Yes, Indeed — You Can Be Fit And Fat

Conflicting information abounds in the medical community.

Some say you enjoy being in the sun for vitamin benefits — others that you should only do so hidden under a kaftan and big-brimmed hat while slathered in SPF 75? For years, women used hormone replacement  derived from horse urine to fight back menopause symptoms. That treatment has been discarded as it produced an unfortunate side effect: heart attacks. Many Baby Boomers walk the earth sans their tonsils because the surgery was the cure-all back in the day. Trends affect medicine as much as any other profession.


The current health debate involves your waistline. How fat is too fat? And, is it possible to be too active and too thin? Recently, two sets of research have came out illustrating the confusion. First, there is a notion that running can be hard on the joints, cause disability and shorten lifespan. Turns out that running is, in fact, healthy and can prolong life. In U.S. News, Amanda Gardner reported

 Many experts believed that vigorous exercise would actually harm older individuals. And running, in particular, would result in an epidemic of joint and bone injuries. But a new study shows otherwise:

Two hundred and eighty-four runners and 156 healthy “controls,” or non-runners, in California completed annual questionnaires over a 21-year period. The participants were 50 years old or over at the beginning of the study and ran an average of about four hours a week. By the end of the study period, the participants were in their 70s or 80s or older and ran about 76 minutes a week.

At 19 years, just 15 percent of the runners had died, compared with 34 percent of the non-runners.

Also, said Fries, who is almost 70, runs 20 miles a week and plays tennis, “Running delayed the onset of disability by an average of 16 years, and that is largely a conservative number, because the control group was pretty darn healthy.”


So, if you’re an obsessive runner, it’s healthy. Today. The study is relatively small, but looks solid. As of this writing, running, a lot, will compress your disability — that is, you’ll show signs of aging later than if you never ran.

And on the very same day, this research was published in the Archives of Internal Medicine:

Among US adults, there is a high prevalence of clustering of cardiometabolic abnormalities among normal-weight individuals and a high prevalence of overweight and obese individuals who are metabolically healthy. Further study into the physiologic mechanisms underlying these different phenotypes and their impact on health is needed.

There’s lots of doctor speak in the article, but here’s the bottom line: There are fat people who are healthy and there are skinny people who are not.

This is distressing news for some, because the conventional wisdom is that fat people are automatically unhealthy and skinny people are healthy. Of course, as the running research demonstrates, people have been suspicious of the super skinny, exercise-obsessed, too and any time an athlete up and drops dead, it gets lots of attention (but it is usually due to an undiagnosed heart  or metabolic  problem or even stress More here.)


The definition of “healthy” has serious ramifications both medically and economically. People may or may not change their lifestyles based on bad information when they should be taking a different course. In addition, managed care is seriously on the table now. Should Barack Obama win the presidency and the Democrats control both the House and Senate, and that includes deciding what it means to be healthy. Forget the pain in your pocketbook, your health care may depend on how health is defined.

So, what is the key to “healthy” since it is possible to be healthy and fat? The key is actually common sense :

In all weight categories, risk factors for heart problems were generally more common in older people, smokers and inactive people. Among obese people who were 50 to 64, just 20 percent were considered healthy compared with half of younger obese people.

The results underscore how important exercise is for staying healthy, even for people of healthy weight, Wylie-Rosett said.

The authors noted that fat tissue releases hormones and other substances that affect things like blood vessels, cholesterol and blood sugar. The results suggest this interaction varies among overweight and obese people, the authors said.

The results also add to mounting evidence that thick waists are linked with heart risks.

To be healthy, the standard advice applies: Don’t smoke, drink alcohol moderately (it even reduces your risk of stroke,) exercise regularly and eat healthy. But what does that mean practically? Too often, people feel overwhelmed by the advice. Quitting smoking is pretty straight forward, if a person can do it. [Health steps to take if you can’t quit or don’t want to, is another article.] But the rest of it can be confounding especially since people lead such busy lives.


Here’s what I tell my patients: Change one thing. Start with something small and doable. For example, sugary soda drinks are just terrible for your health. Give them up. A person who is “addicted” to a couple of sodas a day will lose weight immediately  if he or she just changes this one thing.

Another small change that pays big dividends: daily walks. The benefits are almost infinite . Miss a day? Go out tomorrow and walk. People often get discouraged because they try something dramatic like “working out” or going to the gym or buying some equipment, when something as easy as walking would produce excellent health benefits and be sustainable.

The key to any lifestyle change is to make the benefits outweigh the negatives. Anything that consumes too much time, cuts into preferred activities, hurts, or otherwise makes a person miserable is unlikely to be stuck with long term. Once a person sees the benefits of one change, it’s easier to add another. Success breeds success.

A person doesn’t have to be supermodel skinny to be healthy. In fact, with her smoking, champagne and cheese diet and lack of muscle tone, she is probably unhealthy. Healthy comes in all body types, but healthy people tend to do the same things. So worry less about the scale and more about adding healthy habits.


You can be fat and fit.


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