A Supreme Court Justice Can be Fat and Fit

Ever since a very fit President Obama announced that seemingly fit Supreme Court Justice David H. Souter had tendered his resignation on May 1, there has been much discussion about the health qualifications of the potential nominees, with a particular emphasis on their weight. Concerns have arisen that some of the candidates may not be healthy (and should therefore not be considered for such a long-term post) because they're carrying extra pounds.

I am here to tell you that you can be fat and fit. Appearances can be deceiving.

This idea is not new. In fact, the term "fat and fit" was originally coined by Dr. Steven N. Blair, one of the world's leading exercise scientists, who is currently a professor at the University of South Carolina. For more than 25 years Blair and his associates have been looking at how fitness, fatness, and health outcomes are related. And what they have found is that cardiorespiratory fitness is a better predictor of who will die, and when, than BMI (body mass index), a calculation of body fat based on height and weight. In other words, according to Blair, fitness appears to provide protection against the risk of early mortality posed by fatness. In fact, his research shows that the death rate for women and men who are thin but unfit is at least twice as high as for their obese counterparts who are fit.

I witness the fat-and-fit phenomenon in my preventive cardiology practice every day. Into my examining room will walk a considerably overweight, pear-shaped female who will turn out to have the blood chemistry of a vegetarian marathoner because she actually gets out and walks on a regular basis. Her HDL ("good") cholesterol and triglycerides are excellent and her tests show she is at very low risk for heart disease. My next patient will be a seemingly fit, normal-weight man, who turns out to have terrible blood lipids and is at high risk for heart attack, stroke, and many other diseases. Even though he looks great at first glance, he's actually carrying his "normal" weight as fat (typically a highly inflammatory little bowling ball in his belly), not muscle, because he doesn't exercise. That's why I always go by a person's physiologic risk factors, rather than by BMIs or weight tables.

This was recently backed up by a study of 5,440 adults reported in the August 2008 Archives of Internal Medicine. It found that half of the overweight and one-third of the obese participants were "metabolically healthy." This means they had few, if any, risk factors for heart disease, such as high blood pressure or low levels of HDL cholesterol. The study also found that about one-fourth of the "normal" weight people were "metabolically unhealthy" and exhibited cardiovascular risk factors. The study did not measure fitness levels, as Blair has done.

This said, I don't want you to think that being fat is good. Or, conversely, that being too thin (and unfit) is fine. There is no question that our bellies have grown. Federal health surveys show that, over the past four decades, the mean waist size for men has increased from 35 inches to 39 inches; for women, from 30 inches to 37 inches. The number of people suffering from coronary heart disease, diabetes, arthritis, and other inflammatory conditions has also grown. And while exercise can turn the tide for some, those who don't exercise and continue to eat a nutrient-poor diet, smoke, and drink too much will continue to feed the obesity (and heart disease and diabetes) epidemic in this country. The solution for these people is to focus on making better lifestyle choices overall rather than simply dwelling on a number on the scale.

I can't speak for whether our Supreme Court candidates are fat and fit or not. But I can tell you not to judge a book (or a judge) by its cover.

Comments

[Laura Collins Lyster-Mensh - Huffpost Blogger]

Thank you for this. It is time for some serious though on these issues. Sadly, our society thinks appearance is a proxy for both health and morality.

Be born with good genes, eat well, sleep well, be relatively active. These may not make you pretty or moral but they are the best known way to enjoy life and enjoy health.

[oafishcad]

The truth is someone both thin and fit lives the longest.

[INTERLOCUTOR]

So, this recent study finds risk factors with normal=25%, overweight=50%, obese=66%, without incorporating fitness levels. Not exactly an all-clear!

One always finds the odd healthy obese, or long-lived smoker. That's the way statistics work - they may indicate risk, but not certainty for individuals.

It should be clear that BMI, invented in the 1840's, is a pretty useless indicator for individual health - it does not factor in actual body composition.

Even the miltary now uses body composition measurements (Navy Circumference Method), instead of BMI stats. The body composition (fat %) in combination with cardiovascular fitness will provide a pretty solid health estimate. If you look at 2 persons with a BMI of, say 32, and one has 40% body fat, but the other only 15%, it's not difficult to guess which one, statistically, will be the healthier one. E.g. Mike Tyson having a BMI of 32+ would be overweight with that value...

Also, we must not ignore Willett and Manson's study on mortality rates. Those in the mid-range overweight category who were physically active had a lower risk of death than lean participants who were inactive. But physical activity didn’t eliminate the risks that attended being overweight or obese. When grouped by activity, the heavier people were more likely to have died at every activity level. Even putting on a medium amount of weight was associated with a higher risk of death.

See also: http://www.liebertonline.com/doi/pdf/10.1089/jwh.2006.0080

I.

[HPdevotee]

Thank You!

As an older female who has battled weight issues my entire life and yo-yo dieting your article has the voice of sanity.

I stopped obsessing over the number on a scale to dictate how 'healthy' I was because in essence, the number only indicated how well I was able to punish myself or not. It's a crazy-making cycle that is unfortunately, reinforced in our culture and as studies have shown, is more detrimental to your heart than the extra pounds themselves.

Following a HAES (health at every size) model while being aware of my carbohydrate intake and using my treadmill faithfully, I have finally found what works for me. I feel the best I have in years and have a sense of self-acceptance which is the direct antithesis of 'dieting'.

Hopefully, articles such as yours and a more realistic view on weight/health will begin to turn around the harmful and discriminatory 'studies' so many have come to view as science. Let sanity reign!

[Jsens3]

The doctor is probably right. William Howard Taft was president and later supreme court justice back in the day. He even had a special bathtub installed in the White House. I believe he weighed over 300 lbs. Later, Winston Churchill was a fatty, who drank booze, smoked cigars and eschewed any kind of exercise. He lived a long time. Back then, fat was in or at least acceptable But now, fat is declasse. Some even believe that fat people are somehow morally deficient. Oh well, we'll see.