Tuesday, July 13, 2010

Can You Be Healthy At Any Size?

The Case for Healthy Fat

For Crystal Renn, bulking up has felt nothing but great. The formerly 95-pound model was once depressed, living on little besides veggies and diet soda. Today, she's forever running between editorial shoots and runway gigs. "The caliber of work I do is much higher now that I have energy," Renn says. She certainly looks healthier, but at 5'9" and 170 pounds, she's overweight—at least according to her body mass index (BMI).

How to stop yo-yo dieting.

Doctors have long used BMI to measure whether a patient is at a healthy weight. Anyone scoring above "normal" has been regarded as potentially unwell. But compelling new research shows otherwise, says Paul Campos, author of The Obesity Myth: Why America's Obsession with Weight Is Hazardous to Your Health. "The correlation between weight and health is greatly exaggerated," he says, pointing to studies that found people with an "overweight" BMI have lower incidence of lung cancer, chronic bronchitis, anemia, and osteoporosis than their thinner peers. (Being heavier helps fend off osteoporosis, for example, because a little extra mass helps strengthen bones.)

What's more, a long-term study published in the journal Obesity found that people with "overweight" BMI scores have a lower risk of mortality than any other weight group.

So, hooray for a little junk in the trunk? Yes, some fat can be beneficial, says Konstantinos Manolopoulos, an Oxford University researcher. Pearshaped women can—finally!— rejoice: Thigh, hip, and butt fat is chemically very stable, and stable fat traps harmful compounds released during digestion. Thigh fat also secretes adiponectin, which helps the body metabolize sugar, and leptin, which regulates appetite.

Fortified by such science, the fat-acceptance movement pushes another key point: Extra weight may not be ideal, but it sure beats dieting. Research shows extreme yo-yo dieting can, over time, slow metabolism and cause cardiac stress; it can even lead to longterm weight increases.

Just ask fat-acceptance activist Kate Harding, coauthor of Lessons from the Fat-o-Sphere: Quit Dieting and Declare a Truce with Your Body, who twice lost more than 20 percent of her weight—only to regain it. It left her wondering, What if trying so hard not to be fat is actually a bigger health problem than being fat?

New Research: Why fat comes back.

The Case Against Healthy Fat

There's no chance dieting is worse, says the anti-fat-acceptance camp. Weight loss may be difficult, but it's still worth pursuing in the name of health. Some research shows that extra weight can increase your risk of developing breast cancer. And overweight women with normal cholesterol and blood pressure levels can still go on to develop heart disease at higher rates, says Barbara Berkeley, M.D., director of weight-management services at the Lakehealth System in Cleveland. "In other words, being overweight may look 'healthy' but probably isn't once we follow someone over a period of years," she says. (But what about those studies that show overweight people live longer and avoid a whole host of diseases? Berkeley argues that the overweight seem to fare better because very underweight people do worse and throw the curve.)

Then there's that question of fat placement. When you gain weight through overeating, you can't control where the pounds land. Thigh fat might be beneficial, but abdominal fat is not. Nor is dangerous visceral fat, which infiltrates and coats your organs like candle-wax drippings, releasing inflammatory fatty acids that have been linked to cancer and coronary diseases.

And weight gain can be a slippery slope. In Berkeley's practice, she sees plenty of patients who have let mere love handles escalate into a heaviness that shames them away from the gym or doctor's office. So she opposes any endorsement of being overweight, and maintains that humans, who once had to hunt and gather to survive, evolved to be a lean species.

She's not alone. Lincoln University recently made headlines when the school set up BMI score graduation requirements: Not under 30? No diploma. (Following a public outcry, the university rescinded the rule.) Both Alabama and North Carolina announced they will charge fat state employees an additional monthly fee for health care. And mega-green grocer Whole Foods started up a voluntary employee incentive program— one based, in part, on workers' weights. The lower their BMI, the bigger their discounts.

After all, explains Berkeley, "Your heart is only as big as your fist," and asking a small muscle to power an overweight frame is "like putting a little engine in an SUV."

