Foreword

Part of a daily ritual for millions of people is weighing themselves. They feel "bad" or "good" depending on the number on the scale. Success is measured by those numbers. This is business as usual in a society that worships thinness. The irony is that, despite the cultural obsession with weight (and how to lose it), the average American is roughly 10 pounds heavier than his/her counterpart a generation ago.

The paradox is undeniable: We live in a weight-obsessed culture, with an estimated 50-70 million of us spending in excess of $30 billion annually in an effort to control our waistlines. Yet we're collectively heavier for the effort. Needless to say, "bad scale days" far outnumber the "good" ones. What are we to do?

Well, standard medical practice tells us to keep trying. Indeed the National Institutes of Health guidelines for treating men and women classified as either overweight or obese (based on the new body mass index), released in 1998, call for calorie restriction as the key component of treatment: cut calorie intake by 500-1000 calories per day for six months, in an effort to reduce body weight by 10 percent. To be sure, the guidelines also recommend physical activity. But the calorie-cutting approach to weight loss is clearly the main thrust. This is unfortunate. This approach has absolutely no chance of succeeding for all but a very, very tiny minority of "successful" dieters, and for millions may actually compromise the very thing that weight loss was supposed to improve--health.

This presents us with another paradox: Conventional wisdom tells us that obesity kills. Therefore, weight loss should improve the longevity prospects of obese people. The problem is that there is minimal scientific evidence to prove that weight loss will lengthen the lives of men and women medically classified as overweight or obese. To the contrary, some recent published evidence suggests that intentional weight loss may actually increase (yes, increase!) risk for premature death. Of course, the problem with such studies is so little is known about the subjects being studied...why they lost weight, how they lost weight, over what period of time, whether they maintained their weight loss, etc. And this raises another question about obesity as a "killer."

We have been told by the media that obesity is responsible for the premature deaths of some 300,000 Americans each year, second only to tobacco as a preventable cause of death in this country. This is a misstatement. The actual quote from the data synthesis in the New England Journal of Medicine Nov, 1993 is:

"The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000)..."

The report did NOT say obesity caused these deaths. It said "POOR DIET AND PHYSICAL INACTIVITY" were prominent contributors to mortality. Therefore, I would like to comment on the activity levels of large people. For many reasons, large people tend to be less fit than their thinner counterparts. The physical characteristic of fitness is related to physical activity. Surveys also indicate that large people tend to be less physically active. It's likely that the higher death rates among large people observed in many epidemiological studies are due in part to low fitness levels, stemming from low levels of physical activity.

In fact, data from the ongoing Aerobics Center Longitudinal Study, conducted by researchers at the Cooper Institute for Aerobics, in Dallas, show that the apparent ill effects of body fat are completely negated by aerobic fitness.


In other words, if you are physically active and fit,
body weight is irrelevant as
a predictor of life expectancy.



Furthermore, data from the Cooper Institute reveal that "fat-fit" persons actually have much lower death rates that "thin-unfit" persons...proving that fitness is far more important than thinness in terms of health and longevity.

And this is why Kelly Bliss' new book, Don't Weight: Eat Healthy and Get Moving Now, is so important. As she makes abundantly clear, improved health and well being come about by making healthy choices in our daily living-the foods we eat and the activities we engage in-regardless of weight. The improved health and well being that accompany lifestyle changes are only minimally related to the weight loss itself, and mostly due to the direct effects of the lifestyle changes. Over the past 30 years or so, dozens of studies published in top-notch scientific and medical journals demonstrate unequivocally that health and fitness improvements accompanying lifestyle intervention are largely independent of changes in body weight or body fat.

So the choice seems obvious. We would be a whole lot better off, physically and emotionally, if we accepted the fact that healthy bodies can come in many sizes and shapes. Focus on things we can change, and accept the things we cannot. Kelly's book is an important contribution to the size-acceptance, non-diet movement.



Millions of Americans need to realize that the road to a fitter and healthier body is not so narrow as to prevent them from walking it.



Kelly's inspirational and reassuring book is a good traveling companion. To your good health and fitness, at any weight!



Glenn A. Gaesser, Ph.D.

Professor, Exercise Physiology, University of Virginia

Author of Big Fat Lies: The Truth About Your Weight and Your Health