Fat but Fit: is it Both/And, or Either/Or?

There’s been a simmering debate in the medical community (not to mention the popular press) over whether it’s time to stop making weight loss the primary goal of obesity treatment.

Obesity, as you probably know, is a disease state that’s defined by a BMI of more than 30. What’s that mean in actual numbers?  I’m 5’9” (or 175 cm) tall and at 150 pounds, I’m considered normal weight. At 170 pounds (77 kg) I would be classified as overweight. If my weight crept above 200 pounds (91 kg), I would be classified as obese.

Losing weight (mostly) doesn’t work

Most people suffering from obesity would be a lot healthier if they lost weight. The problem is that many (or even most) of them don’t succeed in losing weight—even when they really try to. We can debate why people are so unsuccessful in these attempts. We can blame the diets, the environment, the food supply, the media. Many are tempted to blame the people suffering from obesity for simply being unwilling to do what they need to do.

But all this finger-pointing—and the competing solutions that arise from it—isn’t solving the problem. A large and growing percentage of our population, including our children, now suffers from seemingly intractable obesity and all the health risks that go with it.

If we can’t actually help people lose weight, maybe we should focus instead on what else we can do to reduce those risks. Or so the argument goes.

Should we promote fitness over weight loss?

In a paper published last month, Glenn Gaesser and Siddhartha Angadi argue for a weight neutral strategy for the treatment of obesity. To support their contention, the authors present data from over a hundred individual studies and meta-analyses on the relationships between weight loss, exercise, disease risks, and mortality.

They point out that achieving moderate-to-high levels of physical activity or cardiovascular fitness can be just as effective in reducing the risk factors associated with obesity, even if those people don’t lose any weight. (Which is a good reminder that weight loss is not the primary benefit—or outcome—of exercise.)

They also note that weight cycling, where people repeatedly lose and gain weight, has a lot of negative health impacts. In fact, losing and regaining weight may actually be worse for you than not losing it in the first place. In other words, telling people with obesity to lose weight may be doing more harm than good, especially if this goal is prioritized above (or to the exclusion of) improving fitness.

So, should we actually stop recommending that people pursue weight loss...

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