researchers measured subjects' body composition (the proportion of fat to muscle) and put them through treadmill tests. They concluded if you are fit, being overweight doesn't increase mortality risk. Steven N. Blair, who heads the Cooper Institute, defends the role of fitness as a major determinant of health regardless of one's weight. "We've studied this from many perspectives in women and in men and we get the same answer: It's not the obesity—it's the fitness," Blair said. "Fitness can substantially reduce, if not eliminate, the high risk of being obese." Results of studies done by Mary Fran Sowers and Judith Wylie, obesity researchers at the University of Michigan, showed that thin, unfit people can develop heart-related problems that fat but fit people often do not. Kelly Brownell, Director of the Yale Center for Eating and Weight Disorders, concluded in a 2003 study that heavy people that are fit have a lower risk of heart disease than thin people who are unfit. However, others are concerned that sending this message will be misunderstood, giving overweight and obese individuals the message that weight doesn't matter; an excuse to accept the extra pounds as unimportant and not to be worried about diet as long as they exercise. "Being overweight has a clear association with important health problems, and even modest weight loss has important health benefits," said Walter Willett, an expert on nutrition and health at the Harvard School of Public Health. "To tell people it doesn't matter is really misleading. It does make a difference. It makes a huge difference." The Nurses' Health Study, which since 1976, has been looking at the lifestyle habits and mortality rates of approximately 238,000 nurses, found that being a little active and a little fat wasn't such a bad combination. But physical activity didn't completely eliminate the risks that were associated with being overweight or obese. In fact, when the nurses were grouped by how active they were, the heavier nurses were more likely to have died than the lighter ones at every activity level. Despite the differences in these studies, they all suggest that physical activity will offset some of the effects of excess weight, if it's just a few extra pounds. No one is debating that there is a marked difference in disease rates in the obese vs. the overweight. When assessing overall health risk, we need to look at many factors, not just the number on the scale. There are many ways to assess overall health and mortality risk, and it's time to look at all these factors together before putting a stamp of "healthy" or "unhealthy" on anyone. The most common measure used to determine if a person's weight puts them at a health risk is the BMI, which is a measurement of the ratio of weight to height. Healthy individuals fall within a BMI range of 18.5-24.9; overweight between 25-29.9; and obese above 30. However, the problem with the BMI is that it does not take into account body composition. Since muscle is more dense than fat is, a person with a high percentage of lean muscle mass may end up in the overweight category, despite being lean and fit. Although the BMI has value, it should be looked at along with other factors. Among healthy weight individuals, people with larger waists and pot bellies have a greater incidence of increased blood pressure and increased cholesterol. Women with a waist circumference over 35, and men over 40, have an increased risk of obesity related diseases. Metabolic syndrome, which is a disorder of growing proportion in this country, is marked with a greater risk for coronary artery disease and diabetes. It is diagnosed when an individual has at least three of the following symptoms:
CRP test, a simple blood test that measures C-reactive protein, is also a strong indicator of heart disease risk. And of course, a health profile would be incomplete without looking at other risk factors such as cigarette smoking and family history. With all of this information, what does it mean for individuals like Lori who overweight, but active, and not displaying many of the measurements of increased health risk? Should the emphasis be on taking the pounds off, improving fitness, or both? The healthcare industry may be missing the mark and doing a disservice to our overweight clients and patients with the typical approach of focusing so heavily on nutritional changes. We've looked at exercise as a modality to help take the extra pounds off, but the main emphasis has been on diet. If the goal is to improve the overall health profile of the individual, could we do this by looking at fitness first? There is no debate that taking off excess pounds improves health. It is a well known documented fact that losing as little as 5% of overall body weight results in significant improvement in the markers that determine health. And it is true that manipulating dietary intake results in faster weight loss than exercise alone. We certainly know that the best approach is dietary changes and exercise together. But this total overhaul of lifestyle can be overwhelming and extremely difficult for people to adopt. It takes patience, perseverance, support and education. Not everyone is ready to embark on all of these changes at once. For most, the first attack on excess pounds is "going on a diet." Unfortunately, this usually brings up feelings of deprivation, boredom, and a serious lack of confidence in permanent success. "Dieters" often focus on everything they no longer can