Apples & Oranges

I was talking with a group of people the other day and one of them brought up the fact that his doctor told him that he had obesity – but that the doctor had to be wrong because he exercised 4-5 times per week and lifted weights. This brought nods of agreement from several other people involved in the conversation and we started talking about the definition of obesity – which is simply the presence of excess adipose tissue – and how you make that diagnosis. If you are a patient in my office, you know that we look at a lot more than simply weight and BMI – we measure body fat percentage and waist circumference every single month. We usually spend more time talking about fat mass loss than actual weight loss – because losing fat mass (and not lean mass) is how we improve obesity.

However, that conversation has stuck in my head and I have returned to it several times since then. There’s more to that gentleman’s original statement. His assumption was that he could not be both a regular exerciser AND someone with obesity. That being classified as one of those things automatically excluded him from the other one. I will tell you that without a doubt, those two things can exist simultaneously.

When I was in my teens and twenties I was both a distance runner (off and on) and a smoker. Apples and oranges. Now I probably could have been a better runner if I wasn’t a smoker back then – but I was still able to be both things at the same time.

I know people that are great parents but lousy spouses. People that are driven and determined during the work week and couch potatoes on the weekends. I know many people that have obesity and exercise regularly. Apples and oranges.

The idea that obesity is a result of eating too much and moving too little has done so much damage to the way we approach the treatment of excess weight. So many people still approach this disease as a disease of sloth and gluttony – of personal weakness.

We can be many things at once. We have to stop shoving ourselves into identity boxes and accept that health isn’t an all-or-none phenomenon. We can struggle with excess weight and still be fit and strong. We can eat really well but manage our stress poorly. We can love vegetables and still love margaritas. Wellness isn’t an absolute identity – and it means different things to different people.

Keep thinking and reflecting and growing…

Courtney Younglove, M.D.