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Can you be overweight and fit? A Q&A with Dr. Amber Cook

Dr. Amber Cook Photo courtesy of UT Health Northeast

Dr. Amber Cook photo courtesy of UT Health Northeast

We’re told to maintain a healthy body weight to reduce the risk of chronic disease. But is there a line or a threshold we shouldn’t cross regarding pounds on the scale? Is it different for black people?
Dr. Amber Cook, a physician at UT Health Northeast North – Tyler Clinic, explains how what you look like on the outside isn’t always an indicator for what’s going on inside.

Q: Can you be overweight and fit? How, or why not?
A: I think it is first helpful to clarify overweight versus obese. Overweight is technically defined as having a BMI (body mass index) of 25 to 29.9. Obese is classified as having a BMI of 30 or higher. It is possible to have a BMI higher than 24.9 and be fit. The BMI chart is a very loose classification of what is normal, in my personal opinion, but is a very useful tool in helping to gauge risk factors. However, there are people, especially ones with high musculature and physical fitness levels, whose weight exceeds normal for their height, but are physically fit. They may have normal body fat percentages and excellent physical condition, as well as stable blood testing, so we don’t adhere strictly to BMI in all cases when assessing risk due to multiple other factors playing a role in assessment of health and fitness. Additionally, having a normal BMI does not always equate with physical fitness or health.

Q: What is considered fit?
A: Fitness can be based on multiple factors, including flexibility, physical strength, lung capacity for exercise, as well as objective physical exam and lab tests. When I assess patients for level of health, I typically assess their blood sugar levels, blood pressure, cardiopulmonary exam, cholesterol levels, as well as their diet and exercise habits. A person may subjectively assess their physical fitness as well by determining how quickly they can complete a mile run compared to their peers or to their timing several weeks prior, how many push-ups or pull ups they can do, etc. Fitness assessment has varying degrees, and depends on the person’s age, gender, past medical history, among other factors. Someone being physically fit to serve in the army or play in the NFL may have a much higher requirement for meeting certain fitness thresholds than persons simply desiring to prevent or manage lifestyle illnesses.

Q: Reports show African-Americans have a high obesity rate, according to BMI. Is there a caveat here, considering body types and muscle mass? For example, being heavy on the bottom with a small waist?
A: BMI is not always the most accurate and helpful assessment in determining fitness. As stated before, fitness and health are based on multiple factors, and African-Americans have been known to have higher BMI levels with stable physical health and fitness, though this isn’t all-inclusive. The African-American population unfortunately still has high rates of lifestyle diseases such as diabetes, hypertension and aggressive cancers, and weight management through improvement in lifestyle choices can help this. It doesn’t indicate a specific need to reach a certain weight number, but it is important to recognize that although higher BMI doesn’t always indicate worse health in Blacks, we are still at significant risk, and making lifestyle changes to prevent that can lead to health benefits at any weight.

Q: Having a “little meat on the bones” may be acceptable in some cultures. When teaching healthy habits, is there push back? Are there specific things you recommend to ensure patients are both healthy and comfortable with their body image?
A: I encourage my patients that when we discuss weight, it has nothing to do with how I or others should perceive their external appearance. The goal in weight loss and improving health through dietary changes and increased physical fitness is to see the blood numbers and risk factors improve so they can enjoy more years with their family and friends, and less co-morbid illness and early death due to preventable diseases. When things are addressed in positive ways that help patients see the benefits more than what they are giving up, they typically are willing to put in effort to see progress.


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