Focus on Fitness, Not Fatness

Critics and experts challenge the goal of thinness as unrealistic and unnecessary; they say fitness is better for health in the long run

By Daniel J. DeNoon
WebMD Weight Loss Clinic - Feature

Reviewed By Michael Smith, MD

Aug. 9, 2004 -- Obesity is a real problem. But the myths we build around it make the problem worse.

The first myth: Fat is bad; thin is good.

The second myth: If you weigh more than "normal," you must lose weight to be healthy.

The third myth: Anyone who is overweight can -- and should -- become thin.

That's the central theme of the new book The Obesity Myth: Why America's Obsession With Weight Is Hazardous to Your Health. Author Paul Campos, JD, is a University of Colorado law professor. He's not a medical doctor -- but he can cite medical literature with the best of them. Perhaps more importantly, he interviewed more than 400 people about their relationship with food, body image, and dieting.

"We are in the grip of a moral panic," Campos tells WebMD. "It is a form of cultural hysteria in which a risk is tremendously exaggerated. Weight has become a dumping ground for neurotic behavior in the culture as a whole. It is this tendency to think in eating-disordered ways that grips American culture."

Focus on Fitness

When we think about "getting in shape," the shape we think about is thin. Being in good shape means improving fitness, but we focus on reducing fatness instead.

Campos points to several major studies often cited as proof that fat kills. A close reading, he says, leads to a different conclusion.

"The crucial variable was not weight but lifestyle changes -- healthy eating and exercise, which seem to be very beneficial whether they produce any weight loss or not," he says. "When people do become more physically active and are cognizant of their nutritional intake, they get real health benefits. Just a little weight loss -- or even no weight loss -- was as good as a lot of weight loss."

CDC data support this idea. CDC epidemiologist Edward W. Gregg, PhD, led a team that analyzed data from some 6,400 overweight and obese adults. They found that people who tried to lose weight -- and did -- live longer than those who don't try to lose weight. That wasn't a surprise.

"What was unexpected was those who tried to lose weight -- but didn't -- those people had a mortality benefit," Gregg tells WebMD. "And our best speculation as to the reason is there are behaviors that go along with weight loss attempts that are good for you. These may have positive effects regardless of whether a person is able to maintain weight loss. They adopt more active lifestyles, they change diets. Over the long haul they are not successful at losing weight, but these lifestyle changes seem to help."

Steven N. Blair, PED, president and CEO of the Cooper Institute, Dallas, is perhaps America's leading advocate for a focus on fitness. He contributed a blurb to Campos' book cover.

"I've never said we should just ignore overweight and obesity," Blair tells WebMD. "But I do think the health hazards of the so-called obesity epidemic are overstated. That diverts attention from a bigger public health problem: declining levels of activity and fitness."

Stanford University's William L. Haskell, PhD, leads a large study of physical fitness, obesity, and heart disease. He's an expert in exercise, health, and healthy aging.

"It is very important that despite being overweight, physical activity has a lot of health benefits," Haskell tells WebMD. "The idea that's out there is if you are not losing weight, you are not getting a benefit from exercise. People think is the case but it really is not."

More Fit Doesn't Mean More Fat

It may actually be healthy for an overweight person to gain some weight -- if the new weight comes as muscle and not fat. Los Angeles psychologist Keith Valone, PhD, PsyD, helps a number of patients in the entertainment industry with issues such as exercise, weight loss, and body image.

"The first thing I do is tell patients to stop focusing on weight loss and to focus on changing their body composition," Valone tells WebMD. "Weight loss really is the wrong goal. The real issue is to reduce percentage of body fat and, parenthetically for most, to increase percentage of muscle mass. Actual weight may increase, but body composition must change. And that comes from changing one's diet and altering one's exercise patterns."

Getting active is only half of the equation. Diet -- as in healthy eating -- is just as important.

"The idea that maybe overweight individuals should focus on activity and not weight loss is probably not a bad idea for a number of people," Haskell says. "But the problem is, we can always eat a lot more calories than we can burn."