By Chris Carmichael,
CTS Founder and Head Coach
A few weeks ago, major media outlets splashed out headlines declaring that “fat but fit” is a myth because a new study suggests that being fit does not protect people from the heart health risks associated with carrying excess bodyfat. The problem is, saying people can either be fat or fit, but not both, doesn’t help anyone.
This most recent study has revived the decades-long debate over whether it is better – from a health perspective – for a person to be overweight and physically active, or leaner yet sedentary. The health debate has more recently merged with the issues related to body image, bullying, and representation in media and marketing. Saying “fat but fit” or “overweight and healthy” is a myth oversimplifies the complex interactions of bodyweight, fat weight, body composition, cardiorespiratory fitness, body positivity, and mental health. It discourages overweight – or more specifically overfat – individuals from exercising by implying that gaining fitness isn’t going to lead to positive outcomes unless it results in weight loss. It also gives lean people a false sense of safety by overemphasizing the protective effects of simply carrying less bodyfat.
The observational study, published in the European Journal of Preventative Cardiology, examined data from more than half a million adults in Spain. In particular, the researchers categorized individuals by Body Mass Index (BMI) and self-reported activity levels based on the World Health Organization’s physical activity guidelines that recommend 150-300 minutes of moderate intensity physical activity, or 75-150 minutes of vigorous activity, or a combination of both, per week. The BMI categories were normal weight (BMI of 20.0–24.9), overweight (BMI of 25.0–29.9), or obese (BMI ≥ 30.0). Researchers then used medical records to evaluate the incidence of diabetes, high cholesterol, and high blood pressure. It’s important to note, no measures of cardiorespiratory fitness (VO2 max, etc.) or training history were included, and BMI is well known to classify muscular individuals as overweight or obese.
The results of crunching the data showed that increased physical activity mitigated cardiovascular disease risk across all BMI categories, but that individuals in the overweight and obese BMI categories still had significantly higher risks for cardiovascular disease, irrespective of activity level. Being active was helpful, but it didn’t completely counter the negative heart health risks associated with being overweight. That’s a reasonable conclusion, but not one that warrants calling “overweight and healthy” a myth.
Health, Fitness and Fatness are on Separate Continuums
After more than 40 years as an athlete and coach, I can tell you that coaches and trainers encounter people who are very healthy with low fitness levels, highly fit individuals with major health problems, fit and healthy people who happen to be overweight, and just about every other combination. Everyone is somewhere on continuums of very sick to extremely healthy, underweight to obese, and sedentary to peak performance. They are interconnected and constantly changing, and virtually no one can optimize all three simultaneously and stay there for very long. There are even scenarios where the pursuit of personal, professional, or athletic goals knowingly puts someone in a temporarily “unhealthy” category. Elite athletes pursuing peak performance may dip their weight toward the underweight end of the continuum. People focusing intensely on career, family, or education for short period may gain weight and reduce activity level. These are normal variations in response to changing goals and circumstances.
Fat Shaming Doesn’t Work
One of the biggest problems I have with headlines like “Overweight and healthy is a big fat lie” is that making people feel bad about being overweight is not an effective way of encouraging them to make positive changes. It never has been. A 2016 study examined how the way media frames obesity. Highlighting the health risks of obesity (termed fat-negative framing) increased anti-fat prejudice, willingness to discriminate against overweight people, and support for charging overweight people more for health insurance. Shifting the framing to fat-positive, which is the “healthy at every size” concept, reduced the anti-fat stigma.
Critics of the “healthy at every size” media framework claim that normalizing overweight and obesity is just an attempt to make people feel better about themselves while denying the fact that excess bodyfat increases health risks. The phenomenon these critics ignore is that a person’s environment and mentality play big roles in determining the actions overweight individuals will take. Stigmatizing and penalizing being overweight reinforce the beliefs and behaviors that lead people to be less active and maintain dysfunctional relationships with food.
If I’m trying to help you get faster by telling you that you’re a slow cyclist or runner, and particularly that being slow is a moral failing, you’re more likely to quit training than to stay engaged. If I’m honest about your current state of fitness, that you’re slow but doing good work and celebrate the enjoyment you get from being active, then you’re more likely to stick with it. The more you experience the positive outcomes of being active, the more likely you are to get faster. The “healthy at every size” framework works the same way. It reinforces positive behaviors and attitudes and encourages people to continue activities that move them toward improved health outcomes.
BMI Studies Look at Fitness the Wrong Way
Cardiorespiratory fitness has far-ranging health and performance benefits on its own, and training to increase performance capacity is different than exercising solely as a means of burning calories. On top of that, the caloric expenditure from exercise is not an effective counterbalance to chronically consuming excessive amounts of food. As an endurance coach, I take a fitness-first approach, even when a person’s primary goal is weight loss or fat loss (which ends up reducing BMI). The focus of exercise is to improve markers of performance so an athlete has an increased capacity to work harder and sustain exercise intensities longer. Energy intake and composition is then tailored to support high-quality training and recovery, rather than restricted to create massive energy deficits. As the person gains fitness, being more active is more enjoyable and they experience positive reinforcement in terms of greater energy levels, elevated mood, and improved performance. At first, bodyweight reduction tends to take care of itself. If there is a need to be more proactive in terms of making dietary changes, this approach means those changes can be made in a positive environment.
Taking a food-first approach is more of a dead end. People can lose significant amounts of weight by transitioning from highly processed to whole foods, reducing portion sizes, and addressing the underlying reasons they may have unhealthy relationships with food. But the only way to continue making progress with a food-first approach is to become more and more restrictive with energy intake, and that reduces energy levels, depresses mood, and diminishes performance capacity.
Fitness isn’t a panacea and won’t protect people from every ailment. Exercising itself won’t bring everyone’s bodyweight or bodyfat into the normal range. But exercise is the best way to improve anyone’s capacity to keep moving, and that increases the options people have to engage with the world, build relationships, and pursue their ambitions.