Body of evidence stresses fitness, not just fatness

THE BALTIMORE SUN

Imagine your doctor telling you that carrying around those 20 extra pounds may actually be better than trying to lose them. In your dreams, you say? After perusing some recent research results, you might conclude that you can stop dreaming and dip into a pint of rocky road. Or two.

Several studies tantalizingly suggest that people who put on pounds over the years live longest while those who lose weight die sooner. Meanwhile, nationwide surveys reveal that cholesterol and blood pressure levels and heart disease rates are falling even as Americans' average weights are rising -- perhaps reflecting a tendency to cut fat but not calories.

People such as President Clinton, who readily acknowledges that he looks fleshy in jogging shorts, add weight to the controversial notion that someone could be somewhat hefty and still be healthy. At his last checkup in January, the president weighed in at 210 pounds, the maximum desirable weight for his 6-foot-2 frame, according to the latest guidelines from the U.S. Department of Agriculture. (And these guidelines are more generous than earlier versions, thanks to the research arguing for weight gain with age.) Although President Clinton appears a bit chunky -- by older charts he's about 15 pounds overweight -- his doctors said his blood pressure and cholesterol levels are OK and he shows no signs of heart disease.

No one goes so far as to suggest that excess fat is purely a cosmetic problem; obesity has been implicated in heart disease as well as certain cancers, stroke and diabetes. Yet a growing chorus of experts maintains that most people put way too much emphasis on weight. "I feel very strongly that there really isn't much mystery about the public health message we should be sending out: If you're concerned about your health, forget about your weight," says Elsie Pamuk, a health statistician for the National Center for Health Statistics.

Instead, better to concentrate on getting up and moving around -- President Clinton jogs 3.5 miles in a half-hour, three or four times a week -- and substituting fruits, vegetables and whole grains for fatty fare. Your blood pressure, cholesterol and insulin readings should improve and, as a bonus, you'll probably drop a few pounds.

Exercise counts

In a study of healthy overweight men above age 65, Robert Schwartz, an associate professor of medicine and gerontology at the University of Washington, found that trimming a mere 5 pounds by walking, jogging or biking raised high-density lipoprotein (HDL, dubbed "good" cholesterol because it keeps the arteries from clogging) even more than did losing 20 pounds by cutting calories alone. Zeroing in on weight is a likely prelude to failure anyway. Study after study shows that within five years after reaching their goal, most people regain all the pounds they had lost by dieting.

"Thin isn't fit, and overweight isn't out of shape," says Rochester, N.Y., aerobics instructor and personal trainer Lori A. Michaels, who dons size 14 street clothes when class is over. Though she's trimmer now than when she was a 185-pound cheerleader in high school, Ms. Michaels still weighs near the top of the USDA-recommended range (134-172 pounds) for her 5-foot-7 height.

And the upper end usually applies to men. Five hours of aerobic activity a week has helped normalize her previously elevated blood sugar and cholesterol levels and maintain her satisfactory blood pressure, Ms. Michaels says. "When I walk into a class, people go, 'Hi, who's teaching?' " she says. That's all the prompting she needs to leave the questioners panting.

If just the thought of an aerobics class leaves you out of breath, take heart. Recent research shows that every extra block walked or flight of stairs climbed counts. "One big step I think we've made in the last few years is realizing that a little bit is better than nothing; a little bit more is better than a little bit," says Harold Kohl, an epidemiologist at the Cooper Institute for Aerobics Research in Dallas. Mr. Kohl co-authored a landmark 1989 study that found that simply walking briskly for a half-hour ,, to an hour each day can reduce your risk of dying from heart disease or cancer almost as much as training for a marathon would.

Pat Lyons will attest to the benefits of moderate exercise in previously sedentary overweight people. A 5-foot-8 nurse who doesn't hesitate to say she weighs 240 pounds, Ms. Lyons co-wrote "Great Shape" (Bull Publishing, $14.95), a book about exercise for large women, and teaches a weekly class with the same goals for Kaiser Permanente in Northern California, where she's a health education consultant.

While the exercise level in the class is modest -- gentle stretching, simple dance steps and walking -- Ms. Lyons says she hopes it will encourage members to become even more active. Most of the class members are size 18 or higher; most of the instructors weigh more than 200 pounds. "I feel it is very important for people to see this person as a role model," says Ms. Lyons, who for years had avoided sports out of embarrassment but now is an avid tennis player and hiker. "My focus is not about weight loss. My focus is about enjoying movements and accepting your body."

