Can You Be Fat & Healthy?

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Not so fast, say other experts. For one thing, it's possible that unacknowledged weight loss is responsible for the improving health numbers. People who are very overweight often pick up or drop 10 or 20 lbs. at a time, fluctuations that get lost in the statistical noise of their overall battle with the scale. If you become physically active, it's hard not to lose at least a little more than you gained, and that little can mean a lot. Normally the greatest weight-loss benefit comes from the first few pounds you shed. A 240-lb. man who drops to 230 lbs. is healthier for the 10 lbs. he lost. But the 10 lbs. he dropped from 250 to 240 may have benefited him even more. "Even the first 5% of weight you lose is very helpful," Cheskin says.

Serious questions have also been raised about the Cooper client base, disproportionately made up of motivated people who are not terribly obese and, significantly, well-to-do and white--a more than trivial problem when the obesity crisis hits hardest in poor and minority communities.

Then, too, there is the chemistry of fat itself. In most parts of the body, fat is packed on under the skin and over the muscle. But fat around the middle also gets stored beneath muscle. This gut fat is far more metabolically active than peripheral fat, releasing inflammatory molecules that contribute to insulin resistance, diabetes and hypertension. Exercise may be a good idea, but until you lose the beer belly, you may still be putting yourself at risk.

But if exercise can't get you all the way to your metabolic goals, it may get you partway there. It certainly appears to have worked for Sandy Schaffer, 47. The 5-ft. 5-in., 280-lb. Schaffer began attending the In Fitness & In Health Wellness Center in New York City more than eight years ago, when she weighed an even more prodigious 350 lbs. She credits her workouts there not only with getting her weight down but also with some other impressive numbers. Her total cholesterol has dropped from 220 to 180, her blood pressure is good, and a recent cardiac-stress test showed that her heart is healthy. She now takes four or five fitness classes a week and teaches two or three herself. "Before I started exercising, I couldn't walk 10 yards without huffing and puffing," she says. "My mother's 80-year-old friends with bad knees were walking better than I was."

The club Schaffer attends is one of a growing number of gyms catering to plus-size patrons. Founder Rochelle Rice, who earned her master's degree in the decidedly specialized field of exercises for the overweight, knows that teaching such a clientele to get up and move is not the same as teaching the slender. "I do a lot of back work," Rice says, "because large breasts or weak posture pulls the body forward. I also do a lot of abdominal work to bring the pelvis back into alignment and shin and calf work to help with walking."

Life Time Fitness, a chain of gyms based in Minneapolis, Minn., that has 39 centers in eight states, is joining the trend. Trainers there have chucked the BMI and now tailor workout regimens to clients according to their aerobic capacity, cardiovascular fitness and more.