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No waif, no problem

Researchers are challenging the assumption that heavy people can't be fit.

May 05, 2003|Marnell Jameson | Special to The Times

At 5 feet 4 and 185 pounds, Irene Rubinsky looks to some like the "before" picture in a gym advertisement. But that impression ends when Rubinsky begins the exercise dance class she teaches six days a week.

Rubinsky -- who, besides dancing 10 hours a week, also takes weekly Pilates classes and weight-trains -- is more fit than the majority of the population. She's strong, has great endurance and her vital statistics would put the lean and unfit to shame: Her blood cholesterol, pressure and glucose levels are all excellent.

The 36-year-old group exercise director for three Gold's Gyms in the L.A. area exemplifies what more researchers are finding -- that health should be measured more by fitness and less by leanness. Research studies and a better understanding of the strong role genes play in determining body shape are leading more doctors to look beyond body size and to focus more on fitness as a measure of true health, says Dr. Steven Blair, an epidemiologist and the chief executive of the Cooper Institute, a Dallas-based organization that studies fitness and health.

"The fact is, if you're fit, it doesn't matter what your BMI is in terms of mortality," Blair says. "Too much focus is placed on diet and weight and not enough on lifestyle and fitness." (BMI, or body mass index, is a single number used to express the relationship of a person's height and weight.)

Glenn Gaesser, professor of kinesiology at the University of Virginia, agrees. His new book, "Big Fat Lies" (Gurze Books), argues that it's time we lightened up on heavy people -- as long as they're fit. Although it's true that many overweight people are out of shape, those who are overweight and in shape are better off health-wise than those who are thin and don't exercise.

"That's still a hard sell in America," says Gaesser. "Even fitness center ads focus not on fitness and health, but on weight loss and looks. People think it's all about losing weight and getting that body, but it's not."

In a large-scale study first reported in 1994, and since repeated, researchers at the Cooper Institute who tracked 20,000 men found that mortality rates went up as fitness levels went down. Although overweight people were more likely to die sooner, that was because overweight people were more likely to be unfit, says Blair. "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."

Those who were thin and unfit had more than twice the mortality rate of those who were fit and overweight. Men who were moderately fit had a 50% reduction in mortality compared with their unfit counterparts. And those who were highly fit had a 60% to 65% reduction in mortality.

The study measured fitness using standardized stress and endurance tests, but Blair says a person can be considered fit if he or she exercises more than 30 minutes most days of the week.

Such findings are good news for people like Mary Bogue. The 52-year-old Arcadia woman has always been heavy and will probably be her current size (an 18) for the rest of her life, she concedes. "I'm the product of two beach balls," says Bogue, a character actor who has worked as a body double for Oscar-winning actress Kathy Bates. But that doesn't mean she's not in great shape. She started working with a trainer 2 1/2 years ago. Today, she swims a mile three times a week and also takes salsa dancing, water aerobics and cardio classes. Though she hasn't lost much weight, she says, that's beside the point: "I exercise to be healthy and feel great."

She stopped getting on the scale a long time ago, "because it really doesn't tell you what kind of physical condition you're in." Instead, she relies on regular checkups to tell her she's doing great. Her cholesterol and blood pressure are low, and she has perfect blood-sugar levels. "Whenever I go to the doctor, they take my blood pressure three times because they can't believe how low it is. They say, 'That can't be,' and I say, 'Yes, it can.' "

This doesn't surprise the Cooper Institute's Blair, who regularly counsels physicians not to judge a patient by his or her contours. Still, many doctors persist in telling the heavy yet healthy to lose weight. "I tell doctors to treat risk factors, not BMI. If a person comes in with a BMI of 31 or 32 and all their risk factors are in the normal range, don't put them on a diet. Pat them on the head."

Most of us will never look like models or movie stars no matter how much we exercise or diet, he adds. Much of how we look, including our weight, is genetic. That people prone to being overweight are also less likely to be fit is partly cultural. Many overweight people don't feel comfortable or welcome in a gym. They fear ridicule. Rubinsky says she often hears fat people say they'll start going to the gym when they lose weight. "That's like saying I'll buy some makeup after I get a date."

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