At 5-foot-4 and 190 pounds, Jude Mathews would seem to personify the health crisis facing a nation in the throes of an obesity epidemic. But the librarian from Evanston, Ill., begs to differ.
"My blood pressure is rock solid. My cholesterol numbers are basically fine. My doctors don't see anything they say I need to worry about," said Mathews, who is 55, exercises regularly and eats a well-balanced diet. "One little number on the scale is not all there is to your health."
"I wouldn't mind losing weight, but I know if I go on a weight-loss diet I'll just spring right back," says Jude Mathews, a librarian. "What is really dangerous is yo-yo dieting, not to mention destroying people's self-esteem."
(John Gress For The Washington Post)
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As medical authorities have become increasingly alarmed by the rapidly rising number of Americans who are overweight and obese, people such as Mathews find themselves at the center of an intense debate: Can people be overweight but still healthy?
In books, in medical journals and at public health conferences, scientists have been dueling over the relative importance of fatness vs. fitness, and whether there is any common ground between the two camps. A small but vocal cadre of researchers has been challenging conventional wisdom, arguing that not only is it possible to be both fat and fit, but fitness is actually more important for health.
"All too often, medical professionals say it's the obesity we have to cure. That's the be-all and end-all. It's not," said Steven N. Blair, who heads the Cooper Institute, a Dallas research foundation focused on physical activity. "The impression is that everyone who is overweight faces an elevated risk for mortality. That's simply not true."
Other experts, however, maintain that while there may be exceptions, the evidence is clear for most people: Being overweight significantly increases the risk of a host of debilitating and often deadly health problems, including heart attacks, strokes, cancer and diabetes.
"Being overweight has a clear association with important health problems, and even modest weight loss has important health benefits," said Walter Willett, an expert on nutrition and health at the Harvard School of Public Health. "To tell people it doesn't matter is really misleading. It does make a difference. It makes a huge difference."
Playing down the risks of excess weight is dangerous, Willett and others say, particularly with two-thirds of Americans already overweight, including one-third who are officially obese.
"I would not want to switch the emphasis away from trying to control weight," said Lawrence J. Cheskin, director of the Johns Hopkins Weight Management Center. "That's a clear risk factor."
Blair and other fitness proponents acknowledge that some overweight people are at increased risk for health problems, and that many people may benefit from losing weight. But they argue that society focuses far too much on dropping pounds and far too little on exercise, eating well and being physically fit.
"I don't believe height and weight is a good indication of health," said Joanne Ikeda, co-director of the Center for Weight and Health at the University of California at Berkeley. "If a fat person or obese person has normal blood pressure, if their total cholesterol and glucose levels are normal and they are healthy, there is no reason they should necessarily have to lose weight."
Many people are simply born to be bigger, which does not necessarily mean they are destined to have health problems because of their weight, especially if they exercise regularly and eat well, she said.
"There is a subset of people who are meant to be large people," Ikeda said. "If they are in fact 'obese' but they are metabolically healthy, their bodies are constructed in a way that carrying a large amount of weight is not deleterious."
The increased health risks blamed on being overweight are really the result of many overweight people being out of shape and having poor diets and other unhealthful habits, Blair and others say. If those factors are considered, studies have found that any increased risk virtually disappears, they say.