Susan Magocsi, a vivacious 50-year-old Milton psychologist, loves to exercise. She’s training for a walking marathon in Alaska in June. She lifts weights. She does yoga and ballet.
In fact, by a number of measures — such as low cholesterol and blood pressure — she’s admirably fit.
But she loves to eat, too. Eating is “embracing life,” she says cheerfully. “I’m always suspicious of people who don’t like to eat. Where is their spirit, their passion?”
That passion has helped her put on 30 pounds since high school, more than enough to double her risk of problems like diabetes and hypertension. Her body mass index, or BMI, is just shy of the new cutoffs the government uses to define overweight.
She couldn’t care less. “I’m fit and fat,” she says proudly.
Can you really be both fit and fat? Yes, at least some fitness-fatness gurus say, but it depends on how fit and how fat.
There’s no question that Americans today are fatter than ever, and fatter than the rest of the world, too. We’re also lazy: Nearly 80 percent of us don’t accumulate even the minimal exercise — 30 minutes daily — recommended by the government.
A whopping 55 percent of adults 20 and over — or 97 million Americans — are overweight or obese, according to guidelines released last year by the National Institutes of Health in Bethesda, Md. If you’re one of them, you have an increased risk of hypertension, high cholesterol, diabetes, heart disease, stroke, gallbladder problems, osteoarthritis, sleep apnea, and some cancers.
The guidelines, which conform to those of the World Health Organization, say you are overweight if you have a BMI of between 25 and 29.9, and obese if it is 30 or more. (To calculate your BMI, multiply your weight in pounds by 703, then divide the answer by your height in inches, twice — or in other words, by the square of your height.)
Overall, 21 percent of Americans are obese — compared to 14 percent of Canadians and 8 to 10 percent of people in other leading industrialized nations, says Claude Bouchard, a geneticist and obesity specialist at Laval University in Quebec.
But whether you can carry around a pile of extra pounds and still be fit if you exercise is “very controversial,” says Miriam Nelson, associate chief of the human physiology laboratory at the Research Center on Aging at Tufts University.
Bouchard, for instance, believes there is a “zone” in which you can be fit and fat. People with BMIs of 27 to 30, “which is becoming fairly chubby, can have fairly high degrees of fitness,” he says. Beyond that, while a few athletes can have a BMI in the obesity range and be fit, most ordinary mortals that size have too little muscle and too much body fat.
If you’re genuinely obese, weight loss is necessary to achieve optimal health, says Dr. JoAnn Manson an endocrinologist at Brigham and Women’s Hospital. In fact, a 1995 study of 170 obese men directly compared the benefits of weight loss without exercise to those of exercise without weight loss for reducing heart disease risk factors like high blood pressure, high cholesterol and diabetes. Weight loss won.
And last year, the American Heart Association added obesity to its list of major heart disease risks, along with smoking, high cholesterol, high blood pressure, and a sedentary lifestyle.
But other researchers flatly disagree, saying fitness may be more important than weight loss. The most persuasive evidence cited by this camp is an eight-year study of more than 25,000 men published in 1995 by Steven N. Blair, director of research at the Cooper Institute for Aerobic Research in Dallas.
Blair found, not surprisingly, that among men with a BMI of 27 or less, the moderately fit had half the risk of death from all causes as the unfit. The really fit were at even less risk.
But Blair’s team also found that even with a BMI of 27 to 30 and 30 or more, moderately fit and very fit men had lower death rates than unfit men. In fact, the Blair team believes that unfit thin men have a higher risk of death than fit but fat men.
“Although physical activity or exercise may not make all people lean, it appears that an active way of life may have important health benefits, even for those who remain overweight,” the team concluded.
Still, it’s “a rare bird who is both fit and fat,” argues Manson. “Fit and fat is clearly better than unfit and fat. But it’s not as healthy as fit and trim.”
To some degree, the relative merits of getting fit versus losing weight depend on what disease you’re trying to prevent.
Osteoporosis and colorectal cancer are more closely linked to a sedentary lifestyle than to obesity. Uterine and breast cancer in older women, on the other hand, are more tied to weight, because fat tissue makes estrogen, which drives these cancers.
For diabetes and high blood pressure, too, obesity is the big culprit. It leads to insulin resistance, which means the body becomes less responsive to the hormone insulin, which escorts sugar from the blood into cells. Insulin resistance leads to diabetes and salt retention, which raises blood pressure.
The bottom line for most people is that, after quitting smoking, “exercise is the single most important thing you can do to benefit your health,” says Manson. “Exercise increases muscle mass, which increases metabolic rate, even when you’re not exercising, which helps burn more calories.”
Generally speaking, of course, weight loss and fitness go hand in hand. But if you have to choose, she says, “focus on healthy lifestyle behaviors like regular exercise and a heart-healthy diet, not what the scale reads.”
Bouchard, the Quebec geneticist, agrees. Diet and exercise are both critical, he says, but if he had to pick just one, “I’d put my money on increasing the level of activity.
In fact, you’re better off eating 2,500 calories a day and working off the extra 500 than consuming just 2,000 and sitting around all day, says Nelson, the Tufts nutritionist.
Even physical activity as minor as fidgeting seems to help, Mayo Clinic researchers reported in last week’s Science journal. The clinic’s newsletter puts it this way: “Concentrate on being fit and healthy rather than squeezing into your old jeans.”
In other words, even small changes in activity make a big difference in fitness and weight over time. Decreasing energy output by 100 calories a day can lead to a gain of 10 pounds in a year. The reverse is also true: You can lose 10 pounds a year by adding a daily, one-mile walk, which burns 100 calories.
Obviously, you don’t have to choose between losing weight and getting fit. The two go together. But focusing on exercising can make things easier.
“For me to lose weight,” says Susan Magocsi, “I’d have to eat 1,200 calories a day. That’s not having fun. Let’s put fun in here.” For her, that means eating and exercising.
Sidebar:
Losing it for keeps
In addition to body mass index, the National Institutes of Health recommends taking stock of your waist circumference, which is associated with abdominal fat. A waist measurement of more than 40 inches in men and 35 in women signifies increased health risk in people whose body mass index is between 25 and 34.9, meaning they are overweight or obese.
Though losing weight and keeping it off isn’t easy, behavior therapy to improve eating and exercise habits can help.
The NIH also says:
- You should engage in moderate physical activity, progressing to 30 minutes or more on most, or preferably all, days of the week.
- Cutting back on fat alone can help reduce calories and cardiovascular disease risk. But reducing dietary fat without reducing overall calorie intake won’t produce weight loss.
- Even losing just 10 percent of body weight can reduce many obesity-related health risks.
- If you’re trying to lose 10 percent of body weight, it’s likely to take six months, with a loss of one to two pounds a week.
For more information on the government’s weight guidelines and the body mass index chart, check the web, atwww.niddk.nih.gov