In the ongoing and often intriguing debate about the importance of fat and the amount of exercise needed, what does the science say?
The research community has long debated the importance of fitness versus fat mass for health.
Are exercise and improving fitness more important than eating well and maintaining a healthy weight?
Some researchers claim that body size has no impact on health as long as you are fit, meaning you have a strong heart and lungs.
And national campaigns such as Let's Move focus on exercise for health without specifically focusing on weight loss.
But for obese people, losing weight may be more important for their overall health than focusing on fitness.
In fact, it has been proven that exercise alone is not an effective way to lose weight. Effective weight loss instead depends on what you eat, although it should also include exercise.
As family physicians, we see obese patients who have heard the message “be fit” and have added 10 to 15 minutes of walking to their daily routine or purchased a Fitbit to track their physical activity. We applaud these efforts.
But for many obese people, the message that physical activity is more important than weight management is not only unhelpful but also false.
When it comes to health and wellness, obesity may be more important than fitness. And of course, for most people, fatness is linked to fitness, as excess weight can make exercise much more difficult.
"For many obese people, the message that physical activity is more important than weight management is not only unhelpful but also false."
What is the link between fitness and obesity?
Multiple studies have considered fitness and obesity as two distinct entities, as they are seemingly separate concepts:
One measures how well your heart and lungs are working to deliver oxygen to your muscles, while the other is a measurement of your height and weight.
However, both fitness and body size measurements are influenced by your weight.
Because of the way fitness is calculated, for two people with the same oxygen transfer capacity, a higher weight usually means lower fitness.
Similarly, what researchers mean by fat is actually body mass index (BMI), a measure of body fat based on height and weight.
People are often surprised by what is considered a normal weight. To be in the normal weight range, a person who is 1.70 m tall must weigh less than 80 kilos. If that same person weighs more than 100 kilos, they will be considered obese.
Strictly speaking, obesity does not mean you are automatically unfit.
There are obese people who run every day, and then there are thin people who couldn't run a mile for their life.
A muscular individual can also be considered obese, as muscle weighs more than fat, and be very fit.
But these are exceptions, not the rule. Studies show that when a person is classified as obese, the likelihood that they are fit is very low. So, in our society, obesity is still generally synonymous with poor physical condition.
Physiologically, it is more difficult for an obese person to get the same amount of exercise as a healthy weight person because of the extra weight they are carrying.
Heavier people need more oxygen to do the same exercise as a healthy weight person.
Some obese people report that even walking can be difficult. Fitness is harder to achieve if you can't move easily.
Being overweight reduces your quality of life
The debate around fitness and body size centers on studies that show that, compared to fit, normal-weight people.
People who are unfit have twice the risk of death, regardless of BMI. But as these studies show, a relatively small proportion of people are fit and obese.
But mortality isn't the only problem. Obesity has been shown to predict diabetes, heart disease, liver disease and a host of health problems that can require daily pills or injections, or lead to invasive procedures.
Even though a higher BMI doesn't predict early death, that doesn't mean it "doesn't matter" to your health.
While exercise can and does improve health, for people with conditions such as diabetes or fatty liver disease, exercise alone will not make a big difference in reversing these conditions.
On the other hand, weight loss (reduction of body fat) can improve or even resolve these problems.
Fat also has many other implications beyond strictly health effects.
For family physicians like us who care for obese patients, the most heartbreaking stories are those of obese patients who can't go on roller coasters with their children or can't stay clean because of their size.
Increasing physical activity without losing weight is unlikely to improve the lives of these patients.
To improve their health and quality of life, it is important to exercise every day, eat healthy foods and, above all, lose weight.
Health Questions: Does Your Weight Really Matter?
The number on the scale doesn't lie. But when it comes to your weight, there are many other factors to consider.
Until about thirty years ago, there was no "official" standard for healthy weight.
It was not until the body mass index became the first nationally accepted standard that public awareness of obesity became widespread.
In fact, calculating BMI (based on a person's weight and height) was the first way Americans could "measure" obesity, instead of simply hearing a doctor tell them "you need to lose weight."
As a result, these numbers have sparked a real obsession, especially since much scientific research has focused on the relationship between BMI and disease risk.
But it can be daunting, for example, if you're a 6'1" woman who weighs 175 pounds and exercises regularly and eats healthily. According to the BMI, you're in a range that's considered "overweight."
Which begs the question: Does your weight really matter?
In short, your weight (and BMI) matters, but only as part of your overall self-assessment.
It's not the only factor. And like most measures of health, BMI isn't perfect.
For example, results may be skewed if you have more muscle mass, higher bone density, or are pregnant.
