Body smarts: food, fat & fitness

Q: Who is healthier: a person who eats well and exercises but is overweight, or a thin person who eats poorly and doesn't exercise?

A: If weight were the only consideration, the thin person would have a lower risk of heart problems, diabetes, hypertension and even breast cancer--all strongly linked to obesity. But in this particular comparison, there's more involved than weight.

The thin person has taken a devil-may-care attitude about diet and exercise, which can eliminate all the advantages of being slim.

An unhealthy diet, bloated with fat and cholesterol, can push the thinnest person's total cholesterol count way up, aggravating conditions such as high blood pressure, which can lead to heart disease. Thin couch potatoes also tend to have lower levels of HDL, the "good" cholesterol.

Even more worrisome is cancer risk: Sending low-fiber, high-fat foods down the digestive tract day after day is flirting with colon cancer; plus a meaty diet often contains carcinogens (due to a chemical reaction formed during cooking) that are also an invitation to colon cancer. In addition, a diet heavy in animal fats ups the risk of breast cancer, partly because fatty foods cause the body to make extra estrogen, and too much is a bad thing.

Now, what about the person who eats well and exercises but still carries around extra pounds? His or her risks partly depend on where that excess weight has settled. Fat stored around the middle--the "apple" shape--is linked to high blood pressure, diabetes and heart disease. But extra weight in the hips and thighs--the "pear" shape--appears to be pretty benign and doesn't carry these risks.

Another part of the answer is in the person's body mass index, or BMI. This number compares weight to height, and it's easy to check in our chart on the next page. If the person's BMI is 25 or higher, that's another sign--in addition to the fat's central location, or "spare tire"--that for health reasons, it's time to lose a little.

Just dropping 10 percent of total body weight by eating fewer calories and continuing to exercise regularly will rapidly lower the risk of serious diseases. So even if a person doesn't quite reach an "ideal" weight, eating well and exercising will cause cholesterol levels to fall, blood pressure to drop and, if diabetes is an issue, blood sugar levels to improve as well. People who upgrade the quality of what they eat by switching to a low-fat vegetarian diet see particularly dramatic effects. For instance, they typically knock 20 to 60 points off their total cholesterol and 15 to 50 points off their "bad" LDL cholesterol.

A recent headline-making study reported in the Journal of the American Medical Association found that overweight people are not much more likely to die prematurely than are normal-weight people. But the reason is that medical advances allow them to survive despite the heart disease, hypertension, diabetes and other illnesses they may develop, so trimming down is still a good idea.

What it comes down to is this: Extra weight increases health risks. But a bad diet increases risks too. So a thin person who eats poorly is definitely not exempt from health problems. And a heavy person should not feel cursed. Regardless of what you weigh, a good diet and regular exercise make a real health difference.

Neal Barnard, MD, is the founder and president of the Physicians Committee for Responsible Medicine (PCRM). He keeps fit by running and rollerblading.

FIND YOUR healthy WEIGHT

You can figure out your own body mass index (BMI) with this handy
chart. Find your height in the left column, then look across the
row until you find your weight. Look up to the top row, and that's
your BMI.

                           NORMAL

BMI        19    20    21    22    23    24    25

Height
(inches)

62         104   109   115   120   126   131   136
63         107   113   118   124   130   135   141
64         110   116   122   128   134   140   145
65         114   120   126   132   138   144   150
66         118   124   130   136   142   148   155
67         121   127   134   140   146   153   159
68         125   131   138   144   151   158   164
69         128   135   142   149   155   162   169
70         132   139   146   153   160   167   174
71         136   143   150   157   165   172   179
72         140   147   154   162   169   177   184
73         144   151   159   166   174   182   189
74         148   155   163   171   179   186   194

           OVERWEIGHT                    OBESE

BMI        26    27    28    29    30    31    32

Height     Body Weight
(inches)   (pounds)

62         142   147   153   158   164   169   175
63         146   152   158   163   169   175   180
64         151   157   163   169   174   180   186
65         156   162   168   174   180   186   192
66         161   167   173   179   186   192   198
67         166   172   178   185   191   198   204
68         171   177   184   190   197   203   210
69         176   182   189   196   203   209   216
70         181   188   195   202   209   216   222
71         186   193   200   208   215   222   229
72         191   199   206   213   221   228   235
73         197   204   212   219   227   235   242
74         202   210   218   225   233   241   249

Adapted from the National Heart, Lung, and Blood
Institute of the National Institutes of Health.

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