Fit or fat? Some say employees can be both
Exercise alone can enhance health significantly
The Kaiser Permanente booklet bears the title, "Living in a Healthy Body."1 Yet most of the "healthy" people portrayed on the cover can only be described as "fat."
Just what’s going on here?
Why would a highly respected health care company such as Oakland, CA-based Kaiser offer such individuals as models of good health? Because their health care staff are among a number of health promotion professionals who have redefined "health," based on a growing body of research. This research shows that most "diets" don’t work, employees who strive to achieve an unrealistic body size can do themselves more harm than good, and exercise may be far more important to overall health than body weight.
"Employees can be healthy at any size," says Susan Kayman, DrPH, RD, senior consultant for Kaiser Permanente’s Northern California region.
"The goal is to educate employees so they realize we don’t have to be super-thin to be healthy that there can be good health at a variety of sizes and shapes."
Pat Lyons, RN, MA, director of Oakland-based Connections Women’s Health Consulting Network, a collaboration among women’s health consultants in a variety of disciplines, agrees. "Living as healthy a life as you can while making peace with your body size is a healthier way to live than to try to equate health with a particular number on a chart," she says. "All of those numbers are simply not attainable for all people."
And trying to achieve those unattainable numbers can do more harm than good, she insists. "Dieting eating in a certain way with losing weight as your primary goal undermines health rather than improving it because people are trying to alter what is their own natural body size," she explains.
Failed diets have physical, mental impact
The negative impact of a series of failed diets can be physical as well as mental, adds Kayman. "One of the striking findings presented at a 1993 NIH [National Institute of Health] conference2 is that it seems to be healthier to maintain a stable weight than to have your weight fluctuate," she notes. "In large populations, it was shown that people with stable weights did better in terms of longevity."
Neither Kayman nor Lyons, however, recommends that employees simply be content with their current physical state, whatever that may be. "What we work for is to encourage physical activity, slow change, and healthy low-fat eating," Kayman explains. "Over time, people may only lose 10, 15, or 20 pounds, but it can have a huge impact on cholesterol or blood pressure levels. If you start at 250 pounds and lose 30 pounds, however, you will still be a large person. You need to come to terms with that."
Beth Barlow, MS, a data analyst at The Cooper Institute for Aerobics Research in Dallas, is quick to point out that, "The best possible scenario is to be of normal weight and highly fit." However, an Institute study in which she was one of the researchers concluded that, "Physical activity may provide health benefits to overweight individuals, even though they remain overweight."3
The data, drawn from a study of 25,389 men between 1970 and 1989, "suggest that moderate and high levels of physical fitness are associated with lower risk of mortality in overweight and normal weight men when compared with their low-fit peers. Although physical activity or exercise training may not make all people lean, it appears that an active way of life may have important health benefits, even for those who remain overweight."3
While the study suggested a "weak direct association" between BMI (Body Mass Index) and mortality risk, a lower risk of mortality was seen among all BMI strata for highly fit men.
Barlow says, "Wellness professionals can encourage their overweight employees to stay on track and still become fit because it is to their benefit, regardless of what their body weight may be."
Is there a way to determine proper weight? "Employees should ask themselves what weight they have been most of their lives without trying to alter it one way or another," Lyons recommends. "They should look at their families are the members fat or thin? Does the employee resemble the people in his or her family? You have to consider the whole question of genetics."
But how do we know if we’re healthy?
Employees who are overweight can still be deemed healthy, says Kayman. "There is a combination of actual parameters of good health, such as normal blood pressure and lipids, and the ability to do the things you want to do in life," she explains. "In other words, you’re not restricted because some of your body parts hurt; you don’t have a condition which would prevent you from living the life that you want to live." (See story on employee wellness, p 41.)
To help employees become as healthy as possible, wellness professionals should consider offering classes for employees with a variety of body sizes, Kayman notes.
"The exercise facility should be welcoming to people of all sizes, and classes should not only be geared to the already active, elite person," she advises. "Larger employees might feel unwelcome, or the exercise might not be appropriate for them. Pay attention to their needs, in terms of space, chairs, changing areas, even appropriate exercise shoes to help them get started." In other words, says Lyons, you should ask yourself, "What are the barriers for certain employees, and how can I reduce them?"
Weight management programming also should be modified, says Lyons. "Instead of setting up weight loss competitions, offer programs on low-fat cooking," she suggests. Everybody can benefit from them, and they’re not linked to a particular body size or weight."
You should also discuss healthy eating habits with your employees, says Lyons.
[Editor’s Note: For more information on research concerning exercise and health, contact: Beth Barlow, data analyst, Cooper Institute for Aerobics Research, 12330 Preston Road, Dallas, TX 75230. Telephone: (972) 341-3200.]
References
1. Lyons P, Kayman S, Carrier K, et al. Living in a Healthy Body. San Bruno, CA: Krames Communications; 1995.
2. Technology Assessment Conference Panel. Methods for voluntary weight loss and control: Technology Assessment Conference statement. Ann Intern Med 1993;119:764-770.
3. Barlow CE, Kohl HW III, Gibbons LW, et al. Physical fitness, mortality and obesity. International Journal of Obesity 1995; 19:supplement 4.
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