Dear Dr Garner,
I am having an argument with my daughter. She says that I don’t exercise enough. I say, look at me, I do not look obese, and probably am of normal weight.
What do you think? She reads the Tablet every week and will listen to your opinion.
Thanks for your help, and I really enjoy the “Ask the Doctor” TV show.
Exercise Averse in Elmhurst

Dear Exercise Averse,
Thank you for the nice comments. I was just talking to my good friend Stella Sumani about the topic of exercise and the importance of light weight training.
I hate to tell you this, but I agree with your daughter regarding this matter.
It is important for people to stay active, at any age. By active, I do not mean pumping iron in the gym, but merely walking instead of riding, doing housework, or climbing the stairs instead of using the elevator and adding light weight training .Being active has been shown to have benefit, not only for the body, but also for the mind. As a matter of fact, Sumo wrestlers (who are very obese)) are actually in good shape, due to their exercise and weight training schedule.
A study published last year by the Mayo Clinic, and updated recently describes a condition known as “normal weight obesity.” This term seems confusing and contradictory, but means that one can have a” normal weight” appearing body, and yet be at increased risk for things like heart disease. The scales may tell you that you are OK weight wise, but it is not an accurate depiction of what is occurring on the inside of the body.
The study found that about 30 million Americans have this condition, and even though they are not over- weight by the scale, that they have excess fat in their body which makes them at risk for fat related disease such as diabetes, and heart disease.
It seems that these people have a very high presence of fat, deep within their body, around the organs such as the kidneys and liver. Their muscle mass, or “lean mass” is low compared to the fat present. It is this ratio that is very important in determining one’s risk for heart disease, diabetes and high cholesterol and the other obesity related problems.
This study showed that losing weight was not enough in trying to improve one’s overall health. Aerobic exercise, such as walking, combined with moderate weight lifting and resistance training, is an integral part in maintaining heart health and building lean body mass.
We also know that the location of fat in the body is very important in determining how harmful it is to you. Fat around the hips and bottom is “good fat” and actually helps to protect you from heart disease and diabetes. Fat around the belly however is no good. In fact, if a woman has a waist circumference of more than 35 inches, or a man has a waist of more than 40 inches, then they will be at increased risk.
Therefore, merely measuring one’s weight is not enough. Waist size and muscle mass are much more important in calculating one’s risks.
Women with “normal weight obesity” have a two times increased risk for dying from heart and other obesity related problems. One’s risk is determined by the amount of fat buildup there is compared to lean muscle mass.
The amount of fat buildup in the body can be accurately noted by a CAT scan.
There are also machines available, which can accurately measure you, body fat mass and help guide you as to the type of exercise you might need. (Combination of walking and weight training).

One other study that recently was published may be of interest to you. It found that senior citizens being a little over-weight may be a good thing. There was a greater 10 year survival rate for older people who were moderately overweight, than those who were of normal weight. We are not yet sure why this happens, but I thought the result might be comforting to you. While I don’t condone being markedly obese, being a little overweight is something senior citizens might not have to worry so much about as long as they are exercising as I noted above.
All of this information shows how much we are learning about fat and obesity and how to stay healthy. It might be a little confusing but the take home messages should be as follows:
1. One cannot tell his or her risk from fat, merely by knowing his or her weight.
2. Fat buildup, in the body, which may not be visible to the eye, is a major determinate in risk for stroke, high cholesterol diabetes and heart attacks.
3. Not all fat is created equal- The fat around the hips and bottom (Jennifer Lopez, to give a visual assist) is considered healthy. This fat may actually help rid the body of bad fat.
4. One might want to rethink liposuction, in the area of the hips and bottom, as it may be removing “good fat.”
5. Being a little overweight as a senior citizen might actually help one to live longer. The reason is not well known.
6. Belt size may be the most important determinant for good health. For those women over 35 inches and men over 40 inches, there is a dramatic increased risk.
7. Exercise, such as walking and climbing steps is excellent for cardiovascular training, but should also include weight and resistance training. This increases the lean muscle mass and lowers risk for fat related disease.

I hope you listen to your daughter and develop an exercise program with the help of your doctor that includes walking as well as weight training. Good luck.

*Reprinted with permission of The Tablet.