Can You Be Fat & Healthy?

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To be sure, no one is ever likely to deny the actuarial fact that staying lean and active is one of the best routes to a long life. Many studies point out that excess weight is associated not only with a lot of frequently cited dangers--diabetes, stroke, heart disease, sleep apnea and joint problems among them--but also with many less frequently cited ones, such as cancer. A recent study of 135 men, published in the American Heart Association (AHA) journal Circulation, seems to confirm this, acknowledging that while getting fit is associated with reducing a number of health risks, failing to tackle the fat problem is linked to many more. "Even if the overweight person doesn't have signs of disease," warns AHA cardiologist Gerald Fletcher, "they will develop them."

But for every expert who is worried that the last thing fat people need is one more excuse not to get thin, there are hints that the problem is in fact more nuanced than that. One is a study that comes from the nonprofit Cooper Institute in Dallas. Since the 1970s doctors there have been amassing a database of the more than 80,000 patients who have passed through their doors to be weighed, measured, pinched, blood-tested and to run on treadmills while their vital signs are monitored. Drawing on that rich lode of data, the institute concluded that overweight and active people may be healthier than those who are thin and sedentary.

Dr. Lawrence Cheskin of the Johns Hopkins Weight Management Center in Baltimore, Md., has concluded something similar. The patients who visit his clinic have an average BMI of 37--moderately to severely obese. Yet only about 30% of them have hypertension, and only 20% have diabetes. While he doesn't speculate about what's behind the low diabetes numbers, physical activity does appear to play a major role in keeping blood pressure in check. "Generally, the health benefits of fitness are cardiovascular," Cheskin says.

More common, if less headline making, than the fat-and-fit are people who are very heavy and not terribly healthy but at least improving. The New England Journal of Medicine recently published a study of 116,000 women and reported that lean but sedentary subjects had a 55% greater chance of dying prematurely than lean and active ones. Fat and active women were worse off still, with almost twice the risk of the lean-and-actives, and fat and sedentary women were worst of all, at nearly 212 times the risk. That's not the rosy picture the Cooper institute paints, but it does show that exercise helps, placing the subjects on a sort of sliding scale of danger. "Physical activity doesn't eliminate the effects of obesity," says Dr. Frank Hu of the Harvard School of Public Health, who co-wrote the study with the University of Minnesota's Jacobs, "but it can diminish them."