Debating Fatness and Fitness

Body Mass Index, not bodily dimension, is what really matters.



Ten days apart in January 2013, CNN carried two items, the first, Big deal: You can be fat and fit, an opinion piece contributed by Marilyn Wann, originator of the Fat!So? e-zine, web site, and blog, and the second a nearly straight-up news story Thin is in but fat might be better.

Fast-forward four years and the fat or fit debate is back with a renewed vigor.

In Britain, researchers at the University of Birmingham declared on May 17, 2017 that “The idea of being healthily obese is an age-old myth,” and that “there is much that health professionals and people who are obese can do to reduce their risk of disease.” Louise Green, a personal trainer in Vancouver, BC, responded within two days that she has “witnessed incredible feats in fitness by obese clients.” And of course, with the baseball season in full swing, there are many who will point to the achievements of legendary players such as Babe Ruth and Ty Cobb, neither of who could be described as “fit” even during their most productive seasons.

So where is the truth? As someone with T2, I can assure you that no doctor I have ever seen has said to me: “Congratulations, you’re not obese, just heavy. Just keep doing what you’re doing. No worries.”

That’s because physicians and nutritionists don’t think in the relative terms of fatness and fitness. They go by a medically sound metric — body mass index (BMI) — to determine if their patients are carrying an unhealthy amount of fat. Fat is not a label when this metric is applied; it’s a word meaning the lipid, or fatty, tissue of the body where energy is stored, which, if allowed to accumulate, wreaks havoc with the heart, the blood vessels, the kidneys, and the metabolism. The BMI number, which you can estimate on your own, will tell whether you are unhealthily underweight, normal, overweight, or unhealthily obese. A nutritionist, an exercise physiologist, or a doctor can measure it precisely, and then give you a goal to reach and help you to obtain it.

Regarding obesity, Taber’s 23rd Cyclopedic Medical Dictionary, has this to say:

Obesity is the most common metabolic/nutritional disease in the U.S., with more than 65% of the adult population being overweight. Obesity is more common in women, minorities, and the poor. The obese have an increased risk of developing diabetes mellitus, hypertension, heart disease, stroke, fatal cancers, and other illnesses. Obese people may also suffer psychologically and socially.

Note that Taber’s doesn’t print “diabetes” after “fatal cancers,” – it’s in first place. And the list is not in alphabetical order.

For some people, obesity is not a matter of avoiding exercise. They have an unfortunate familial tendency to be predisposed towards hypercholesterolemia. This is a genetic problem that manifests itself with sustained high levels of LDL, the bad kind of cholesterol, and as a result many of these people develop T2D. Then there are people who don’t have the genetic tendency but still, try as they may to eat properly and exercise, just can’t succeed in keeping the pounds off, and need gastric bypass or gastric sleeve surgery.

I’ve been luckier, so far, but I didn’t heed what my doctor told me for twenty years about diet and exercise. In 1988, I had a company life insurance physical and found I’d gotten to 241 pounds. Within two years, I was a contributor to the stats (with a T2D asterisk) in the Diabetes Almanac. Since then, I have reduced my weight to 186 pounds, but I ought to be around 160. That would move me out of the clinically “overweight” category to a bracket where I ought to be, based upon my age and height among other measures. I will, however, concede this point: I wouldn’t be cured, nor would my diabetes be “reversed,” as some have claimed possible. But my liver and pancreas wouldn’t have to work nearly as hard to keep me within a healthy A1c, and the risks that my pancreas will one day give out, or heart disease and neuropathy will come on, would be substantially cut.

Lest there be any doubt remaining, the direct link between obesity and prevalence of T2D was once again demonstrated in 2014, the most recent time the Centers for Disease Control and Prevention published the Estimates of Diabetes and Its Burden in the United States. When there was a drop in the prevalence of obesity, there followed a drop in newly diagnosed cases of T2D.

Scientific studies being published all the time reinforce these truths, and educate us. Look carefully at the information that comes with every Type 2 medication that you’re using. It will say that it is effective along with diet and exercise to control blood glucose.

I’ll conclude with a few anecdotes for those still hanging on to the examples of old-time baseball legends:

In 1991, Catfish Hunter told the Washington Post that it was Yankees owner George Steinbrenner’s compassion and generosity that had made it possible for him to get his diabetes under control after being diagnosed at spring training in 1977. The club offered Hunter nutritional counseling and sent him to doctors who coached him successfully through the World Series that year and the following one.

“I thought I was through, that my life was over,” Hunter said. “Then I got educated.”

As for baseball legend Ty Cobb? Well, he owned 24,000 shares of Coca Cola when he died – of cancer, heart failure, and diabetes.

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Jim Cahill is a senior writer for Insulin Nation and Type 2 Nation. Before turning to writing, he was a lawyer in government and private practice who focused on consumer protection and regulatory law. He can be contacted at jcahill@epscomm.com.