Find out what's most important for your health
By Kathleen Zelman, MPH, RD, LD
WebMD Weight Loss Clinic - Expert Column
When you see an overweight fellow on the golf course, do you assume he couldn't possibly be physically fit?
Before you answer, consider this: Research suggests that just because someone is overweight, it doesn't mean he or she is not fit or healthy.
So what exactly does it mean to be fit and fat, and which is more important to good health? Read on for some answers.
How Good Is the BMI?
The body mass index (BMI) has replaced the old height and weight charts as the most widely used tool to assess whether someone is at a healthy body weight. Both men and women use the same formula, a ratio of height to weight that helps assess whether they are underweight, normal weight, or overweight.
For most people, the BMI is a good assessment of body fat, overweight, and health risk. But the BMI may not be accurate for those who are muscular, of short stature, or elderly. For instance, someone who is 5 feet 10 inches and 220 pounds with 12% body fat would be considered obese based on BMI standards. Obviously, someone with 12% body fat is not obese.
To determine your risk for obesity-related diseases such as type 2 diabetes, high blood pressure, and heart disease, the BMI is best considered along with waist circumference. To reduce the risk of obesity-related diseases, people with BMIs of 25-29.9 (overweight) and 30-34.9 (level 1 obese) should have waist sizes no more than 35 inches for women and 40 inches for men (for people with BMIs over 35, the waist measurement is not a valid marker of risk factors).
How to Be Overweight and Healthy
Yes, you can be overweight and healthy, according to the National Institutes of Health's 1998 report, Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults.
People who are overweight can be considered healthy if their waist size is less than 35 inches for women or 40 inches for men, and if they do not have two or more of the following conditions:
- High blood pressure
- High blood sugar
- High cholesterol
The guidelines point out that overweight people should not gain additional weight, and, preferably, should lose a few pounds. Other risk factors, such as smoking, also affect whether a person is considered healthy.
What Are the Risks?
Obesity and its related diseases claim many lives each year. The annual figure was initially estimated at 400,000, but was recently revised to 112,000, according to a study published in the Journal of the American Medical Association. The researchers found that underweight and obese people had a higher risk of death compared with normal-weight people.
One thing that came as a huge surprise was that the study found no increased risk of death for overweight people (those with BMIs of 25-29.9), suggesting that people with a few extra pounds but otherwise healthy lifestyles can be relatively healthy.
But don't go running to the candy store quite yet. These findings are promising only if all the other factors are in order, such as waist circumference, regular physical activity, a healthy diet, no smoking, and a lack of significant medical problems or family history for chronic diseases.
Being overweight can increase your risk of health problems, especially for type 2 diabetes, heart disease, and high blood pressure. Overweight is still considered a healthy condition that needs to be addressed. The best line of defense is a healthy lifestyle, including regular physical activity and a nutritious eating plan.
The bottom line is that your fitness level seems to be more important than your weight, unless you're obese.
"People who are obese but fit...have death rates half that of normal-weight people who are unfit."
There are plenty of overweight fitness buffs like Steven Blair, PED, of the Cooper Institute in Dallas, who describes himself as a short, fat guy who runs every day. Blair says that people who are obese but fit, according to cardiovascular measurement such as stress tests, have death rates half that of normal-weight people who are unfit.
The benefits of exercise go far beyond burning calories. Being physically active helps prevent heart disease, type 2 diabetes, depression, some forms of cancer, and osteoporosis. It can also improve your mood, enhance self-esteem, reduce anxiety, and help manage stress. And improving your fitness level usually results in increased muscle mass, which means your body burns more calories all the time.
In fact, the government's new food guide pyramid has a jogger trotting up its side, to depict the importance of exercise along with a healthy diet. The U.S. recommendations encourage adults to be active every day from 30-90 minutes, depending on their goals. A half-hour daily is the guideline for everyone; 60 minutes is recommended to prevent weight gain; and 90 minutes is the recommendation for people trying to lose weight.
Critics worry that the very idea of finding an hour and a half a day for fitness is enough to make some folks throw in the towel. But fitness and weight loss results are highly individual. Something as simple as a 30-minute walk each day may be enough to do the trick for some people.
At the WebMD Weight Loss Clinic, we advocate doing something physical each day. Start where you're comfortable, and slowly build your fitness level. If you're accustomed to sitting all day, taking 5- to 10-minute walks a few times a day is a great beginning. Remember that any exercise is better than nothing, and that you can break up your activity into increments that add up to 30 minutes daily.
As you become more fit, increase the length or intensity of your workouts to build your fitness level (if you're not sure where or how to begin, consult our fitness guru, Rich Weil, on his "Exercise and Fitness" message board).
Everyone Is Unique
If all this confuses you, you're not alone. New information about the relationship between diet, exercise, weight management, and overall health is continually emerging.
While the simple formula of "calories in minus calories out" is the foundation for weight management, people come in all shape and sizes. Everyone burns calories and exercises at different rates, which affects weight control. Add in genetics, and you can see how hard it is to come up with single, weight loss formula for everyone.
The thing to remember is that healthy eating and regular exercise are great for your health whether or not they lead to weight loss. And losing just a little weight can boost your health without necessarily moving your BMI into the "normal" range. Losing as little as 5%-10% of body weight is linked to improved cholesterol, blood sugar, and blood pressure levels.
This is not a justification to promote excess weight, just a recognition that improving your habits -- especially eating more healthfully and getting regular exercise -- are more important than the numbers on the scale.
Published June 9, 2005.
SOURCES: Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, National Heart, Lung, and Blood Institute and National Institutes of Health, June 1998. Journal of the American Medical Association, April 20, 2005. WebMD feature, Focus on Fitness, Not Fatness by Daniel DeNoon, published Aug. 9, 2004.