eat. Too many end up feeling badly about themselves when they have lapses in willpower and are unable to completely eliminate "bad foods." Rather than dieting, a lifestyle approach that includes dietary changes is essential. Similarly, if the main reason exercise is encouraged is to help with weight loss, you may be sorely disappointed. But when you view exercise as a means to improve health and well-being, rather than something you have to do in order to lose weight, you can measure success from a different parameter. Once adopted, exercise often leads to marked improvements in emotional outlook, physical strength, and self-esteem—no matter what your size. Ironically, when an individual embarks on an exercise program, they often report feeling more in control of their dietary habits. They suddenly want to eat healthier to fuel the new active lifestyle. So apart from any weight-loss goals you've set for yourself, it's important to exercise regularly. However, it's salient to realize exercise isn't going to magically erase all the health risks of being heavy--especially if you're doing a minimal amount of exercise. Inconsistent physical activity isn't enough to keep you healthy at any size. Neither will doing just the minimum requirments (or less). Regular exercise that includes cardiovascular (aerobic), flexibility and strength components and adds up to at least 150 minutes per week is essential. To find out just how fit you are, try these four fitness tests you can do at home to assess your current fitness level. Weight has no factor on these results, but if your fitness scores are poor or below average, that would be an indication that you need to step it up in the exercise department if you hope to offset the risks associated with being overweight. Rather than going on a diet, eat for good health and energy. By de-emphasizing the number on the scale, and looking at all the measures of health risk, you'll feel empowered to be proactive about their health. Ironically, when this healthy lifestyle pattern becomes habitual, excess pounds often disappear as a result. So what was my advice to Lori? Continue to exercise, eat for good health and vitality, pay attention to all the health parameters—not just the number on the scale—and lastly, find a new, more compassionate and knowledgeable physician! Sources Is It Okay to be Fat if You're Fit?, The Harvard Medical School Family Health Guide. Do You Know the Health Risks of Being Overweight?, Weight-control Information Network. Myth: You Can't Be Overweight and Healthy, An Epidemic of Obesity Myths. This article has been reviewed and approved by SparkPeople's nutrition expert, Becky Hand, M.S., Licensed and Registered Dietitian, and SparkPeople's fitness expert, Nicole Nichols, B.S., Certified Personal Trainer. |
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Fitness Articles › Special ConcernsCan You Be Overweight and Healthy?Getting to the Weight of the Matter-- By Ellen G. Goldman, Health and Wellness CoachSparkPeople advertisers help keep the site free! Learn more
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About The Author
Ellen Goldman
Ellen Goldman has bachelor's and master's degrees in health and physical education. An AFAA-certified personal trainer and certified wellness coach, she is also the founder EnerG Coaching, LLC. Through one-on-one and group sessions, Ellen helps individuals make positive lifestyle changes, lose weight, manage stress and attain work-life balance. Visit her at www.EnerGcoaching.com. |
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Member Comments
What I found out to my pleasant surprise is that my body became quite accustomed slowly to being fat, I found I like how I look and feel. Yes I have a belly but it really is not that bad, and yes I work out 5 to 6 dayss an week and yes I am very active. I have never felt so good being fat.
The weight around 30 pounds went right into my belly and since it went on slowly I have come to accept the fact that I will always be rather fat, but I have full intentions of being fit. Now I am just a fat guy, but I am fit.
I checked with my doctor and my blood pressure has stayed the same low, and since I became fat slowly and do exercise my blood sugare is very normal. - 1/7/2013 4:29:30 PM
Over the past year, I've lost over 80 pounds... And, when I had the annual work physical - they didn't comment on how far I've come. Didn't comment that I'd lost so much weight, dropped my BMI (which is a stupid system, btw) from grossly obese to the very low end of overweight....
NOOOO... they just kept harping that I was overweight & should consider changing my diet/exercise habits because I was "overweight".
Nevermind the fact that I've run several 5ks this past year, that I run twice a week & do weight training twice a week. That I've gone from a size 26 to a 12.
Bastards. - 12/7/2012 11:06:44 AM
But it is relative fitness, not absolute. The same individual, less active but not overeating, could remain overweight and become less fit. The same individual, more active and eating just below needs, could move toward a healthy weight and become more fit.
No matter how fit we believe ourselves to be when overweight, we do have long-term issues that slowly build up. Joints, tendons, and ligaments are more stressed from the greater amount of weight / pressure with every action. Organs work harder to keep up with the larger amount of food being consumed and to process the excesses in the blood and body.
