Can You Be Hefty and Healthy?

For years this columnist and others have been screaming from the rooftops that excess pounds are unhealthy. Now several reports show that a healthy weight is not that simple, and it’s possible to be both hefty and healthy. So how should you measure it?

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A study of 2,600 people published in The Journal of The American Medical Association showed that physically active people had about the same mortality rate regardless of whether they were underweight, normal weight or overweight. In fact, the news was even better for those who were overweight. People who were obese, but fit and in good cardiovascular health, had a strong survival edge over those who were thin couch potatoes. I’ve told patients for years to buy a scale and step on it every day. That’s because I see too many patients who say to me, “I didn’t realize I’d gained so much weight”. But researchers at Harvard University and Brigham Women’s Hospital report that weight loss is not the whole story. To reach this conclusion researchers followed the lives of 27,000 women ages 45 and over for 10 years. At the end of the study women who were physically active had a 40 percent less chance of a heart attack or stroke than those who were physically inactive. The big message; exercise can improve health even though the scale doesn’t budge one pound. So why have this journalist and others been so insistent that everyone should be careful about putting on extra pounds? For years the gold standard for determining whether you’re the right or the wrong weight has been the Body Mass Index (BMI). Now experts claim it’s an inaccurate way to assess overall health. Rather, the determining factor should be healthy lifestyle, not strictly the numbers on a bathroom scale. But wouldn’t it still be wise to lose a few pounds to live longer? The well respected National Health and Nutrition Examination Survey has also shot this theory down in flames. In fact, this study and a dozen others have shown that moderately overweight people live just as long, or a little longer, than so-called normal weight ones. I love potatoes, so at this point I’m about to tell the waiter I’ll have a double order of mashed potatoes. Extra pounds be damned. But unfortunately the prestigious New England Journal of Medicine, noted for its scientific thoroughness, published two studies that reached further conclusions about weight. One involved 1.2 million Korean women. The other study analyzed 500,000 members of the American Association of Retired Persons. Both reports showed an increase in mortality in those who were only moderately overweight. So I believe you should think twice if you still want to order “double mashed”. I always cast a jaundiced eye at large statistical studies, particularly when they reach divergent conclusions. I believe you get closer to the truth by using good old-fashioned horse sense. We know it’s a “no-brainer” that marked obesity does not foster a long life. Excessive weight is associated with a host of medical problems such as diabetes, hypertension, cardiovascular disease and other life-threatening troubles. And one of the best ways to assess potential medical problems is the circumference of the abdomen. Women should try not to exceed 90 centimeters (35 inches) and men 100 centimeters (40 inches). My advice to step on the scale regularly continues to makes sense. The New England Journal of Medicine agrees that those who weighed themselves often and took action when the scale showed a gain of three pounds were 82 percent more likely to keep their weight within reasonable limits. But it also makes sense that those who are moderately overweight, but are physically active with good cardiovascular function, are at less risk than thin couch potatoes. So let’s end on this happy note reported in the American Journal of Public Health. Columbia University researchers studied 170,000 people and found that those who were happy with their weight, regardless of their size, were in better physical and mental health. That was great news for me as I’ve always been happy with my weight. So, Waiter, “Please make that “double mashed”.