Preventive Medicine Column
Dr. David L. Katz
I am generally known, and reasonably so, for my interest in obesity prevention and control. But that is something of a distortion. My real interest is health promotion.
The reason I can’t simply ignore obesity and focus on health is that the two are inextricably intertwined. Someone trying to promote health is obligated to contend with whatever the clearest and most omnipresent threats to health happen to be. Obesity easily makes the short list.
Obesity is, inarguably, an enormously out-of-control epidemic; among the most pressing public health problems of our time; and well established on the causal pathway to virtually every major chronic disease that plagues our society: diabetes, cardiovascular disease, stroke, cancer, arthritis, and more. Despite an appreciation for the laudable motives of the ‘OK at any size’ movement, I can’t sign up, because type 2 diabetes in children just isn’t OK.
But a focus on weight when you really want to focus on health can cause both confusion, and consternation. Some people get upset with a focus on weight, per se, thinking it will compound the prevailing problems of weight bias and stigma- something I certainly don’t ever want to do. We should be able to fight the health threats engendered by obesity, without blaming the victims of the epidemic for their plight- although historically, we’ve done a poor job of it.
Others simply think that weight might be a distraction that takes one’s eyes off the prize. Competing attention to weight as an important determinant of health, or to health regardless of weight, has resulted, for example, in a spirited, and long-roiling debate in academic circles, generally referred to as “fatness versus fitness.” In a nut shell, one side of the debate tends to argue that weight control is essential to health, while the other argues that fat people can be fit (and thus healthy), while thin people can be unfit (and thus unhealthy).
There is scientific literature to support both sides of the debate; if there weren’t, it would long since have been over. But I tend to think- as with many debates- that this one is mostly academic.
Yes, it is possible to be fat and fit- but very few people are. Harvard School of Public Health research in roughly 100,000 people, for example, shows just what one would expect: lots of people are both heavy and unfit; far fewer are thin and unfit; some are both lean and fit; and only a very small number indeed are heavy, but fit. Possible, yes, but exception rather than rule, and for the most obvious of reasons: generally people who become and stay fit are attentive to their health, and a focus on health may be the best bet there is for lasting weight control.
A new paper recently published in the Archives of Disease in Childhood adds a bit of fuel to the fire, although whether that generates light, or just heat, remains to be seen. Researchers in England followed a group of 200 children for 11 years, tracking both their body composition and physical activity. What they found is unwelcome news for those who think fitness is the better focus than fatness. A rising body fat percentage in these children reliably predicted a decline in physical activity, whereas a decline in physical activity did not predict a rise in body fat. Nor, for that matter, did a rise in physical activity reliably defend against weight gain.
The message in the paper, then, is that getting heavy is likely to lead to less physical activity- rather than the other way around. This was an observational study, not a true test of cause and effect, and thus not definitive. But provocative, nonetheless.
Its publication comes at an interesting time for me, as an international medical journal recently asked me to write an article championing one side of a related debate: does diet, or exercise, matter more for weight control? I had only just submitted my paper –in which I argued that diet matters more- when this new study was published. It comes down on my side.
There is science to support arguments for the importance of both diet (calories in) and physical activity (calories out) in weight balance. I cited papers on my side of the divide, and my ‘opponent’ no doubt cited papers on his. But my argument was based more on sense, than science.
Just one ounce of ‘cheese snacks’ (who eats just one ounce?) provides 160 calories. One large soda from a fast food restaurant provides 310 calories. A small order of fast food French fries is 230 calories.
Now consider that a full hour a day of brisk biking, or moderately fast walking, would burn roughly an additional 240 calories over resting energy expenditure in an average adult. In other words, one order of fries can fully replace, and one soda can more than replace, the calories burned in a dedicated hour of moderately intense exercise.
In the modern world, one may, alas, all too readily out-eat even somewhat impressive levels of physical activity. Most of us, however, will find it very difficult to out-exercise even fairly ordinary levels of dietary intake.
But that is a position I take only when asked to choose, and defend, one side of the energy balance equation. I would advise against you taking sides at all. After all, exercise is the vital conditioning work of the human machine; diet is its fuel.
So choose not to choose sides of the energy balance equation. Instead, be as active as you can, and eat as well as you can. Choose to pursue the happiness that only vitality confers. As the academics debate fatness versus fitness, diet versus exercise, simply take good care of yourself. And let weigh what may.
Dr. David L. Katz; www.davidkatzmd.com