A common misconception in our society is that bigger people are unhealthy. This view stems from the assumption that big-boned or heavy people must have one or more undesirable health risks, such as high blood pressure, high cholesterol or poor lipid profiles.

This widespread belief is the result of over-simplifying a very complex problem. There is no doubt that high blood pressure, high cholesterol and poor lipid profiles are unhealthy and result in higher incidences of disease and death. But here's the million-dollar question: Is excess weight the cause of these disorders, or are they both consequences of the way we choose to live our life?

If the former is true, the only path to becoming healthy is to achieve "normal weight"; the latter suggests that you can be healthy at almost any size.

This debate has raged for years, with experts divided over the issue. Increasingly, the overwhelming body of evidence supports the conclusion that people of any size can be healthy.

What we think we know
Most people assume that losing weight will increases their chances of living long and healthy lives. This view has driven the weight-loss and fitness industries for years, resulting in fad diets, "magic" pills and sales of bogus exercise machines aimed at consumers who are desperate to lose weight‹and willing to spend hundreds or thousands of dollars to do it. A critical look at the data on which we base this belief, however, reveals that while losing weight may be important, weight loss does not necessarily make us healthier.

Let me explain. The theory that excess weight results in ill health and early death is based primarily on studies that analyze mortality rates of different groups of people. Most of these studies are based on questionnaires sent out to a random sample of people who record their height, weight and a variety of lifestyle variables, such as whether or not they smoke. The information is then used to calculate each person's Body Mass Index (BMI) and subsequent categorization as normal, overweight or obese. Researchers track these participants over several years, noting the date of death or disease onset for each person. Based on this data, they come up with a relative risk (RR) for people in each BMI category, which represents their increased chance of death or disease in comparison with those in the healthiest category.

The main problem with these studies is that they are based on the assumption that people with higher BMIs have more body fat, which may not necessarily be true. Some big people have very little body fat, but their large bones and high muscle content puts them in a higher BMI category. And even if we assume that the BMI scale gives us an accurate measure of body fat content, we must still determine if the fat is truly the cause of disease and death.

Can you be big and still be healthy?
In order to know if bigger people—especially those with a higher percentage of body fat—are at a higher risk of disease and death, we need to weed through some confusing issues.

Numerous studies performed in the past five years have confirmed the obvious: there is a correlation between lifestyle and body weight. In other words, bigger people tend to have a less healthy diet and fail to exercise regularly. This means that the higher incidence of disease and death could be the result of a person's lifestyle rather than his body type. Research that puts the blame on weight often fails to account for the way people choose to live their lives, which may be the most important health issue of all. Fortunately, more precise studies have categorized people based on their fitness level and amount of exercise in addition to the common height and weight classification. When these variables are taken into consideration, the results shed new light on the issue.

Studies that took fitness levels into account found that being active is more important than being lean. For example, one such study classified people into categories based on fitness (unfit, moderately fit, highly fit) and weight (underweight, normal weight, overweight, obese). They found that "unfit" people in the "normal weight" category were less healthy and had higher mortality rates than "moderately fit" people in the "obese" category.

Another study looked only at obese women, defined in this case as those with a BMI over 35, who did not exercise regularly and who were considered to be unfit. Almost all of these women had unhealthy metabolic parameters such as high blood pressure and high cholesterol. Researchers found that the women who became at least "moderately fit" after several weeks also became significantly healthier. In fact, their metabolic parameters reached normal levels. Here's the kicker — every one of these women were still considered "obese!"

What does this all mean to you?
The take-home message here is that a person's weight cannot be used to estimate how healthy she is. Everyone has a different body type and healthy people come in all shapes and sizes. It is important to recognize that the positive benefits of becoming active are not dependent on weight loss. Of course, the benefits increase when they are accompanied by modest weight loss, but losing weight should be a result of, not the focus of our efforts.

Simple lifestyle changes can make a huge difference in your health and happiness. Selecting healthy foods, increasing your activity level by walking, jogging, biking or swimming several times a week, joining an exercise class, or simply taking the stairs instead of the elevator can make a tremendous difference. Don't be discouraged if you exercise often and lead a healthy life, but can't seem to shed the pounds. Your life and your health are improving in ways that cannot be measured on a scale.

Bryan Owen has a Master's degree in exercise physiology and is the manager of technology and fitness at Built2XL, Inc., a Web site targeting plus-sized, muscular, big-boned and very tall people. Scheduled to launch in October 2000, Built2XL is committed to motivating and empowering big people everywhere to achieve their personal fitness, sports and wellness goals. By helping big people thrive, we hope to empower them to live each day to its fullest potential and to always Dream Big.