Why Should I Care About Healthy Lifestyle, I’m Not Fat

This post was inspired by a friend of mine who told me she has trouble getting motivated to exercise because, well, she’s not overweight, so why bother?

One unfortunate consequence of the so-called “obesity epidemic” is that it has made body mass index (BMI) the definition of health.  It sends the message that all you need to do is get (or keep) your BMI into the “normal” range and then voila! you are healthy.  It also sends the message that BMI outside the “normal” range is inherently unhealthy. Nothing could be further from the truth. We have become so focused on BMI because population-level studies show that it predicts risk for various diseases, but there are actually much stronger predictors.  Also, BMI as an indicator of health on the individual level is weak at best, because so many other things matter.  Consider the pic of Arnold Schwartznegger. With a BMI well within the obese range, should we convince him to lose some weight?  Of course not.  Consider also that 15% of people with type 2 diabetes (CDC) and about 26% of people who have had heart attacks (Basoor et al 2011) have BMIs in the “normal” range.  Should we have been more concerned about their risk? YES.

Which Health Metrics Matter More Than BMI?

BMI is one of many risk factors and not the most important risk factor to be paying attention to. Here are a few:  cholesterol (“good” HDL and “bad” LDL, and the total cholesterol/HDL ratio), triglycerides, waist circumference, % lean body mass, % fat mass, fasting blood sugar, and C-reactive protein. If you have a family history of diabetes and/or heart disease, then keep a regular eye on these because you may find these numbers are a little harder to control or that they change in a bad direction with age even though you don’t feel like your lifestyle has changed much.

Reasons to Embrace Healthy Diet and Exercise NOW

1. Batten Down the Hatches.  If you are female and pre-menopausal, your body will change when menopause comes even if you do NOTHING different.  Menopause slows the metabolic rate, accelerates loss of muscle mass, and reduces bone density.  Think of menopause as an impending hurricane.  Instead of waiting until it makes landfall, prepare ahead of time to offset the toll. Weight-bearing exercise, as well as strength training exercise, are the two types you need now. If you are already in menopause or past it, now is the time to rebuild after the storm.

2. Not So Fast Guys…  Boys, you are getting older too, and while you don’t have the menopausal sh$@storm to deal with, you guys have heart disease bullseyes on your foreheads because well… you are male.  Unfortunately, you have more heart attacks and heart disease amongst you at all ages. Your metabolic rates will also slow with age.  Embracing a healthy diet and exercise now, no matter what your age, will offset your risk, which is steadily increasing with age.

3. Don’t Sit on The Decision to Live Healthy.  Much research has now established that a sedentary lifestyle is a stronger predictor of heart disease than being overweight and obese.  Keep in mind that sedentary doesn’t just refer to people who never exercise, but even people who are lightly active but spend a great deal of time sitting.  This is a fantastic reason to stay active, think of it as an investment in your lifespan.  If you exercise, quite simply, you will live healthier longer.

4.  Eat Like You Want Your Heart To Beat. Diet can have a huge impact on your non-BMI risk factors, such as your cholesterol profile.  Consumption of cholesterol, saturated fat, alcohol, and yes, sugar! can negatively impact your cholesterol profile. Cholesterol and saturated fat drive up your LDL “bad” cholesterol levels, and sugar and alcohol drive up your triglycerides because excess calories from these foods are converted to triglycerides in your body.  If you don’t gain weight from indulgence, that doesn’t mean that the food you eat isn’t gradually increasing your risk for disease.  Be assured, it most definitely is!

5.  Exercise Doesn’t Cancel Out Chili Fries –If your weight is under control and you are physically active, you might be tempted to feel that exercise is permission to eat high-fat and high-sugar foods. Heck, if I just burned 1,000 calories exercising today, then why should I care about a chili dog or two?  From the perspective of energy balance (calories in/calories out) you would be right, however, weight loss is not the path to maximizing health for someone of normal weight, so it will not be useful for you to focus on calories.  Consider the list of health indicators above. Let those numbers (not the scale!) guide your dietary decisions.  If you can eat an extra 1,000 calories thanks to a vigorous workout, doing so with healthy options like nuts, lean meats, lean dairy, and/or whole grains would really balance your commitment to health.  Also, healthier foods will likely have a better impact on muscle recovery, energy levels, and overall physical fitness.

If you look in the mirror and are pretty satisfied with what you see on the outside, keep in mind that health, like happiness, is actually an inside job…



Centers for Disease Control and Prevention. Prevalence of overweight and obesity among adults with diagnosed diabetes –United States, 1988 – 1994 and 1999 – 2002. MMWR Morb Mortal Weekly Rep 2004;53(45):1066-1068.

Basoor et al (2011).  High prevalence of obesity in young patients with ST Elevation Myocardial Infarction.  American Heart Hospital Journal, 9(1), 37-40.


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