Great Weight Debate

American Fitness, Jan, 1999 by Pat Lyons

With the release of the National Institute of Health's new weight guidelines, millions went from being "okay" to "overweight" overnight. What will the effects be on America's health and well-being?

"There are people who will argue that fat people cannot be healthy and fit, that the terms `fat' and `fit' are mutually exclusive. While experts will continue to disagree, even contradict one another on the actual health risks of being fat, you need not wait for their consensus to become more fit and healthy, regardless of your weight. What's most important is to define what health means to you and reach for that goal."

-From Great Shape: The First Fitness Guide for Large Women (Bull Publishing, $14.95)

Living life to the fullest is one definition of health. But many people, especially young women, put life on hold waiting to be thinner. Without any other factors being considered, obesity researchers claim that 29 million more Americans can now be called unhealthy due to new weight guidelines issued in June, 1998 by the National Institute of Health (NIH). However, researchers have not found a way to make everybody thin, and the war against fat has had many casualties.

Last January, the New England Journal of Medicine challenged the obesity researchers' findings in an unprecedented editorial:

"Since many people cannot lose much weight no matter how hard they try and promptly regain whatever they do lose, the $30-50 billion [spent] yearly is wasted. Given the enormous social pressure to lose weight, one might suppose there is clear and overwhelming evidence of the risks of obesity and the benefits of weight loss. Unfortunately, the data linking obesity and death-as well as data showing the beneficial effects of weight loss-is limited, fragmentary and often ambiguous. Until we have better data about the risks of being overweight and the benefits and risks of trying to lose weight, we should remember that the cure for obesity may be worse than the condition" (New England Journal of Medicine, 1988).

The authors also expressed concern over increasing rates of chronic dieting and eating disorders in girls and went on to cite metabolic and genetic research that disputes the simplistic notion that anyone can lose weight if they just eat less and exercise more. The new NIH guidelines being sent to physicians nationwide ignore these issues completely. Doctors are advised to tell patients that "the most successful strategies for weight loss include calorie reduction, increased physical activity and behavior therapy," and to prescribe drugs and surgery when these strategies fail (NIH, 1998).

Of course, these strategies will fail for 95% of people who try them-which was the conclusion of the 1992 NIH review of weight loss research. No new research to contradict these findings was cited for their new guidelines.

Lowering the body mass index (BMI) point at which weight is considered a medical problem from 27 to 25 creates a vast new market for diet drugs. It opens the door to a repeat of the Redux/Pen-Fhen diet pill debacle, but on an even larger scale. Even Judith Stern, M.D., a staunch advocate for the "weight-loss-at-any-cost" point of view and a member of the NIH Task Force on the Prevention and Treatment of Obesity, publicly criticized the new guidelines. "They have misquoted the data. If they are going to do it scientifically, they should do it scientifically. There will be a big push to lower the BMI at which we treat with drugs, and that's not justified given the current drugs," she says (San Francisco Chronicle, June 4, 1998).

While obesity researchers recommend lifestyle change, it appears they won't settle for it if it does not make people thin. A New York Times article on the new guidelines featured a woman in her late 30's who "tries to eat a balanced diet, sleeps well and works an hour of exercise into her busy schedule almost every day." She considers herself fit and her weight has remained stable for 14 years, but she is 5'11" and 227 pounds. Claude Bouchard, M.D., who has conducted much of the twins research on genetics and weight, was quoted as saying it was "marvelous" that she exercised, "but at this weight she remains at great risk of having medical difficulties down the road. Safe medication capable of inducing weight loss of 25 to 30 pounds could help her dramatically, but at the moment we don't have that" (June 23, 1998).

Given the staggering financial profits at stake-since people regain any lost weight if they stop using the drugs-the drug companies are in a diet drug development frenzy. They are probably already knocking on the FDA's door to change the prescription rules. Also, diet drug companies fund a great deal of obesity research.

If 14 years at a stable weight and living an active, healthy lifestyle still requires a woman to use drugs to be considered acceptable by the "experts," where are the those "just say no to drugs" people when we really need them? Fortunately, fitness professionals can look to Steve Blair, Ed.D., senior scientific editor of the Surgeon General's Report on Physical Activity and Health. Blair, who describes himself as fat and fit, cites his own research with thousands of people and was also quoted in the New York Times article. "I'm darned sure that her exercise habits are improving her health even if she remains heavy," he said. "Healthy bodies come in all shapes and sizes."