I ~AM~ relatively fit for an overweight person. But I want to be even more fit and be able to say "I am fit" without the qualifier. - 8/10/2012 3:52:29 AM
About two years ago, I had normal lipid profile, great blood pressure, sugar, etc. but I was overweight. By looking at my test results you would have never suspected that I was days away from what would have surely been a fatal heart attack - my doctor, following a hunch about my vague "allergy" symptoms, had me stress-tested and I had an angioplasty that same day to open a 99.9% blocked artery. We have to deal with abdominal fat, no matter how many pushups we can do in a minute. - 7/10/2012 10:33:38 AM
But I don't care how healthy you seem to be and what you do, if you have rolls of fat or too much excess showing anywhere, you need to lose weight. If you are young it might not registered as a medical issue. But as you age if you carry around that extra fat you will be subject to medical issues.
Too many of the population these days seems to think they are looking great and flaunting all the extra weight as if it's fabulous looking. It's not. There is an obesity epidemic happening across the country.
The medical problems that this epidemic will cause is frightening.
Don't look for excuse to be fat or over weight. - 7/8/2012 4:25:11 PM
I know people do not want to use that dirty "D" word...diet. But those changes are important and necessary! Call it what you want, eating healthier, choosing to not eat like crap, lifestyle change, whatever, changing the intake of your food is a MUST!
I believe just as much emphasis has to be put on one as the other. Diet and Exercise go hand in hand and it sucks when you FINALLY understand that, and you realize just what that means and what you have to be willing to do but it's worth it. Not easy by any means, but absolutely worth it!
Everything on TV or magazine articles seem to want us to do this one extreme thing for X amount of time and then POOF, you will have the body you never thought you could and be "healthy and fit". There is no ONE THING that will make you fit and healthy and there is no "end". You choose to eat healthier and exercise. That becomes your life, not for 60 days or 90 days, for the rest of your life. Just like this article said, there are many factors to be considered in determining health, likewise, you must make multiple changes in your life to get on the road to a healthier you.
I don't think one success story from SparkPeople will tell you that the weight they have lost and their accomplishments have been easy but they will all agree it's been worth it. And after reading several success stories on Spark, I have noticed they all have one thing in common...they changed their eating habits and they exercised!
The article points out the obvious...that making multiple changes to eating and including exercise is daunting. Yeah well no kidding, of course it is! That is why it takes people so many tries and attempts to lose the weight. ... - 7/5/2012 4:56:09 PM
Also, it depends on what we are qualifying as body fat.
If more people got their ACTUAL body fat percentages done - via water weighing - I think most of the so-called - "fit fat" people would have a lower body fat percentage, placing them in the average to fitness category.
If however, we are going by just the BMI tables, a 5'7" a person who weighs 155 to 180 is overweight. Again, I can see that. But anything over 180 is obese. Frankly, that seems right to me. A 5'7" person over 180 can't be healthy. Period.
- 7/5/2012 4:17:07 PM
ng and weight. We go through biometric testing to determine our results and although I am considered morbidly obese I qualified for 4 of the 5 incentives and get 16.00 per pay removed from my insurance premium.
I'm not saying that this extra weight is a good idea, it is breaking down my skeletal structure, I need a knee replacement. But, otherwise, I am healthy. It is partly genetic as my dad's family all have great health, even those with weight issues.
My sister-in-law weighs about 115 and takes medicine for high blood pressure, her cholesterol is bad and at 32 she is already developing a hump in her back from weak muscles and poor posture.
I think there is more to obesity than simply weak willpower and maybe this will get the researchers looking for some sort of answer.
Nice article - 7/5/2012 3:30:15 PM
I am lucky that while I have lost weight but am still a big girl, and still classed as obese.My doctor is very supportive. In fact tells me that I am one of her healthiest clients not lcounting what the scale says. At my regular physical it was noted that i had gain weight. But my doctor was not worried. I have been doing a lot of weight training and she was well aware my weight gain was muscle. All my blood level are in the healthy range, I workout on average 120 mins a day of cardio and weights. I also walk daily with my dogs. I eat healthy. But with a thyroid condition it has been hard to get the weigh off. My doctor notes that while I still have belly fat I am solid muscle on the rest of my body. And as she points out when your 51 year old female client can bench press more than you weight you don't really want to tell her she isn't trying hard enough. LOL (for the record that is 155lbs) - 7/5/2012 2:18:16 PM