Lose Weight or Eat Well?

Picking one over the other happens more often than you think

Obesity and a poor diet are both established risk factors for a long list of chronic diseases and for early death. Obviously, it’s recommended to maintain a normal body weight and to eat a healthy diet. 

But if you had to choose one over the other, which is more important?

Here’s why the question is relevant: Losing weight and keeping that weight off are a very difficult task, one that only ten percent of dieters manage to stick to long-term, no matter how strong their will power. Does a healthy diet compensate for the adverse effects of the extra weight? 

And here’s the other reason why this question is pertinent: People often dismiss advice to improve diet quality since they think that their normal weight status protects them from heart disease and other ailments. They believe that unhealthy diets increase risk only through obesity. Is an unhealthy diet indeed compensated for if you’re sufficiently thin?

To address this question, a new study in PLOS Medicine looked at the longevity of a large cohort of about 80,000 representative Swedish people, aged 45-83 years, for a mean of 17 years. The participants’ diet was scored against a modified Mediterranean diet, which looks at eight components: fruit and vegetables, legumes (such as peas, lentils and beans) nuts, unrefined or high-fiber grains (such as whole-wheat bread, oatmeal), fermented dairy products (such as yogurt, and cheese), fish, red and processed meat, olive or rapeseed oil, and alcohol intake.

Thin isn’t everything

And the results: People with obesity, who adhered to a Mediterranean diet, did not have a higher overall mortality rate usually associated with a high BMI. On the other hand, a normal BMI did not protect those eating lower on the Mediterranean-like diet from early death.

The authors claim that theirs is the first study to look at the combined effect of BMI and Mediterranean-like diet on mortality rates. The correlation between obesity and premature death was, however, shown in other studies, and the link between a Mediterranean style eating pattern and good health and longevity is also quite established.

The author’s conclusion: “Obese individuals adhering to a Mediterranean diet did not have an increased mortality in comparison to more lean individuals. In contrast, a lean BMI did not offset a poor diet.”

Obesity rates in the US are sky high – 40 percent of adults and almost a fifth of our kids are obese. For the sake of weight loss, people often select foods they know do not promote health – low-calorie highly-processed foods and drinks for instance. This may not be a wise choice.

Improving diet quality should be a more achievable and worthy goal, even as we also try to reverse our worrying obesity rates.

So rather than obsessing over the number on the scale, first focus on what you eat and how you feel. A healthy diet is an independent factor – much like exercise – that protects at any weight level, while an unhealthy one ads to your risk even if you’re not overweight.

Dr. Ayala