Monday, August 25, 2008

Defining Healthy -- Physically fit and overweight/obese or thin and unfit?

This post is a little off "food", but it is one that I posted on the CES blog and thought it would be excellent for the Twin City Nutrition Blog...

Are you healthy? Overweight or obese?

Can you be healthy and overweight? For most health care practitioners, a body mass index (BMI) is the measurement used to diagnose a person's body size -- either thin or fat. This tool is used by most physician's, dietitian's, nurses, health and exercise professionals. Most of us visit our physician and they either tell us, "hey, you are doing great" or " hey, you need to lose weight". Those people who have a BMI greater than 25, probably leave their physician's office feeling shameful, failed, defected, fearful and so desperate to work towards getting their BMI lower that, for some, their brain becomes bombarded with thoughts about food, weight and body image.

Take for example, a client of mine who I will call Mary for annonymity. Mary is a professional in the health care field. She understands numbers, research and is incredibly smart. She came to visit me at my practice, Twin City Nutrition, feeling threatened, shamed and with a strong belief that she was "defected". She has been dietiting since her twenties and now being in her forties, she felt out of control with food and couldn't make sense of all of the nutrition information. She shared that she has hated her body image since her early twenties and has NEVER had a good relationship with food. She has been active, but still set the expectation that she "should be doing more" to be "healthy". She has always feared food, and when asked why, part of her explanation was that she felt that she was a "good" person when she ate balanced and a "bad" person when she ate out of balance -- food, weight and body image was defining her self worth. Since she worked in a medical office, she was regularly counseling on BMI and everyday was reminded that her BMI was high, therefore putting her into a stress response frequently throughout the day.

When I first met Mary, I asked her how often she thought that she was going into a stress response around food? She stated initially, that she didn't think that she was stressing out "too much", but after several weeks of working together it became clear as to how much she was going into a physiological stress response, thus triggering an array of hundreds of hormones, including cortisol and others that drive cravings, thoughts about food, behaviors, etc. Since she did understand the physiological world, she was able to quickly start to compartmentalize feelings from physiological imbalance from those feelings that were evolved from past experiences around weight, including the many of physician visits when she was told that "something wasn't right". If you look at Mary's health history -- she is healthy. She exercises, eats structured meals (timing) and doesn't take any medication. Her lab values are within normal limits and she supplements her diet with vitamins/minerals and essential fatty acids. She has worked hard on balancing out meals to feel good and has seen significant decreases with symptoms (fatigue, hunger, cravings, crashes, headaches, etc). She feels GREAT, except she is still very worried about her body mass index.

I was delighted to read the article, Better to Be Fat and Fit Than Skinny and Unfit, in the New York Times published on August 19, 2008. The article highlights a study that was published in The Archives of Internal Medicine, which compared weight and cardiovascular risk factors among more than 5400 adults. The findings found that half of the overweight people and one-third of the obese people are "metabolically healthy"....meaning that they have healthy lipid levels (cholesterol), blood pressure, blood glucose and other risk factors for heart disease.

The study also found that about 1 out of 4 thin people had at least 2 cardivascular risk factors associated with obesity.According to the article, this study does not dismiss the associations between overweight/obesity with health problems and "obese people were more likely to have two or more cardiovascular risk factors than slim people...but it was the proportion of people who were overweight/obese who were metabolically healthy."

The article also highlights studies at the Cooper Instute in Dallas that have shown that fitness, is a far better indicator of health than body mass index. They note, "in several studies, the researchers have shown that people who are fat but can still keep up on treadmill tests have much lower heart risk than people who are slim and unfit".

I do believe that people can be healthy and be overweight/obese. Looking solely at weight loss based on the BMI (which doesn't take into account muscle mass) is very limiting and doesn't take into account all of the other factors that defines health -- physical activity, hormonal balances, relationships with food and body image, genetic risk factors, laboratory markers, etc....

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