Fit, fat and healthy

October 6, 2003

Pam Nelson weighs 110 kilograms, but there would be few women in Melbourne fitter than her. Each week, she works out for up to 10 hours in the gym. "My whole life is active … my energy is contagious," the 32-year-old says.

But Nelson’s high energy isn’t just devoted to keeping fit. The personal trainer of 16 years and aerobics instructor leads water workouts and a cardio-fitness program for people over 55 at the Coburg Leisure Centre.

"They look at me and think ‘How can you instruct if you’re overweight?’ I am proud of who I am and once people get past stereotyping me as an instructor, they get fitter."

Although Nelson falls 30 kilograms out of her recommended body mass index (BMI), she is in terrific shape and health. Her endurance and stamina pushes limits. She has a positive attitude to life. And her blood-cholesterol, pressure and sugar levels are all excellent.

Nelson exemplifies what health researchers are finding: That you don’t have to resemble the models or movie stars in glossy magazines to be in shape — that heavy people can be fit.

Dr Rick Kausman, Australian Medical Association spokesman, believes in looking beyond body size — instead focusing on fitness as a measure of true health. "We’ve been brainwashed to believe that healthy weight is a size 8 . . . We’re clearly not all meant to have a BMI of 22, or be a size eight or 10," he says.

"Human beings are meant to come in all shapes and sizes. We have to allow our weight to be the healthiest it can be to us, not to anyone else."

Kausman’s message is the focus of his most recent book, If not dieting, then what? He says physical activity and "little changes" to our lifestyle, such as decreasing non-hungry eating and fine-tuning food content can help reach a healthy weight.

People normally believe being skinny means you’re fit and healthy ... the facts show us that in terms of mortality levels, it’s better to be active and fat than inactive and lean.

One of the largest studies on the topic was undertaken in 1994 and repeat results were reported in 1999. Researchers at the Cooper Institute in Dallas, an organisation that studies health and fitness, traced about 20,000 men and determined that mortality rates went up as fitness levels dropped.

"The fact is, if you’re fit, it doesn’t matter what your BMI is in terms of mortality," says Dr Steven Blair, an epidemiologist and president of the institute recently told the Los Angeles Times.

"Once we adjusted for fitness levels, we didn’t see any difference in death rates between the fit and lean and the fit and fat," Blair said.

That’s good news for fat-but-fit people, who can’t seem to shed the extra baggage. Nelson says she’s "always been big". Her exercise regimen ranges from the treadmill to scuba-diving. In the gym, she does cardio-fitness, which involves work on the exercise bike and stepper, tae-bo style classes, weight training and muscle strength exercises, such as push-ups, sit-ups and squats.

She also jogs up to 27 kilometres a week, swims, cycles in the mountains and skis. "Because I can do these and do them well, I don’t worry about my size," she says.

Nelson triples the moderate fitness level, recommended by Blair and presented by the institute’s research into physical inactivity in Melbourne in August. At the time, he said that 30 minute walks for at least five days a week lead to reduced risks of disease and death.

His study showed that lean and unfit men had more than twice the mortality rate of overweight and fit men. Men who were moderately fit lived about six years longer than men of lower fitness. Low fitness was as evident as cigarette smoking in terms of mortality.

With obesity becoming a growing problem worldwide, messages from health experts to "move more" continue. "If you want to be active, all you have to do is get out there and walk," says Nick Green, spokesman for the Bluearth Institute, a non-profit organisation. "People normally believe being skinny means you’re fit and healthy . . . the facts show us that in terms of mortality levels, it’s better to be active and fat than inactive and lean."

Dr Jo Salmon, of VicHealth, and a research fellow at Deakin University, agrees with the Cooper Institute’s findings that physical activity offers protection to health "no matter what weight you are". However, she says overweight and obese people are at much higher risk of premature death compared to people who fall into their average weight range.

Although it is possible to be fat-but-fit, some health experts say the issue is more complex. "Being overweight will still pose risks when you’re older," says David Blackman, health and fitness expert at Melbourne City Baths. "You may be heavy and fit now, but what’s to say you’re not going to be open to health complications down the track?"

Blackman recommends fat-but-fit people shed weight if they are legitimately overweight. "Being overweight exacerbates conditions," he says. Those conditions include heart disease, diabetes, stroke, cancer and poor fitness potential.

He also says that being overweight gets in the way when it comes to getting fit. "Being overweight is more likely to get in your way as far as the biomechanics of exercise. Any form of obesity will make a fitness test hard.

"My bottom line is you have to be very careful about making blanket statements about being overweight and ‘fit’. Fitness depends on what training you undertake," he says.

Another who encourages overweight people to shed weight regardless of their fitness is Tania Ferraretto, from the Dietitians Association of Australia. She says that even if the blood pressure, cholesterol and sugar levels of overweight people are good, health problems can surface in the long-term.

"Even if symptoms for diseases are not apparent now, that’s not to say that they aren’t at risk in five or 10 years time," she says.

Ferraretto describes the notion that fitness decreases mortality rates for people in any weight range as simplistic. "They can still have risk factors for diseases regardless (of) if they’re fit," she says.

"Mortality rates depend on a range of factors, such as genetics, alcohol consumption, family history, exercise, diet, smoking and weight distribution."

Excess baggage around the abdomen, which is more common in men than women, is risky. "It interferes with vital organs and their functions and that’s why it’s dangerous … insulin doesn’t work so well so it increases the risk of diabetes," says Ferraretto.

Sarah Loh, of YMCA fitness, says men tend to gain weight when they grow out of their youth and do less exercise. The YMCA recently launched a boot-camp style program, aimed at men in their 30s that takes them back to their youth with exercises such as speed drills and push-ups.

Like Ferraretto, YMCA nutritionist Sarina Lococo, says being fat-but-fit, or lean and fit for that matter, "doesn’t mean that people should pig out or eat badly; they still need to have a healthy diet".

Excess baggage can also lead to poor quality of life, according to a study of almost 500 severely obese people, conducted by Monash University’s surgery department. It found that obesity exacerbates or even causes depression.

While not everyone agrees that it’s OK to be fat-but-fit, a small group of people, including Nelson, can’t seem to shed the weight. She is aware of the risks associated with being overweight but remains positive about her attitude, her shape and her body size.

"I am active, I am healthy, I have no concerns."

This story was found at: http://www.theage.com.au/articles/2003/10/05/1065292465637.html

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