The Fit and Fat Debate, Part 1

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Can a person be both fat and fit? The question has attracted the interest of some obese doctors with a vested interest in the outcome, and of many civilians who would like to go on believing that no lifestyle changes are necessary in their corner of the world. Some people feel it’s totally unfair to brand overweight and obese people as unhealthy, as long as they are not actually sitting in the emergency room waiting for their turn. Others maintain that obesity itself is un-health, and that is the bottom line with no more to be said about it. They see no merit in promoting any notions that smack of “fat acceptance.”

In discussing the issue, journalists use such words as “intense debate” and even “dueling,” and the whole issue is so complex it’s really hard to get a handle on it. For starters, a person’s degree of overweight or obesity is measured mainly by the Body Mass Index (BMI), whose usefulness only goes so far. The reason for this is variations in body composition. Since muscle is more dense than fat, a strong muscular and healthy person can wind up with a “worse” BMI than a comparable subject whose fat cells are taking over. This is why some characterize BMI results as gross oversimplification.

Much more important, many health professionals believe, is the overall picture as shown by the presence or absence of metabolic syndrome. That label can be earned by possessing three out of four of these markers: big waistline, high blood pressure, a high triglyceride level, and a low HDL level.

Though there is general agreement on the importance of these, there is also strong insistence from some quarters that it doesn’t matter how exemplary the blood test scores look on paper. This faction says that being overweight, in and of itself, increases the risk of heart disease, and people who believe differently are only kidding themselves.

Health and wellness coach Ellen G. Goldman quotes a Harvard School of Public Health expert on nutrition, Walter Willett:

To tell people it doesn’t matter is really misleading. It does make a difference. It makes a huge difference.

Alexandra Sifferlin found a quotation that pretty much sums up one point of view, articulated by Dr. Timothy Church, who directs the preventative medicine lab at Baton Rouge’s Pennington Biomedical Research Center. Dr. Church’s opinion is:

Weight is a major issue when it’s combined with a metabolic abnormality. When you have weight plus insulin resistance, weight plus hypertension, weight plus abnormal cholesterol — then you have an issue. Obviously the more overweight and the more obese you are, the more likely you are to have a metabolic abnormality.

The eminent Dr. Kelly Brownell, of the Yale Center for Eating and Weight Disorders, may have been the catalyst for this never-ending debate when about 10 years ago he publicized the news that thin, unfit people have more of a heart disease risk than heavy, fit people.

Since then, some studies have seemed to show Dr. Brownell’s optimism in this area to be justified. Journalist Goldman looked up information on several of them, to compare and contrast. For instance, the Cooper Institute, a Dallas nonprofit organization, looked at the health records of 22,000 men and concluded, in the words of its head, Steven N. Blair:

It’s not the obesity — it’s the fitness. Fitness can substantially reduce, if not eliminate, the high risk of being obese.

On the other hand, Goldman reminds us:

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.

Sifferlin cites the Nurses’ Health Study, which keeps track of 238,000 participating nurses, to the effect that physical activity cannot eliminate the risks of overweight and obesity. She says, “the heavier nurses were more likely to have died than the lighter ones at every activity level.”

But then, contradicting other findings, there is something called the “obesity paradox,” examples of which are noted by Sifferlin:

Another study published in the Journal of the American Medical Association in early August added evidence for the so-called obesity paradox, finding that among people already diagnosed with Type 2 diabetes, those who were obese lived longer than their thinner peers.

Similarly, in a second study published in the current issue of the European Heart Journal, researchers looked at nearly 65,000 patients with heart disease and found that overweight and obese people had the lowest risk of early death, compared with normal-weight or underweight patients; those who were underweight had the highest death risk.

(To be continued…)

Your responses and feedback are welcome!

Source: “Can You Be Fat and Fit — or Thin and Unhealthy?,” TIME, 09/05/12
Source: “Can You Be Overweight and Healthy?,”, 09/20/11
Image by Lars Plougmann.

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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