February 29, 2008

Skinny vs. Healthy - Warshaw's interview with www.diabetesmine.com

Skinny vs. Healthy

The following is the interview Amy Tenderich of diabetesmine.com, award winning blogger posted on 2/26/08

For some expert advice, I turned again to dietitian, diabetes educator and author Hope Warshaw, who's many nutrition titles include Eat Out, Eat Right and Guide to Healthy Fast Food Eating. I ought to mention that Hope is a very attractive and healthy lady, but not someone you'd describe as "skinny."

DiabetesMine (DM) How do you define "healthy"?

Hope Warshaw (HW): Weight is not the only indicator of health or longevity. Clearly genes play a role. Also nutrition -– how well you eat and nourish yourself -- plays a role as well. Interestingly there is research being done on and a group of people that believe that regularly restricting calorie intake below daily need can lead to a longer and healthier life. The jury is still out.

As a dietitian and diabetes educator, I believe that the window for healthy includes both maintaining a desirable weight and eating healthy. I feel strongly that there’s a big body of evidence that supports the Dietary Guidelines for Americans –- plenty of fruits and vegetables (note: for Type 1s - that fruit issue again!), whole grains, low fat dairy foods, light on the red meats and other protein sources, and light on the saturated and trans fats. No one needs to wait for more evidence to follow these healthy eating principles.

Another area that deserves mention is the discussion that Covert Bailey began a number of years ago: Fit or Fat? Research has been done in this area as well. Is the large muscular football player healthier at 250 pounds than the sedentary person at that weight? Likely so. Or is it OK to carry around a few extra pounds as long as you eat healthy and are physically active? Likely so.

DM) Can you elaborate on the "skinny is not synonymous with healthy" concept?

HW: To answer this requires considering both ends of the spectrum and the gamut in between –- from too thin to obese. It’s known that people who are too thin, possibly thinner than skinny (of their own choice or disease-related, such as anorexia or cancer) are often not healthy. On the other side of the spectrum, people who are obese (30% more than their desirable body weight) are often also not healthy. It’s well known that people who are obese have much greater incidence of many diseases. This includes the disease generating influence of insulin resistance (metabolic syndrome) which often begets high blood pressure, heart disease and last, but not least type 2 diabetes. Additionally being obese has been linked to certain cancers, orthopedic problems, sleep apnea and more.

There appears to be a window of desirable body weight – between too thin and overweight - that people should stay within to promote disease prevention and long term health. In terms of body mass index, the current favored tool to discuss a person or population’s weight to height relationship or body fatness, it’s ideal to be in the normal weight range, between 18.5 – 24.9. (note: calculate yours HERE).

Another measure of healthiness or not so that is gaining favor is waist circumference (WC). It is known that women who’s WC is more than 35 inches and men who’s WC is more than 40 inches, are at risk for the above mentioned insulin resistance syndrome and related diseases.

DM) For those who need to lose weight, is it wrong to focus on "thin" as a goal? Or how should they envision themselves trimming down?

HW: One needs to discuss this question from a weight loss and weight maintenance perspective. People who "go on diets" want to achieve their desired body weight -- "get back to my skinny weight or into my skinny jeans." For people who are significantly overweight and have been so for years, getting to the weight they were at when they were 18, 25 or whenever, is likely both not realistic and not necessary when it comes to their health. For example, it is well known looking at the pre-diabetes, type 2 diabetes and general weight control literature that losing 5-7% of body weight (what people did in the DPP) can help people lower blood glucose and blood pressure and improve lipids. Losing more weight may not be realistic or necessary. The bigger issue though is that it’s tough enough to maintain this small amount of weight loss. Any change in the less weight direction is good.