And while BMI is an important predictor of disease risk, it's not the only one. People with a BMI slightly above 25 aren't necessarily at extra risk.
And their blood tests (like cholesterol and glucose) and blood pressure may be completely normal, which is often a reflection of a positive lifestyle, including healthy eating and increased physical activity.
Furthermore, it is estimated that up to a third of people with a "healthy" BMI are at increased health risk, when these same factors are considered.
Here are some other factors you need to think about (and can measure):
- Your muscle and body fat percentage
- Your waist size
- Your waist to hip ratio
- Your fitness level
- Your blood tests (cholesterol, glucose, liver function tests, etc.)
- Your blood pressure
- Your family history.
Consider all of these health factors, including weight, to determine a realistic target weight and how to achieve it.
The good news is that healthy living (diet, exercise, stress management, sleep, etc.) can often improve your health, even without losing weight.
Working with your doctor, you may find that a weight (and BMI) that suggests increased risk does not automatically translate into a significant weight loss effort.
Sometimes the best solution is not to gain weight. Maintaining a stable weight takes effort - and it's often a more productive approach to avoiding the dreaded "weight gain" as you age!
Some researchers claim that body size does not affect health as long as you are fit, meaning your heart and lungs are strong.
And national campaigns such as Let's Move focus on exercise for health without specifically focusing on weight loss.
But for obese people, losing weight may be more important for their overall health than focusing on fitness.
In fact, it has been proven that exercise alone is not an effective way to lose weight. Effective weight loss instead depends on what you eat, although it should also include exercise.
As family physicians, we see obese patients who have heard the message “be fit” and have added 10 to 15 minutes of walking to their daily routine or purchased a Fitbit to track their physical activity. We applaud these efforts.
But for many obese people, the message that physical activity is more important than weight management is not only unhelpful but also false.
When it comes to health and wellness, obesity may be more important than fitness. And of course, for most people, fatness is linked to fitness, as excess weight can make exercise much more difficult.
What is the link between fitness and obesity?
Many studies have considered fitness and obesity as two distinct entities, because they are seemingly separate concepts:
One measures the ability of your heart and lungs to deliver oxygen to your muscles, while the other is a measurement of your height and weight.
However, both fitness and body size measurements are influenced by your weight.
Because of the way fitness is calculated, for two people with the same oxygen transfer capacity, a higher weight usually means lower fitness.
Similarly, what researchers mean by fat is actually body mass index (BMI), a measure of body fat based on height and weight.
People are often surprised by what is considered a normal weight. To be in the normal weight range, a person who is 5'7" tall must weigh less than 170 pounds. If that same person weighs more than 220 pounds, they are considered obese.
Strictly speaking, obesity does not automatically mean you are out of shape.
There are obese people who run every day, and then there are thin people who couldn't run a mile for their life.
A muscular individual can also be considered obese, as muscle weighs more than fat, and be very fit.
But these are exceptions, not the rule. Studies show that when a person is classified as obese, the likelihood of them being fit is very low.
Thus, in our society, obesity generally remains synonymous with poor physical condition.
Obesity makes it harder to improve fitness
For obese people, it is better to start with weight loss rather than focusing on fitness.
In fact, extra pounds can make movement more difficult, and therefore make exercise more difficult. Obese people often have difficulty exercising due to their size, limited mobility, and joint pain.
Physiologically, it is more difficult for an obese person to get the same amount of exercise as a healthy weight person because of the extra weight they are carrying.
Heavier people need more oxygen to do the same exercise as a healthy weight person. Some obese people report that even walking can feel difficult.
Fitness is harder to achieve if you can't move easily.
Fat decreases your quality of life
Debate about fitness and body size.
Focuses on studies that show that, compared to people of normal weight and good health, people who are unfit have a risk of mortality twice as high, regardless of their BMI.
But as these studies show, a relatively small proportion of people are fit and obese.
But mortality isn't the only problem. Obesity has been shown to be a predictor of diabetes, heart disease, liver disease and a host of health problems.
This may require taking daily pills or injections, or lead to invasive procedures. While a higher BMI does not predict early death, that does not mean it “doesn’t matter” to your health.
Although exercise can and does improve health for people with conditions such as diabetes or fatty liver disease.
Exercise alone will not make a big difference in reversing these conditions. However, weight loss (reducing body fat) can improve or even resolve these problems.
Fat also has many other implications beyond strictly health effects.
For family physicians like us who care for obese patients, the most heartbreaking stories are those of obese patients who can't go on roller coasters with their children or can't stay clean because of their size.
Increasing physical activity without losing weight is unlikely to improve the lives of these patients.
To improve their health and quality of life, it is important to exercise every day, eat healthy foods and, above all, lose weight.
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