Fat: What the Experts Don't Know About Obesity

By Maggie Mahar, Health Beat. Posted December 5, 2008.

What exactly does "obesity reduction without weight loss" mean? The obese men in the study who participated in aerobic exercise five times per week for 60 minutes did not shed pounds. The study was designed to make sure that they wouldn’t: "To allow us to test the hypothesis that significant obesity reduction could occur despite the absence of change in body weight, all subjects were asked to maintain body weight, and they consumed the calories required to compensate for the energy expended during the exercise sessions," the researchers explain.

Nevertheless, the obese men and the control group of lean men who participated in the study watched their waist circumferences shrink. Cardiorespiratory fitness increased in both groups, as did skeletal muscle, with total fat reduced. These changes were roughly equal in both groups. But when it came time to measure abdominal fat, reductions in the obese group were significantly greater.

The researchers acknowledge that the levels of fat loss observed in this study are less than those generally observed in response to exercise-induced weight loss that includes dieting.

"This reinforces current guidelines [that a combination of exercise and eating fewer calories] is the principal therapy for overweight and obese individuals ..." they observed. "However, the findings here extend these guidelines and provide substantial support for the recommendation that exercise without weight loss represents another strategy for obesity reduction.

"This is good news," they conclude, "and may be used to encourage and counsel those who appear resistant to substantial weight loss despite considerable effort. Stated differently, health care professionals should recognize that exercise without weight loss is not a failure when obesity reduction is the desired outcome. To the contrary, combined with the knowledge that exercise is associated with substantial health benefits independent of obesity, exercise without weight loss is a useful strategy for reducing obesity and related comorbid conditions: a win-win scenario."

I would add only that our obsession with whether or not people meet cultural norms for beauty -- rather than whether they are happy and healthy -- fuels the prejudice against obesity that can make even physicians cruel when their patients fail to lose weight.

As the public health nurse in the film Fat observes: "These are free-range fat people, just trying to do their best in a culture that hates them."

At the end of Fat, we return to the charismatic redhead who we saw at the beginning, puffing away on a treadmill. As the film closes, she’s still on the treadmill, mopping her brow with a towel.

"Sometimes I wonder, why the hell am I doing this to myself?" she confesses. "Can’t I just be happy with who I am?" She explains that part of why she exercises so relentlessly is "for my career. I’m in TV -- I have to look good. And so I associate myself with the number I see on the scale. I don’t know of that’s right or wrong, but it just is."

She blames herself: "How can I ever be happy unless I can control what I put in my mouth? On the inside, I may feel like I’m a good person. But what people see from the outside -- it stops people."

See more stories tagged with: health, fat, obesity

Maggie Mahar is a fellow at the Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).

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