Is it possible to be overweight yet healthy?
According to Beth Marshall-Bergman, DO, an internist at Rush Oak Park Hospital, there isn’t a one-size-fits-all answer to this frequently asked question.
More than 70% of Americans are overweight, so Marshall-Bergman, like most other primary care physicians, often finds herself discussing this concern with her patients.
"Carrying excess weight isn't necessarily a health crisis, but it could put you at risk in the future," says Marshall-Bergman, who sees patients at the new Rush Center for Weight Loss and Bariatric Surgery at Rush Oak Park Hospital. She is a diplomate of the American Board of Obesity Medicine, trained in the treatment of obesity and related disorders.
Excess weight is associated with some seriously unhealthy conditions, like diabetes, hypertension and colon cancer, which all can be "silent" early on; that is, symptoms don't appear until these diseases are fairly advanced.
What is a healthy weight?
How can you tell if you weigh too much? One simple tool is the body mass index (BMI), which assesses your weight relative to your height.
- Anything below 18.5 is considered underweight, which can be dangerous, too, as we need some fat to live.
- The range for a normal BMI is 18.5 to 24.9.
- A BMI of 25 to 29.9 is overweight.
- A BMI of 30 or more is considered obese.
- A BMI higher than 40 indicates severe obesity.
Nearly 40% of American adults are obese, and they are more likely to have risk factors for certain unhealthy conditions than people who are just overweight.
It’s possible to address some of the conditions associated with carrying excess weight right now. For example, sleep apnea, which can be caused by being overweight, is very treatable, primarily by wearing a continuous positive airway pressure device (CPAP) while sleeping. And other weight-related conditions like diabetes and hypertension may respond to medications. However, weight loss is likely to be a top recommendation from doctors for people who are overweight and have these conditions.
Getting down to a healthy weight may require a weight-loss program that includes behavioral changes. "The good news is that even small weight losses can improve many of these issues," Marshall-Bergman says — a loss as small as 5% to 10% of total body weight.
Is all fat bad?
But the numbers on the scale alone do not tell the whole story. It's also important to consider how your weight is distributed.
While it gets a bad rap, it actually plays an important role in a healthy life. First, stores of fat in our bodies are warehouses of energy against a time when we might not have enough to eat. In addition, they protect our internal organs and keep us warm.
"Fat is not inert, though," Marshall-Bergman explains. "Fat is active. It's hormone responsive."
In fact, fat, or adipose tissue, is an endocrine organ in its own right, helping to maintain organ functions from the brain to the heart to reproduction, as well as bone health, digestion, growth and the immune system.
Humans have two kinds of fat: the subcutaneous type that's under the skin and between the muscles; and visceral adipose tissue (VAT), which we carry around our mid-sections. And too much VAT can be concerning.
When you talk about the classic “apple” vs. “pear” body type, the “apple” refers to people who have more VAT at the waistline, which has been proven to contribute to many unhealthy conditions, including diabetes, heart disease and some cancers.
There is a surprisingly simple tool for measuring VAT — a tape measure. A woman's waist should measure no more than 35 inches; a man’s waist circumference should be no more than 40 inches.
A diet is a short-term project; good health is a lifelong endeavor.
Accentuate positive behaviors
While everyone should strive to have a BMI and waist circumference in the healthy range, good health is not defined solely by those numbers, either, according to Marshall-Bergman.
"It's also about your diet in general; how much sleep you're getting, and the quality of that sleep; the stress in your life; how much exercise you get and what types; your genetics; your environment; and the medications you're taking," she says.
For example, people who don't sleep well often weigh more than people who do, and studies have shown that poor sleeping might actually make a person hungrier.
With her own patients, Marshall-Bergman says she focuses on the positive — daily behaviors that can bolster good health while also contributing to weight loss. "Sleep seven to nine hours every night, do whatever kind of healthy movement you enjoy, quit smoking, watch your stress and pay attention to the foods you eat, emphasizing fruits, vegetables, whole grains and lean sources of protein,” she says.
Marshall-Bergman does not, however, encourage her patients to swear off foods they love. "That's how people get in trouble," she says. "Choose your weekly treat and plan for it. It will help you pass up the donuts at work if you know you have a slice of cheesecake waiting for you on Friday." In other words, it’s all about moderation.
The secret to weight loss success
Of course, even when you know what you should be doing, it's not always easy to sustain healthy behaviors. That’s why you shouldn’t think about achieving better health as just losing weight or dieting. Weight loss is a short-term project; good health is a lifelong endeavor.
“The approach should be that you are adopting a new lifestyle, changing your behaviors in a way that you can keep them going forever," Marshall-Bergman says. "The first thing I ask my patients is, 'Is your weight an issue you want to work on?' "
The key is setting small goals and working incrementally, "but you have to address all your issues — food, exercise, sleep and stress — if you want to be successful,” she says. For example, if you have a hard time moving, you can start by doing "walking" exercises in a chair. If you’re used to eating three cookies a day, you could start by cutting back to three cookies a week. Looking forward to that occasional treat can help strengthen your resolve
Maintaining a healthy lifestyle is something many people struggle with, Marshall-Bergman says. She suggests enlisting the help of your primary care physician and, if need be, a nutritionist. Comprehensive programs like the Center for Weight Loss and Bariatric Surgery, with locations at Rush’s downtown campus, the Gold Coast and the South Loop, as well as at Rush Oak Park Hospital, can also be a great one-stop resource.
"Being overweight can cause depression and feelings of failure — the idea that weight loss is something you should be able to manage — especially if you’ve attempted it before, if you have lost weight and regained it,” Marshall-Bergman says. “That can be really discouraging. It's important to recognize first that you’re ready to work on it. Then, you can put the support system in place to move forward and work together to achieve lasting results."