FAT BUT FIT
Some overweight people exercise and diet and still can't lose those stubborn pounds. But for them, being overweight doesn't necessarily mean being unhealthy. -by Camille Rey-

Jan. 28, 2002 -- Looking in the mirror can be a frustrating experience for someone who is trying to live right but just can't get those last few pounds off. But which is more important -- being thin or being fit?

"You can be fit and fat," says Jody Wilkinson, MD, a researcher at the Cooper Institute for Aerobic Research in Dallas. "And it's better than being skinny and sedentary." Wilkinson and his colleagues at the Institute have produced strong evidence in support of this claim. Consider some of their findings:

A 1995 study published in the International Journal of Obesity involving more than 25,000 men tracked over a 23-year period found that fitness level was a better predictor of heart disease than weight. In other words, overweight men weren't necessarily at high risk for heart disease if they were fit.

A study published in the October 1999 issue of The Journal of the American Medical Association found that overweight men who exercised regularly had death rates, based on any cause, only slightly higher than those of unfit men of normal weight. (Obese men who didn't work out had death rates two to three times those of the normal weight men; thus, exercise offered substantial protection even to very heavy men.)

A study published in a 1998 issue of the International Journal of Obesity showed that of 21,000 men, unfit men were much more likely to die of heart disease than fit men -- regardless of how much they weighed.


The Other Shoe

These findings haven't convinced everyone, though. Certainly not the federal government. In 1998, the National Heart, Lung, and Blood Institute issued the first national guidelines on obesity in adults. The government came down hard on the U.S., changing the definition of healthy weight to classify 29 million additional Americans as both overweight and unhealthy. And carrying excess pounds, federal officials say, raises a person's risk of heart disease, diabetes, and numerous other ailments.

But Wilkinson says there is a crucial flaw in most of the studies cited by the "you can't be fit and fat" crowd. He acknowledges that many overweight people are indeed at greater risk of chronic disease. But most studies that have fingered weight as a culprit in these ailments have not factored in physical fitness. Without a way to separate overweight people who are fit from those who are not, Wilkinson argues, the numbers are misleading.


Finding the Middle Ground

Gerald Fletcher, MD, a cardiologist at the Mayo Clinic in Jacksonville, Fla., agrees that a person can be both fit and fat. "But most people are not," he says. That's why he, like most doctors, continues to urge his patients to lose weight -- particularly those whose excess weight is concentrated around their abdomen, who have even borderline high blood pressure or cholesterol, and who have a family history of heart disease.

Regardless of inherited tendencies, size, or shape, doctors, including Fletcher, agree that maintaining a healthy lifestyle remains the single most important advice they can give to their patients. In addition to regular exercise, Wilkinson encourages his patients to eat healthful foods and to change unhealthy habits, such as cigarette smoking.

In addition to body mass index, the following factors are indicators of better health:

Total cholesterol levels below 200 mg/dL
Blood pressure below 140/85
Blood sugar level between 80 and 120 mg/dL before meals
The majority of body fat occurring below the waist
The ability to jog at a light pace for 20 minutes while holding a conversation

"It makes you feel better and improves the quality of life," Wilkinson says. "That's really the bottom line."