Fat & fit: Can people really be both?


Written by:

There’s been a simmering debate in the medical community (not to mention the popular press) over whether it’s time to stop making weight loss the primary goal of obesity treatment.

Obesity, as you probably know, is a disease state that’s defined by a BMI of more than 30. What’s that mean in actual numbers?  I’m 5’9” (or 175 cm) tall and at 150 pounds, I’m considered normal weight. At 170 pounds (77 kg) I would be classified as overweight. If my weight crept above 200 pounds (91 kg), I would be classified as obese.

Losing weight (mostly) doesn’t work

Most people suffering from obesity would be a lot healthier if they lost weight. The problem is that many (or even most) of them don’t succeed in losing weight—even when they really try to. We can debate why people are so unsuccessful in these attempts. We can blame the diets, the environment, the food supply, the media. Many are tempted to blame the people suffering from obesity for simply being unwilling to do what they need to do. 

But all this finger-pointing—and the competing solutions that arise from it—isn’t solving the problem. A large and growing percentage of our population, including our children, now suffers from seemingly intractable obesity and all the health risks that go with it. 

If we can’t actually help people lose weight, maybe we should focus instead on what else we can do to reduce those risks. Or so the argument goes.

Should we promote fitness over weight loss?

In a paper published last month, Glenn Gaesser and Siddhartha Angadi argue for a weight neutral strategy for the treatment of obesity. To support their contention, the authors present data from over a hundred individual studies and meta-analyses on the relationships between weight loss, exercise, disease risks, and mortality.

They point out that achieving moderate-to-high levels of physical activity or cardiovascular fitness can be just as effective in reducing the risk factors associated with obesity, even if those people don’t lose any weight. (Which is a good reminder that weight loss is not the primary benefit—or outcome—of exercise.)

They also note that weight cycling, where people repeatedly lose and gain weight, has a lot of negative health impacts. In fact, losing and regaining weight may actually be worse for you than not losing it in the first place. In other words, telling people with obesity to lose weight may be doing more harm than good, especially if this goal is prioritized above (or to the exclusion of) improving fitness.

So, should we actually stop recommending that people pursue weight loss and just focus on helping them get more fit?

Listen to the podcast:

Is fitness an easier sell than weight loss?

I can see the logic to this argument: Let’s not allow what we can’t do keep us from doing what we can. But for those with obesity, I’m not sure that achieving moderate-to-high levels of physical activity or cardiovascular fitness is any less daunting than achieving significant weight less.

Excess body weight—which can limit endurance and mobility—can make even light exercise very challenging. People with overweight and obesity are more likely to suffer from back problems, knee pain, and are more prone to exercise related injuries. Of course, you can (and should) start wherever you are—even if it’s just walking 5 minutes a day—and build from there. But it’s not an instant or easy solution to the problem. As with weight loss, achieving significant improvements in fitness may take a lot of time, effort, and patience. Sustaining a higher level of activity requires a long-term commitment.

Must we choose?

There’s no doubt that a fitter body—of any size—is a healthier body. But at the same time, I’d like to think that this can be a Both/And, instead of an Either/Or.  And that seemed to be the general consensus among a group of health professionals discussing this study recently on LinkedIn. The real take home here is not that weight doesn’t matter but that the emphasis should not be on weight loss to the exclusion of other measures.

Social scientist Marlena Hanlon stresses that it’s really about the focus of the intervention. “If you focus on exercise and healthy habits, weight loss may follow, but if it doesn’t, better health still will. Conversely, if you focus on weight loss, there is nothing which inherently ensures better health outcomes.”

Especially, I would add, because weight loss is a goal so infrequently and fleetingly achieved. In fact, as the authors of this recent paper point out, some data suggest that a person with obesity who is in good shape may have a greater life expectancy than someone of normal weight but below average fitness. But, they are quick to point out, “physically active adults in the normal weight BMI range had the lowest risk.”

It’s not necessarily just the health professionals who are overly focused on weight loss, however. Dr. Jonathan Ehrman, who runs a preventive cardiology program for a Michigan hospital, points out that most of his patients with obesity “first and foremost want to lose a significant amount of weight.”

Weight is not the only thing that matters

Part of the problem certainly lies in how we approach weight loss. Dr. Tom Rafai of the Harvard Medical School of Lifestyle Medicine deplores approaches based in extreme food restriction. “In my opinion, there are better ways to achieve health, and even weight loss, than one that worships at the altar of the scale or meal replacements.” Hear, hear!

So, let’s not pretend that weight doesn’t matter to your health. It does matter. It’s just not the only thing that matters. Let’s continue to work on understanding and resolving the issues that make weight loss so difficult. But let’s use all the tools in our toolbox to help people live the healthiest lives they can. And, finally, let’s work towards a society where people are not stigmatized, judged, or discriminated against because of the size of their bodies.

This article originally appeared on Quick and Dirty Tips and was syndicated by MediaFeed.org.

More from MediaFeed:

How to eat better without going on a fad diet

How to eat better without going on a fad diet

A smart friend of mine keeps falling for gimmicky fad diets. A while back, he told me he couldn’t eat beans. When I asked why, he said, “Cause I heard there’s lectins in beans.”