Obesity researchers agree that simply telling people to lose weight usually is futile. But many scientists believe that excessive poundage, by itself, increases the danger of disease and so can be risky even in people who appear to be physically fit and healthy. "Even though you may not have hypertension or diabetes today, your chances of getting it in the next three years are much higher than those of someone who's lean," says Walter Willett, chairman of the nutrition department at the Harvard School of Public Health.

Generally, when other risk factors -- such as a family history of heart disease or a smoking habit -- are present, people should be especially concerned, says Scott Grundy, director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas.

At what point they should become concerned is debatable. The experts don't agree on what constitutes obesity, though a rough guideline places mild obesity at 10 percent to 20 percent above desirable weight, moderate at 20 percent to 30 percent above

and severe at more than 30 percent overweight.

Questionable standards

But "desirable weight" also defies definition. The various standardized height-weight tables, such as those published by the Metropolitan Life Insurance Co. and the USDA, are merely a starting point. "Any weight table in itself must be a gross simplification of a very complex problem," says Reubin Andres, clinical director of the National Institute on Aging.

XTC Mr. Andres says he believes that the desirable weights on most standard tables are too high for a 25-year-old and too low for a 55-year-old, for example. The lowest death rates among young adults are in the thinnest group, Mr. Andres explains, but people middle-aged and older seem to live longer if they're a bit on the pudgy side.

Mr. Andres theorizes that heavier people may be more likely to consume sufficient amounts of nutrients than thinner people who eat less and that fat reserves may help old people survive illnesses. He advocates a modest weight gain with age -- 1/2 to 1 pound every year after 40. Critics argue that gaining weight only appears to be healthy because it often occurs when people quit their deadliest habit, smoking. Weight loss may get an unfair rap because it often results from illnesses such as cancer.

The best weight for most people is simply the lowest they've been able to maintain for a year as an adult without struggling, says Kelly Brownell, a Yale University psychology professor who has written extensively about dieting and obesity. If you've had to diet constantly and work out slavishly to stay at a particular weight level, it's probably too low. For people who descend from a long line of chart-toppers, a realistic weight might well be above their "ideal" range.

Body shape enters into figuring out desirable weight, too. People who carry their excess pounds below the belt line might find reaching some standardized ideal weight especially difficult -- and might not need to try. Over the past decade, scientists have found that heavy hips, thighs and buttocks are more an annoyance than a health concern.

Fat around internal organs, however, can raise cholesterol, blood pressure and insulin levels. As a result, people with slender arms, legs and hips who have a thick-around-the-middle, apple-shaped physique may have to dip below the standard for their height to reduce their risk of developing fat-related illnesses. The research by Robert Schwartz and others has shown that exercise can pare apples' abdominal fat and improve their cholesterol levels while hardly budging the numbers on the scale.

Fat vs. calories

Simply reducing fat intake can lower high cholesterol levels even if body weight stays the same. The proportion of calories consumed as fat by the average American has dropped from 42 percent in the 1960s to a current level of 34 percent -- still higher than the 30 percent recommended by the American Heart Association, which itself has been criticized as too lenient. But Americans' waistlines haven't shrunk. A government survey released in March found that the average weight of Americans 25 to 30 years old rose a whopping 10 pounds from 1985 to 1992, to 173 pounds for men and 148 pounds for women.

One possible explanation: Less fat doesn't necessarily mean fewer calories. The corn syrup and other carbohydrates that often replace fat in the new reduced- or no-fat products are actually quite caloric.

"You can get fat from eating carbohydrates," says Chris Rosenbloom, an associate professor of nutrition and dietetics at Georgia State University. "It's just going to take a little longer." Fat, she explains, is easier for the body to store; for every 100 unused calories taken in as fat, 97 are stored as fat. For every 100 unused calories taken in as starches or sugars, only 77 are stored as fat; the rest fuel the process of converting these carbohydrates to fat.

Scientists aren't yet sure how useful reduced-fat or no-fat products are in losing or maintaining weight. But human-nutrition researcher Richard Mattes, a member of the Monell Chemical Senses Center in Philadelphia, has found that if people are told food is lower in fat, they tend to eat more of it than they normally would. Mr. Mattes' research also suggests that switching to reduced-fat versions of high-fat foods rather than giving them up does little to help curb fat cravings, which may be a throwback to prehistoric times when the source of the next meal was in question and gobbling calories was vital to survival. Today, with fast-food drive-throughs on every corner, survival depends more on burning calories than storing them.

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