Lean and Fit: Better Together

Older Hispanic woman lifting weights in living room
Jose Luis Pelaez Inc / Getty Images

Maybe it seems rather obvious that being lean and fit are both good, and that they are even better for health in combination. That topic, however, has been controversial over recent years. The argument has been made that fitness and fatness can occur together and that when they do, the former may overcome the adverse health effects of the latter.

The other matter fostering debate and controversy is the idea of the obesity paradox.

This position, predicated on some large epidemiologic studies, argues that there is actually a health advantage in being overweight or slightly obese relative to truly lean.

Uncertainty about these matters has spawned a number of studies intended to resolve these issues, with results now coming our way with regularity.

A study in the August 2017 edition of the European Heart Journal, which I addressed here in a prior column, indicated that obesity was a reliable predictor of increased health risk, independent of any metabolic abnormalities. A newer study in the Journal of the American College of Cardiology, conducted on 3.5 million people over five years, found higher rates of heart disease, stroke, and heart failure associated with obesity even in the absence of any overt markers of metabolic risk, such as high blood pressure, abnormal blood sugar, or an unfavorable blood lipid pattern.

Seeing the Light

The conclusion is increasingly clear: Being lean is part of overall health, and it makes an important contribution independent of all other risk markers.

As for the obesity paradox, it is increasingly clear there really is no such thing. Older people who start losing weight often have the early stages of potentially serious illness, and that tends to confound many of the older studies on that topic. Obviously, people who have serious illness tend to do worse than people who don’t.

If the serious illness causes weight loss, it can make it seem that weight loss—from overweight to normal weight—is harmful. The reality, however, is that such weight loss is an effect, not a cause. People who are lean because they work to be, rather than because an illness is causing weight loss, consistently have the best health outcomes of all.

In my opinion, the data available to us are sufficient to resolve these matters once and for all. There really is no obesity paradox. But if you are at or after mid-life and start losing weight for any reason other than eating better and exercising more, it is concerning. Your counterparts who don’t start losing weight inexplicably are apt to be better off, and you should confer promptly with your doctor.

One can be fit despite being fat, but few people are, if only because the requirements of genuine fitness tend to provide a fairly robust defense against fatness. Still, there are people who find it nearly impossible to be truly lean despite considerable physical activity. Anyone in this group certainly is better off being active than not. The studies indicating that lean and fit both matter also show, consistently, that either is better than neither.

Smart Strategies

Given, then, that lean and fit matter independently but are even better together, what should your action plan be?  Here are my four tips:

  • Don’t focus on weight. Yes, it matters. But the best way to lose weight is to find health. The best way to maintain a healthy weight over time is to focus on being healthy, not thin. There are ways to get thin that have nothing to do with health, but there are no ways to pursue optimal health that don’t offer benefits for weight control. Focus, always, on finding health—and let your weight take care of itself.
  • Move often and in many ways. Our bodies were made to move, and modern living conspires against that. Yes, an hour at the gym each day is a good thing (and it’s much more than many of us manage). But even that may mean lots of sedentary hours. Be as physically active as you can, as often as you can, in as many ways as you can. By all means, go to the gym, or run, or bike, or dance. But in addition, take the stairs instead of the elevator when you can; walk or bike instead of driving when you can; stand up and move intermittently throughout your work or school day. The more motion in your daily routine, the better.
  • Don’t try to outrun calories! The simple fact is that the bounty of highly processed, often quite tasty, calorie-dense foods available in modern society makes it much, much easier to out-eat exercise, than to out-exercise all those calories; so don't try the latter. Most relevant research indicates that for weight, per se, calories in are more important than calories out.

    But I don’t necessarily recommend you count calories. Rather, focus on the quality of your food choices. The more you eat wholesome, whole, minimally processed foods, the less subject you are to the manipulations of a food industry that profits when you eat more than you should. Improve the quality of your food choices, all at once or little by little, and that quality will, in turn, help you control the quantity you eat. Choosing better food means filling up on fewer calories, so you can be lean without being hungry all the time.
  • In unity, there is strength. While losing weight might be something you would want to do alone, finding health should not be. That is something to share with those you love. The word I find missing from discussions of health and weight far too often is family. Once we acknowledge that both lean and fit are in the service of your health, and not a number on the scale, there is every reason to pursue them as a family, for two reasons.

First, we all want the people we love to enjoy good health; we should tell them that, and work on it with them. Second, in unity there truly is strength. If you make activity routine and healthy eating a “family value,” both are much easier to maintain than if you try to go it alone with no support.

Lean and fit are, truly, better together. I think our best opportunity to enjoy the benefits of both is to work together with our families to find and share the advantages of health. Finally, remember why it’s all worth it: Other things being equal, healthy people have more fun!