The 'Fat But Fit' Fallacy

We all like to eat. Most of us want to eat well; at least we try to be good some of the time. We all know that how and what we eat directly impact our health and well-being. Yet few subjects are more prone to confusion and distortion than diet and nutrition.

We are promised amazing results with an endless stream of diet plans: Atkins, Dean Ornish, the Zone, South Beach, Glycemic Index, the list is nearly endless. Grocery stores sell magazines shouting out blatantly false claims that promise to help readers "lose weight like a teenager," "lose belly fat," "lose 11 lbs a week," and "fill up on fat-burning super foods." We are sold hormone supplements, told the benefits of "anti-inflammatory foods" and promised results if we only would take acetyl coenzyme A. These promises cannot be kept because they defy the simplest laws of biology and physics. This is what the FDA and nutritionists say about fat-burning foods: "No substance has ever been shown to actually do this." "Consumers should know that there is no such thing as a fat-burning pill." So much misinformation and myth has enveloped popular ideas about diet and nutrition that even the most basic facts have become distorted. Commonly used terms like fat, calorie or body mass index (BMI) are widely misunderstood and abused by the unscrupulous. Some of this is harmless hype that will simply part some fools from their money; but some common myths are downright dangerous. Perhaps none is more so than the idea of "fat but fit."

Fat is Not Fit

A recent article in the New York Times rightly explained the limits and deficiencies in using BMI as an indicator of health and longevity. BMI misses more than half of people with excess body fat. Inversely, because BMI is deeply flawed, we find that some people considered overweight according to BMI measurements are at least as healthy as someone considered of normal weight (in terms of BMI). Fine, so far; we can use this knowledge to moderate and guide the use of BMI as a tool in our arsenal. But something more nefarious has happened: this inherent flaw in BMI has led to the dangerous and patently ridiculous idea that one can be simultaneously fat but healthy. Nothing could be further from the truth, as we will see next. Data provided here are taken from the original citations in Calorie Wars: Fat, Fact and Fiction.

Biology is a science of averages in which we can see significant individual variability. While smoking hugely increases one's risk for lung cancer, not all smokers get the disease. Such outliers prove rather than refute the rule by emphasizing the rarity of the unusual. Indeed a small percentage of obese people do not exhibit some of the problems associated with being overweight. This is to be expected because few things are absolute in biology. Yet while we can point to a few obese individuals who do not appear to be at increased risk for heart disease, that should offer no consolation to anybody, nor can we draw any meaningful conclusions from the outliers. Just because Betty Sue won the lottery does not mean her neighbor will too. On average, obesity leads to an increased risk for a variety of deadly ailments, and obese individuals have a greater chance of suffering from such diseases. Most Americans die sooner than necessary by stroke, heart attack or cancer, and obesity increases the risk for all of these.

We know absolutely that obesity creates an increased risk of diabetes. In 1990 about 11 million Americans had type 2 adult onset diabetes, a disease of insulin resistance that commonly coexists with obesity; just nine years later the number was 16 million, or about 6 percent of all Americans. Then from 1999 to 2003 we saw a 41 percent increase in diagnosed diabetes. Since then obesity has ballooned to an astounding 64 percent of all Americans and the number of diabetics continues to explode. The insulin resistance syndrome associated with obesity has other dire consequences, including hypertension and the increased risk of atherosclerotic cardiovascular disease.

Another problem with "fat but fit" is simple mechanics. The human body evolved from a period of deprivation where food was scarce and difficult to obtain. Our ancestors were almost certainly lean. In any case, we are not engineered to bear excess weight on our joints. Obesity leads to arthritis -- and often to joint replacement not only because of the mechanical stress it can cause but because fat produces chemicals that attack cartilage. Think of it this way: If you stuff 20 people into a VW Bug, the suspension will wear out faster and the engine will have to work harder, ultimately reducing its useful life.

Also, consider the following realities:

• About 300,000 deaths per year are attributed to obesity; in spite of the deep flaws in BMI, we know that individuals with a body mass index (BMI) over 30 have a 50 percent to 100 percent increased risk of premature death from all causes compared to lean people with lower BMIs.

• High blood pressure is twice as common in obese adults compared to those with a healthy weight; obesity is associated with elevated blood fat (triglycerides) and decreased good cholesterol (HDL).

• A weight gain of only 11 to 18 pounds increases the risk of developing type 2 diabetes; over 80 percent of people with type 2 diabetes are overweight or obese.

• Obesity is associated with an increased risk of cancer of the uterus, colon, gall bladder, prostate, kidney, and postmenopausal breast cancer.

• Sleep apnea is more common in obese people. And some recent studies have indicated that a lack of sleep might impact hormone levels to a degree that could, indeed, cause weight gain.

• Obesity during pregnancy is associated with a greater risk of birth defects, including spina bifida.

• Every increase in weight of two pounds increases the risk of arthritis by 9 percent to 13 percent.

One final consideration on the idea of being fat but fit: Obesity affects quality of life through limited mobility, decreased physical endurance, and social, academic and job discrimination. While we know we should not judge a book by its cover, we all do. Yes, we should be comfortable with and love ourselves for who we are, and we need not look like a fashion model. But that truth is no excuse for carrying around excess weight, or deluding oneself into thinking that fat can be healthy.

Fat is Not Inevitable

The idea of "fat but fit" is simply an attempt to justify rather than address a problem. Countless people struggle daily with excess weight, and wishing it away won't help. Too much is at stake for us to succumb to lies, misleading advertisements, disinformation and bad biology perpetrated on us by a $40 billion diet industry and unscrupulous doctors. We are all easy targets because we want to be attractive, trim and sexy. We want to feel good about ourselves. We want so badly to find a magic bullet, discover a pill that will help put right our image in the mirror. That wish for a quick fix is pure fantasy, but do not despair, because the truth too is that the solutions to diet problems are simple -- and realistic.

We need not be victims of pseudo-medicine, bad science and bogus claims. In spite of all the phony prophets and charlatan MDs selling false hope, we each have the power to take control over our own lives; we can control our health, our diet and nutrition, our weight. You don't need a ridiculous doctor in surgical scrubs on TV telling you what to do; you don't need a mega-corporation telling you what to eat.

With just a few simple ideas, we can master our struggle with weight gain. Want to be slimmer and healthier? The rules are straightforward. Yes, following the simple rules is not always so easy; maintaining a good weight and a trim figure requires commitment and work. Like all things in life, anything worth achieving requires some effort. But if we can incorporate these three simple rules into our daily lives, we can be successful.

Eat less: Snack less often, eat slowly, reduce portions or pick full portions of lower calorie foods. This does not mean deprivation; just less than what you eat now.

Eat well: Eat more fresh fruits and vegetables and less processed food, eat fiber and whole grains; drink water. Run like mad if someone tries to sell you a diet that excludes a major food group like carbs, fats or proteins.

Exercise: Even five minutes per day is better than nothing at all; incorporate something, anything, that involves physical activity into your daily routine that you can live with and stick to.

That is it; everything else is fluff, an unnecessary distraction from what is real. There is no fat-but-fit, no magic bullets, no fantasy fat-burning foods. Diet supplements, pills, elaborate meal plans, hormones, energy powders, protein drinks are all devious ways to separate us from our money. We need to embrace just three simple rules to lose weight, trim down and be healthier. That is the truth. The whole truth.