"Get The Skinny."   by Caroline J. Cederquist, M.D.

Fatness or Fitness? Making a Plan of Attack

You know they're coming. It's almost time. 

   No, not the relatives; the resolutions! As you're making your way through the holiday season, toasting everyone's health and well-being and thinking ahead to next year, you'll probably give a moment's thought to what your own health resolutions for the New Year might be. 

   May be you want a diet and exercise plan. Maybe you want to eat better; perhaps you're planning to actually exercise more often, rather than just thinking about it more often. 

   Maybe you don't want to take on too much; you don't want to tackle the whole kit and kaboodle at once with your diet and exercise plan. So you're considering which of these is best to start with. Shall I diet? Shall I exercise? Where to begin? It's a perennial debate, even in scientific circles. 

   Consider a recent issue of the Journal of the American Medical Association. In one article, new research showed that a person's body mass index is more closely associated with his diabetes risk than is his activity level. 

   Another article in the same issue showed that a woman's risk of heart disease is more closely associated with her activity level than it is with her body mass index. 

So where do you start in your diet and exercise plan? 

   The data aren't exactly contradictory, but they do suggest a greater causal significance for weight, in the first case, and for physical inactivity in the 
second. And this sort of disparity is what leads to the old "fatness versus fitness" debate. Can you be fat and still be healthy? 

   The truth is that if you're overweight, you're at high risk for both heart disease AND diabetes, and other factors may put you at higher risk for one or the other, or something else entirely. 

   And yes, there are indeed a few people who carry excess body weight and yet all their blood work comes up healthy and they're active and physically 
fit. But the fact is, people who are fat and fit are the exception that makes the rule. And they're few and far between. Most Americans are sedentary and overweight. In my clinical experience, it may start with one or the other, but almost always ends up being both. 

   So if you're trying to decide how to tackle a weight problem, there's no obvious answer suggested by the research here. If you change your diet 
without exercising, you may drop weight without other significant health improvements you want to achieve. Will it stay off? Statistically, if you don't 
start exercising eventually, the chances aren't very good. 

   But if you exercise without dietary change, you can improve fitness and strength without ever losing any weight. Many people do. And then in spite of 
increased strength and energy, these folks often end up giving up the activity because when we're working that hard at it, we want that effort to help us feel 
better about how we look, too. 

   So is there an actual answer to what's more significant, the weight or the inactivity? The answer is: it depends! 

But perhaps a better answer is: Who cares? 

   In the same issue of JAMA, there's a very good, common-sense editorial that says, in part, " the relative contribution of fitness and obesity to overall 
health and risk actually may be a trivial matter, because a common treatment is already available for both" 

   That's right. And you didn't hear it here first. It's the same old conventional wisdom we've always had. "Physical activity is the common denominator for the clinical treatment of low fitness and excess weight," says the JAMA editorial. 

   Consider: Exercise alone won't take off 50 pounds of excess weight. That would demand a phenomenal caloric output. Most people aren't aware 
that the majority of the energy we burn is used up simply metabolizing and supporting essential systems. For instance, you'll burn about 100 calories in an hour of good walking. But you'll burn about 60 calories in an hour of good sitting around. 

   If you're trying to take weight off, you've got to adjust the diet, and fortunately, that's often an easier place to start. I often have patients start with 
a dietary approach alone. Once they've easily taken off a few pounds without exercise, increasing the activity level doesn't seem so daunting. 

   And that's good, because all the data show that while diet is initially more important in terms of losing weight, regular activity is essential for maintaining 
weight loss, for improving cardiovascular health and ramping up the metabolic rate so that your body is naturally burning more, even when you are just 
sitting around. 

   While I would encourage everyone to become more physically active eventually, it's actually an unwise way to start for some patients, those whose 
bodies are extremely stressed by their excess weight. And people very often have no idea how bad off they are, so a careful, gradual approach may not 
only be emotionally appealing, it could be the difference between life and death. 

   That's where good medical supervision is important. Weight loss has been trivialized by generations of fad diets and wacky gadgets, but with 
two-thirds of Americans now overweight, this health crisis is becoming increasingly relevant and increasingly complex to treat. 

   But no two people are the same, so anyone trying to get healthy should have individualized care. Whether you're most concerned about your fatness 
or your fitness, you eventually do want to get the whole kit and caboodle in a gentle and comprehensive approach that will incorporate both dietary changes and increased activity, at a level appropriate to your own health and interests. 

And that's a resolution every body deserves. 

Through Thick & Thin: Diet and Exercise Plan

   Virtually anyone can benefit from both better diet and more exercise. Good medical guidance can help you understand which results your specific efforts 
can reasonably generate, and if you want more or different results, you can always adjust and refocus your efforts. 

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Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center, her Naples, FL private practice, you can also get more information about Dr Cederquist and her 
weight management plan by visiting www.DietToYourDoor.com