“OK, what’s the bad part about that?” I asked, genuinely curious.

“I don’t know,” he replied, “but there was a whole book about it, so now I can’t eat beans.”

More recently, he decided to go on a food cleanse, which has been super popular the past few years. Never mind that your body naturally detoxes and most of those approaches are based on pseudo-science. Here’s the bottom line. If a diet has a funky name, encourages strange portioning, or tells you to eat extra bacon, it’s probably wrong.

Instead of adhering to the latest “healthy eating” fad, here are 10 healthy eating practices that are simple to follow and easy to work into your daily routine.


Chop up your veggies and portion them in to-go containers so they’re ready to grab the next morning. Prepping the night before is especially good if you aren’t a morning person and want to get a couple extra minutes of sleep.

You may have heard that it’s better to chop up food right before you eat it so it’s fresher and has more nutrients. This is true, but not-quite-as-fresh veggies are still better than no veggies at all. It may not be the most perfect of all perfect practices, but creating convenience foods is time-effective and health-forward.


If you and your family enjoy Taco Tuesday every week, knowing that allows you to plan accordingly. Not only can you health-up your tacos by adding lettuce and sautéed veggies, you can also plan to eat salmon every Wednesday. By removing the choice and planning ahead, it keeps you from making bad decisions and can help with your shopping and food prep.

Everything doesn’t have to be homemade from scratch, either — try supplementing pre-made foods with healthier ingredients. For instance, pre-made quinoa, chopped veggies, or even leafy greens are super healthy add-ins to canned soups.


Ordering in social settings can be uncomfortable. You see everybody else ordering some big greasy menu item, so your impulse is to order something similar, even though it’s not what you want for your body. It’s too bad that guilt and shame can follow us to social situations—increasing the likelihood of an impulsive decision that isn’t aligned with our health plans.

Combat the impulse by looking at online menus before you go to a restaurant. That way, you know exactly what you want and can make a point to order first so others’ orders don’t tempt you.


There’s always plenty to eat at a get-together, but most spreads could use a couple more healthy options. You can decide to be the person who brings a healthy dish—even if you’re the only one who eats it.

For those moments when bringing a healthy dish simply isn’t an option, choose to eat something healthy ahead of time. That way, you’re not starving when you get to the event, you can better limit your food and portion choices, and you can enjoy yourself, grazing lightly on the unhealthy stuff.


If someone gives you a Hershey’s Kiss, what do you do? Most likely, you take it, quickly unwrap it, pop it in your mouth, swallow it, and then find yourself wanting another one.

Food is many things. It’s social, sensual, and attached to a variety of experiences. We use all our senses to enjoy food—smell, taste, touch, sight, and even sound. But nobody wants to mindlessly eat the foods they enjoy. We want to experience them with every sense.

Naturally, we all still want to graze from time to time, too. That’s where chopping veggies ahead of time comes in handy. Now, you always have a convenient, but healthy, mindless option to munch on.


Some people eat the thing they like the least on their dinner plate first—and really quickly—and then they slow down to enjoy the rest of their meal. This is a great trick to get your healthy eating in without having to entirely cut out the foods you like.


Spices have high antioxidant and anti-inflammatory components. It’s like adding a little antioxidant, anticancer punch to your meals. There’s almost no downside. Plus, they make food less boring.

Experimenting with spices can be an unexpected, fun component of your new healthy eating goals. Hit the markets for interesting dried and fresh spices, and put them on everything.


Try sneaking some black beans into your brownies—you won’t even notice they’re there. It’s an easy thing that’s a nice compromise between homemade and pre-made. Plus, little touches like this make it a whole lot easier to check off those weekly food boxes and get your required amount of fruits and vegetables.

If you need to put toppings on your vegetables or quinoa to make it palatable, go for it. Eventually, you’ll probably find that your taste buds will change and you won’t need them anymore.

This goes for microwaving, too. You may have read that it’s not great to microwave vegetables, but again, microwaved vegetables are better than no vegetables. A little Parmesan cheese on your broccoli is better than no broccoli at all.

After a few weeks of this, you’ll likely notice yourself dialing down these toppings anyway. Plus, when you’re eating more fresh foods, you’ll become much more sensitive to the salt and artificial flavors in prepackaged foods and crave them less.


Make a conscious decision to eat and enjoy something. If you’re going to eat a piece of cake, eat it—and don’t hide in the bathroom in shame while you do. Instead, portion the cake out, look at it, and say, “Yes, this is a portion that I’m comfortable with.” Then, enjoy the hell out of it.

If you follow these ten healthy eating practices and make them a part of your everyday habits, you won’t need a fad diet or complicated rules to keep you aligned with your goals.

This article was adapted from Dr. Jaime Hope’s book, Habit That! and was syndicated by MediaFeed.org. Dr. Hope is a dual board-certified physician in one of the busiest emergency departments in the country. Her book helps show others how to create better habits and make healthy living fun, practical, and accessible.


Featured Image Credit: Rostislav_Sedlacek / istockphoto.