Beyond BMI

If the two sides were to agree on anything, it would be this: Fitness is key, and pounds matter less than type of body fat. "Recently, there have been efforts to look beyond BMI,"says Margaret Lewin, M.D., clinical assistant professor at Cornell University's Weill Medical College. The oldschool measurement does serve a purpose, but its shortcomings are clear. On her blog, Shapely Prose, activist Harding runs a "BMI project," a series of photos of people of different sizes accompanied by their BMI labels. They range from "underweight" to "morbidly obese," but for the most part they look, well, pretty normal. Last is a shot of the seemingly healthy Harding, balanced on her hands in the crow yoga pose. Her BMI category? "Obese."

Exercise, everyone concurs, is crucial. It reduces mortality risk by a whopping 50 percent, regardless of weight, says Steven Blair, P.E.D., professor at the University of South Carolina. Aerobic exercise and resistance training attack waistline fat, both the padding you can see and the visceral stuff you can't. Scientists have even found that working out prevents the latter from forming in the first place. In fact, between a plus-size gymgoer and a thin couch potato, the bigger girl is better off, says Blair, and less likely to develop weight-related illnesses. That's something to hold on to as the fat-acceptance argument roils. Whether or not extra girth is indeed healthy, everyone should be active.

Speaking recently on the Ellen DeGeneres Show, Oscar-winning actress Mo'Nique recounted the moment she decided to shape up. The fat-pride supporter was standing nude before a mirror when her husband asked her how much she weighed. The answer: 262 pounds. "He said, 'Mama, that's too much. I want you for a lifetime,' " she recalled. She has since lost 40 pounds. She's certainly not thin—her BMI is likely in the "obese" range—but she's working on that visceral fat with exercise. "Everybody can't be a size zero," she has said. "But let's be healthy, big people."

Are your friends and family a fat influence?

More and more doctors feel that body mass index, or BMI, isn't the best gauge of health. So consider these barometers as well.

Blood Pressure

Calculates how intensely your heart works to pump blood through your body. It's broken into two parts: systolic, which measures outgoing flow, and diastolic, which assesses incoming flow. The heavier you are, the more real estate your heart has to service—and the harder it has to labor.

How it's measured: With that familiar arm cuff at your doc's office. Healthy women should be screened at their annual physical.

Healthy range: 90/60 to 120/80 (systolic/ diastolic)

Resting Heart Rate

Measures how many times your heart beats per minute when you're resting (read: not stressed out). A heart that's chronically overworked, such as one pumping blood to a tooheavy body, can become enlarged and susceptible to a heart attack.

How it's measured: Take your pulse for 60 seconds in the a.m. by placing a finger on your carotid artery, located just below your right ear. Do it a few days in a row; if the number is too high, see your M.D.

Healthy range: 60 to 100 beats per minute


Made up of low-density lipoprotein (LDL), the "bad" cholesterol that can cause arterial blockages, and high-density lipoprotein (HDL), the "good" cholesterol that removes LDL deposits. Some docs also measure very low-density lipoprotein (VLDL) and triglycerides, chemical fats associated with cardiac risk.

How it's measured: Get screened at least once every five years at your doctor's office. Healthy ranges: LDL below 100,

HDL above 50, VLDL under 40, triglycerides below 150

Fasting Blood Glucose

Tallies the amount of sugar in your bloodstream. A high score means your body is likely unable to metabolize all the sugar in the foods you're eating. People who consistently overconsume run the risk of high blood sugar and diabetes.

How it's measured: Your doctor can check your glucose at the same time as your cholesterol.

Healthy range: 70 to 100

Waist-to- Hip Ratio

Studies have shown this works better than BMI in terms of predicting heart disease, because it measures potentially risky abdominal fat.

How it's measured: Get your waist circumference by wrapping a measuring tape around the narrowest part of your stomach, usually right at or above your belly button. Then measure around the widest part of your hips and butt. Divide the first number by the second. Check yourself once every year.