By focusing on weight, we may be missing the broader picture of what it means to be healthy.

Brian Mattson is not the picture of health. Few would look at him and say: “There’s a healthy fellow.” But that’s a shame, because Mattson is a pretty healthy guy. In fact, by a number of measures, he’s healthier than most Americans.

Mattson walks every day, on average exceeding the CDC recommendations for daily aerobic physical activity. Less than half (48%) of Americans meet this benchmark. Mattson also eats about three servings of fruits and vegetables every day. Estimates of the average American fruit and vegetable consumption range from one and a half, to three servings a day. The target should be 5 to 13 servings, or at least “half your plate” according to latest USDA dietary guidelines.

Sure, Mattson is the first to admit it’s not perfect, but compared to his situation five years ago, he’s doing quite well, and the changes he’s made in his life have become habits that he’s been able to maintain over years.

Brian took his first steps towards healthier living in 2009, when the wellness organization Blue Zones initiated a pilot project in his home town of Albert Lea, Minnesota. As part of the program he took a life expectancy assessment, the results of which had him on the road to dying young--in his 50s. This wake up call got him walking every day and eating more vegetables. The walking group he joined also got him out into the community, interacting with people, and even resuming his involvement in the local theater. These simple things extended his estimated life expectancy by 20 years. He didn’t start a restrictive diet. He didn’t join his local gym’s extreme weight loss challenge. And that’s probably a good thing, because the weight-loss industry has yielded poor results.

Mattson told me on the phone that since we met last year, he’s lost 20 pounds, averaging a pound of weight loss per month. Not because he was trying to lose weight, but merely as a side effect of the healthy habits he developed. The habits were encouraged by changes instituted in Albert Lea as part of Blue Zones’ efforts to emulate the healthiest and happiest communities in the world. The book The Blue Zones, points out that dieting and exercise are not common in these long-living communities. I asked author and Blue Zones CEO Dan Buettner why weight loss was not a primary focus of his organization’s efforts:

“To see your weight go down isn’t an answer for a happy life. People we’ve seen in the Blue Zones not only live a long time, but they’re also in the top quintile of the happiest places in the world. It turns out most of what makes us feel truly genuinely happy is also good for our health. I’d just as soon lead with quality of life and leave the weight-loss as a happy byproduct.

Sure, Albert Lea collectively shaved about two tons [of body weight] among the [participants], but that’s not what we set out to do. We set out to get them more connected socially, to change their environment to make walking easier, and to make fruits and vegetables more available, and eating them more socially acceptable and a common part of daily life.”

I asked Brian Mattson how he thinks things would have turned out if he had started with a weight loss goal, rather than his modest eating and walking goals.

“I don’t think I would have done it.” He said. “It’s the same as the 10 or 12 other times in my life I’d tried to lose weight. I’d last about a week and a half and then give up and gain it all back. Now I’m taking small things each time, and I’m not killing myself doing it. A pound a month doesn’t seem like much, but it’s a consistent pound a month.”

A meta-analysis published late last year suggested that obesity in and of itself is a risk factor for heart attacks and early death. The ensuing media coverage shouted “you can’t be fit and fat!” Another study published this January seemed to respond: “yes you can!”

In light of this, a brief thought experiment:

Assuming the you-can’t-be-fat-and-fit study is accurate (it didn’t actually take into account fitness among other issues), the risk for cardiovascular events and/or death was 24% higher in metabolically healthy overweight folks compared to metabolically healthy normal weight folks.

Compare that with a 2003 Danish cohort study that found a 29% reduction in risk of death from adopting regular moderate physical activity, and another more recent cohort study describing a 53% higher mortality rate among non-fruit and vegetable eaters, versus those getting their 5-a-day.

Why do we obsessively focus on a very-hard-to-affect risk factor (body weight) that yields no better results than easier-to-adopt habits, that provide clear health benefits? If you were an inactive person who eats a poor diet and suffers from obesity and were presented with these numbers, knowing that dieting and sustained weight-loss are very difficult and usually unsuccessful, what would you do?

Everywhere we go, from the mouths of our peers, on every magazine rack, Internet ad, and weight-loss reality show, we get the message: you need to lose weight. You are too fat. Maybe it’s time to retire this line of thinking. Maybe it’s time to go for a walk, or eat some asparagus, just because those are good, pleasurable things to do, and will make our lives better, whatever our weight.

Brian Mattson’s story should help us rethink what health looks like. If we decide that health looks like chiseled abs, toned arms and yoga pants, we’re leaving a lot of people behind. When our health ideal comes in the form of a cover model on Shape, no one will ever be healthy, and if we can’t be healthy, what’s the point? It’s a recipe for defeat.

I’ve heard it rightly argued that we should refrain from judging someone's health based on appearance. For all we know, that overweight woman we see on the street might be exercising every day, eating better and may have already lost a lot of weight, and just “isn’t there yet.” I would take it further and argue that if those habits are now a part of her life, she’s already made it.

If we were to shift the conversation towards a culture of health--one that values healthy eating and regular physical activity as ends unto themselves, we may be happily surprised to find that not only are we living longer, happier lives, with less disease and fewer health costs, but also, we may need to drop a collective pant size or two. Or not. Either way, we're better off.

Post Script:

This reads as if health outcomes were entirely dependent upon what individuals consciously choose or choose not to do. Most of the literature indicates that a vast number of complex environmental factors have far more to do with our health outcomes than our personal choices. However, the choices we make certainly come into play, and this post explores a new way to approach those choices and how we talk about them.

Photos courtesy of the Rudd Center for Food Policy & Obesity.