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Fitness, not fatness, is key to health
by Cara Hetland, Minnesota Public Radio
June 2, 2003

A 30-minute walk every day is enough activity to increase almost everyone's health, even if they don't lose much weight. (MPR Photo/Cara Hetland)

Research shows interesting new correlations between exercise and health. Even obese people who exercise are healthier than thin people who don't. A leading researcher on obesity says you don't have to lose weight to be healthy -- you just have to walk. People who exercise -- no matter what their weight -- have half the death rate of those who just sit around. Increasing your life span could be as simple as walking 30 minutes each day.

Sioux Falls, S.D. — There are so many diets it's hard to keep them all straight. Are carbohydrates good or bad? Is meat a healthy choice? Should you eat more fruits and vegetables? And what about fat -- there's good fat and bad fat and calories from fat. What's the right balance?

Dr. E.W. Filler is the only doctor in Sioux Falls who specializes in bariatric medicine. Bariatrics is a medical specialty that deals with the diagnosis, treatment and management of obesity and weight-related health problems. He knows even the most motivated patients are confused about what's best for them. "There's a lot of information out in the public. Do this, do that kind of a thing. A lot of controversy," says Dr. Filler. "Nobody seems to really know for sure what needs to be done. It's a lot like the weather. We all talk about it, but no one can really do much about it."

Filler says everyone needs to lose weight their own way. Some people just need to change their diet. Others need to change their lifestyle completely.

	Jovette Van Horn

People come to the bariatric clinic with high blood pressure, heart disease, diabetes -- diseases that kill.

But a recent study concludes fitness, not fatness, is the issue. The study followed the mortality rate of 25,000 men over 19 years. Participants filled out a lifestyle questionnaire and took an exercise test on a treadmill. They ranged from very fit, to couch potatoes.

Surprisingly, mortality rates for the men had more to do with whether they exercised, not how much they weighed. Death rates were lower even for overweight men, if they exercised. The study's basic conclusion is that you live longer if you're active.

The College of Sports Medicine recommends 30 minutes of moderate activity most days of the week. Dr. E.W. Filler says that's not something most of his patients can do. He says it's a good goal, but it takes time for some people to do much more than step onto a treadmill -- let alone walk on one. He has patients whose daily exercise routine is to step onto the treadmill, and step off it.

"That's their whole exercise regimen, and they have to do that once a day. And they can't hardly do that, because they have so much knee pain or joint pain or something else, and they can't hardly tolerate more than that," says Filler.

	Before and after

"It's a bit of an extreme example, but that's just an example of how deconditioned our society has really become," Filler says. "So for me to tell that individual to go out and walk 30 minutes is ludicrous. There's no way that person can be able to do that. Yet."

Filler says it should be a goal for everyone, but they have to have realistic expectations or they'll stop trying at all.

Jovette Van Horn was a normal active teen, and was never really overweight. When she went to college she put on the "freshman 15," and then some. Late-night pizzas were the norm. Van Horn continued to gain weight. She tried every diet, every program, and after a few weeks or months she would go back to her old habits.

A year ago, Van Horn went to the bariatric clinic. She realized it was time to lose weight. Her goal was to lose 200 pounds.

"Before I started the program I had borderline high blood pressure. I was sort of what I would call pre-diabetic. I had high blood sugars," says Van Horn. "I couldn't walk from my car into the building without becoming short of breath," says Van Horn.

	Dr. E.W. Filler, bariatric specialist

Van Horn learned she needed more fruits and vegetables in her diet. She needed to exercise. She started walking and swimming. In the year since she started to exercise she's lost 85 pounds.

"My blood pressure is down to darn near perfect when they take it. I don't have trouble with high blood sugars anymore. I can walk. I can take a flight of stairs without becoming short of breath," says Van Horn. "I've really seen the difference in both losing weight and increasing activity."

Van Horn is still considered medically obese -- but she's healthy. She knows if she keeps doing what she's doing, she'll lose another 75 pounds. What's different this time is her attitude. Losing weight is about health now. Watching her blood pressure come down was more important than the numbers on the scale. She has a different motivation at the bariatric clinic than she had with other weight loss programs.

"You're actually battling the scale. You hate the scale. Their whole attitude over there is -- it's not about the scale, it's what changes in your blood level, what changes in your heart rate, what changes in your blood pressure. You look at the whole picture rather than the scale," says Van Horn.

"I tell people, 'Put your scale in the garage sale,'" says exercise specialist Jan Thilges.

Thilges tells people to weigh themselves only once or twice a month. She says it's more important to judge weight by how your clothes fit and how you feel.

	'Put your scale in the garage sale'

"Look at things like -- are you sleeping better at night. Do you have more energy to mow your lawn or play with your kids. Can you open that jar of mayonnaise without struggling with it. Can you climb three flights of stairs at work without being winded. Can you do daily activities without being challenged with them," says Thilges.

Thilges says exercise is the answer to wellness. She says people have to realize they can't always control their body shape, but they can control what they do with it and what kind of food they put into it.

Jovette Van Horn adds it's important to take it slow. She keeps her tennis shoes by her desk, and walks stairs and the skywalk system at work. She used to take a break by having a snack. Now she walks, and has more energy because of it. Her desk is lined with pictures. Shots of her family are on one side. On the other are framed pictures of her over the last year.

"I just kind of keep them as a reminder of where I've been, and it shows me where I am not, too," says Van Horn. "I don't get that mindset of, 'Oh, I've got so far to go,' it's, 'Here is where I have been and where am I now."

For Van Horn, fitness is about being healthy. Losing weight is just a bonus. She says she wants to be thin by society's standards, but this time she's exercising for the right reasons.

Exercise specialists say people who don't need to work at being thin, still need to get off the couch. They could be unhealthy and not even know it.

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