Tyra Banks has a new mission: Cast an unlikely group
of aspiring models--namely, those whose curves can fill out a size
14--for a plus-size competition. "Plus-size is really the average
American woman," Banks has said. "And that woman is healthy." That woman
is also, says the Centers for Disease Control and Prevention, more than
20 pounds overweight.
In fact, a growing collective of doctors and activists have begun to
argue that lifestyle and genetics are what determine a woman's health.
Even our new (zaftig) surgeon general, Regina Benjamin, M.D., recently
said, "Being healthy is not about a dress size."
That's hopeful news for the 33 percent of Americans who are overweight
(this doesn't include the 34 percent who are obese). It's also news a
rival camp of experts isn't buying. Any equating of "overweight" and
"healthy" is irresponsible, they say. Especially in a nation where
health-care costs have skyrocketed, due in part to the rising rates of
illnesses linked to excess pounds.
The Case for Healthy Fat
For Crystal Renn, bulking up has felt nothing but great. The formerly
95-pound model was once depressed, living on little besides veggies and
diet soda. Today, she's forever running between editorial shoots and
runway gigs. "The caliber of work I do is much higher now that I have
energy," Renn says. She certainly looks healthier, but at 5'9" and 170
pounds, she's overweight--at least according to her body mass index
(BMI).
Doctors have long used BMI to measure whether a patient is at a healthy
weight. Anyone scoring above "normal" has been regarded as potentially
unwell. But compelling new research shows otherwise, says Paul Campos,
author of The Obesity Myth: Why America's Obsession with Weight Is Hazardous to Your Health.
"The correlation between weight and health is greatly exaggerated," he
says, pointing to studies that found people with an "overweight" BMI
have lower incidence of lung cancer, chronic bronchitis, anemia, and
osteoporosis than their thinner peers. (Being heavier helps fend off
osteoporosis, for example, because a little extra mass helps strengthen
bones.)
What's more, a long-term study published in the journal Obesity found that people with "overweight" BMI scores have a lower risk of mortality than any other weight group.
So, hooray for a little junk in the trunk? Yes, some fat can be
beneficial, says Konstantinos Manolopoulos, an Oxford University
researcher. Pear-shaped women can finally rejoice: Thigh, hip, and butt
fat is chemically very stable, and stable fat traps harmful compounds
released during digestion. Thigh fat also secretes adiponectin, which
helps the body metabolize sugar, and leptin, which regulates appetite.
Fortified by such science, the fat-acceptance movement pushes another
key point: Extra weight may not be ideal, but it sure beats dieting.
Research shows extreme yo-yo dieting can, over time, slow metabolism and
cause cardiac stress; it can even lead to long-term weight increases.
Just ask fat-acceptance activist Kate Harding, coauthor of Lessons from the Fat-o-Sphere: Quit Dieting and Declare a Truce with Your Body, who twice lost more than 20 percent of her weight only to regain it. It left her wondering, What if trying so hard not to be fat is actually a bigger health problem than being fat?
The Case Against Healthy Fat
There's no chance dieting is worse, says the anti-fat-acceptance camp.
Weight loss may be difficult, but it's still worth pursuing in the name
of health. Some research shows that extra weight can increase your risk
of developing breast cancer. And overweight women with normal
cholesterol and blood pressure levels can still go on to develop heart
disease at higher rates, says Barbara Berkeley, M.D., director of
weight-management services at the Lakehealth System in Cleveland. "In
other words, being overweight may look 'healthy' but probably isn't once
we follow someone over a period of years," she says. (But what about
those studies that show overweight people live longer and avoid a whole
host of diseases? Berkeley argues that the overweight seem to fare
better because very underweight people do worse and throw the curve.)
Then there's that question of fat placement. When you gain weight
through overeating, you can't control where the pounds land. Thigh fat
might be beneficial, but abdominal fat is not. Nor is dangerous visceral
fat, which infiltrates and coats your organs like candle-wax drippings,
releasing inflammatory fatty acids that have been linked to cancer and
coronary diseases.
And weight gain can be a slippery slope. In Berkeley's practice, she
sees plenty of patients who have let mere love handles escalate into a
heaviness that shames them away from the gym or doctor's office. So she
opposes any endorsement of being overweight, and maintains that humans,
who once had to hunt and gather to survive, evolved to be a lean
species.
She's not alone. Lincoln University recently made headlines when the
school set up BMI score graduation requirements: Not under 30? No
diploma. (Following a public outcry, the university rescinded the rule.)
Both Alabama and North Carolina announced they will charge fat state
employees an additional monthly fee for health care. And mega-green
grocer Whole Foods started up a voluntary employee incentive programone
based, in part, on workers' weights. The lower their BMI, the bigger
their discounts.
After all, explains Berkeley, "Your heart is only as big as your fist,"
and asking a small muscle to power an overweight frame is "like putting a
little engine in an SUV."
Beyond BMI
If the two sides were to agree on anything, it would be this: Fitness is
key, and pounds matter less than type of body fat. "Recently, there
have been efforts to look beyond BMI," says Margaret Lewin, M.D.,
clinical assistant professor at Cornell University's Weill Medical
College. The old-school measurement does serve a purpose, but its
shortcomings are clear. On her blog, Shapely Prose, activist Harding
runs a "BMI project," a series of photos of people of different sizes
accompanied by their BMI labels. They range from "underweight" to
"morbidly obese," but for the most part they look, well, pretty normal.
Last is a shot of the seemingly healthy Harding, balanced on her hands
in the crow yoga pose. Her BMI category? "Obese."
Exercise, everyone concurs, is crucial. It reduces mortality risk by a
whopping 50 percent, regardless of weight, says Steven Blair, P.E.D.,
professor at the University of South Carolina. Aerobic exercise and
resistance training attack waistline fat, both the padding you can see
and the visceral stuff you can't. Scientists have even found that
working out prevents the latter from forming in the first place. In
fact, between a plus-size gym-goer and a thin couch potato, the bigger
girl is better off, says Blair, and less likely to develop
weight-related illnesses.
That's something to hold on to as the fat-acceptance argument roils.
Whether or not extra girth is indeed healthy, everyone should be active.
Speaking recently on the Ellen DeGeneres Show, Oscar-winning
actress Mo'Nique recounted the moment she decided to shape up. The
fat-pride supporter was standing nude before a mirror when her husband
asked her how much she weighed. The answer: 262 pounds. "He said, 'Mama,
that's too much. I want you for a lifetime,'" she recalled. She has
since lost 40 pounds. She's certainly not thin--her BMI is likely in the
"obese" range--but she's working on that visceral fat with exercise.
"Everybody can't be a size zero," she has said. "But let's be healthy,
big people."
