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Each month, Dr. Jeffrey Sankoff looks at a recent study or body of research to talk to the researchers, explain the process behind it, and break down the findings.
This month: This recent study on the effects of taking a weight-neutral approach to promoting fitness—ie. can you achieve better long-term health outcomes by disassociating weight loss from physical activity?
Runners have a reputation for being muscular and lean. In reality though, one of the things that makes our sport so welcoming is that there is no one body type or shape required to run or race. Anyone can be a runner.
Part of this comes from the fact that many athletes find running as they pursue other goals—often that can be jump-starting their fitness, motivation, or health, or weight loss (and then sticking around because they love the sport).
Since 1980, obesity rates have doubled in more than seventy countries, with a three-fold increase in the United States to more than 42% in 2018. While there are a number of well-studied reasons for this, in the same time frame, there has been a similar increase in weight loss attempts—just under half of all Americans say they’ve tried to lose weight in the previous twelve months.
Given the seeming futility of diet culture and weight loss efforts, researchers have begun to question if there isn’t a better way to approach obesity rates and the associated health outcomes. Instead of focusing on weight loss, the goal should be on lifestyle changes and physical activity, which could result in improved quality of life and lower rates of diseases often associated with being overweight—ie. better health outcomes, without worrying about the weight loss itself.
A recent review article by Glenn Gaesser and Siddhartha Angadi sought to answer this question by looking specifically at the impact that being physically active can have on disease and mortality rates in people who are overweight or obese. “We have been on this diet rollercoaster for decades now and from an exercise physiologist standpoint we wanted to ask the question ‘What would happen if someone just focused on their fitness,’ and it appears to be a lot,” Gaesser told me about the rationale for the study.
In their review, Gaesser and Siddhartha found abundant evidence that being active was associated with significant benefits to health and well-being for all people, whether they are obese, overweight, or of normal weight (as defined by BMI—which, yes, has its own flaws). However, the benefits to those who were overweight were more dramatic. Several large studies were found to have demonstrated that among those who are overweight or obese, being active and improving physical fitness can reduce the rates of cardiovascular disease and all-cause mortality almost to normal rates.
This is very important given the reality that weight loss is so difficult. Most people who undertake weight loss regimens fail, or worse find it unsustainable in the long-run and regain the weight they lost.
This weight yo-yo-ing or cycling has been shown to be associated with significant health risks, and it is primarily for this reason that Gaesser and others in the field feel that by emphasizing fitness, better health can be achieved with that naturally leading to improved diet and, eventually, a more sustainable weight loss. “A person can have a weight loss goal, but we would first like them to have a physical activity and fitness goal and keep that as the main prize, with weight loss being secondary to that,” Gaesser said.
Gaesser does not intend to diminish the adverse health effects associated with being overweight, but he does note that in study after study, losing weight is not associated with improvements in markers of poor health, whereas improving physical fitness is regardless of weight. “Physical activity likely has its own intrinsic benefits regardless of weight and whether or not you lose it,” he said.
“We are not saying that obesity is benign or something that can be dismissed as something without any health consequences,” he said—while weight loss may remain a subsidiary goal for many, the first and primary goal should be physical activity, “but we are seeing that many of the health conditions and risks can be ameliorated or even resolved with improved physical activity and fitness.”
“What I am saying is that it is perfectly possible for an overweight person to be fit, those two things can coexist, but you can not have fitness without the physical activity.”
For runners, or anyone aspiring to be one, this should come as welcome news. Focusing on the training and the goal of being as fit as possible is extremely beneficial to overall health and well-being, and de-emphasizing weight loss can take some of the stress and frustration out of the process for many. By making your primary goal one of fitness, the secondary goal of weight loss (if that’s a goal at all) need not be as all-consuming and can follow more naturally. And athletes of all sizes and shapes can know we are all pursuing a common goal: getting to the finish line.