Diet Face-Off: Dr. Abby vs. Dr. South Beach

Blog posted originally on diet.com - 5/4/09

Is it possible to be both fat and fit? It's a question that's been near and dear to me for many years now. I believe that YES... you can be "fat" and still fit.

I recently sat down with a respected diet expert -- Dr. Arthur Agatston, creator of The South Beach Diet -- to get his opinions on this important matter.

Does Dr. Agatston, aka "Dr. South Beach" believe that people can be fat and fit, or does he believe that fat people need to lose weight in order to be healthy? His answers to my probing questions may surprise you.

Check out Part 1 of this exclusive interview with the South Beach Diet Doc:

Dr. Abby: Dr. Agatston, you have used the term "fat and fit." Could you please elaborate on how that's possible?

Dr. Agatston: Yes, actually the term is from Dr. Steven Blair from the Cooper Clinic originally. It's the idea that some people who are a little pudgy or overweight, or have a high BMI, can be in good shape. They have a low risk for coronary disease. In my practice we see, for instance, overweight women with blood chemistries of a vegetarian marathoner! Instead of high triglycerides and low HDL (good cholesterol), they have low triglycerides and very high HDLs. They're really at low risk. The flip side is what's been coined at the Mayo clinic as "normal weight obesity," where people have normal BMI's but have little bowling balls in their bellies, and are at high risk.

Dr. Abby: I agree! I have certainly found that people can be fit and fat in my practice. It has been frustrating for them and frustrating for me to help them to accept their bodies, which they see as not thin enough. How might one identify their ideal weight?

Dr. Agatston: I go patient by patient looking at their "lifestyle numbers," including triglycerides, HDL, insulin resistance and blood pressure. If they're not having exaggerated swings in blood sugar, then they lose cravings and are satisfied with food. I really go by the physiologic risk factors, rather than by BMI's or weight tables. There are some pretty extreme cases. One woman I discuss has always been "roly poly." She doesn't have cravings, and doesn't eat a lot. She's been on a diet and lost a little bit, but has an HDL of 80 and triglycerides in the 50s. She's just not at high risk. She has something that people don't understand in general; I'll say a low metabolism.

Dr. Abby: I agree that we need to get away from an ideal weight or BMI. It’s more about those lifestyle measures. Thank you so much for sharing your thoughts on this important matter.

Commentary: I am thrilled to hear the South Beach diet doc acknowledge that it’s all about living the healthiest life you can, without regard for weight. We must accept whatever size our body becomes… with grace and dignity. I call it our personal best!

However, the hard part is accepting the body size that results from living a relatively healthy lifestyle. We will probably think it looks too fat, since very few people are naturally thin.

Natural body weights are very diverse, yet we have been taught that fat people are ugly, unattractive, and worth less than thin people. You may believe this yourself, and beat yourself up for being what is considered overweight, unhealthy and unattractive.

This begins a very unhealthy cycle, which drains self-esteem, erodes confidence and diminishes self worth. This deteriorates the desire and ability to take good care of yourself and stand proud.

A more complete version of this interview will be found in my next book, Dr. Abby’s Diet Revolution! This is a small excerpt from a rather extensive interview. To obtain a copy of the complete interview when it becomes available, please click here to sign up, and receive a free PDF of my current book, Your Final Diet.

Please check back soon for the next installment of the "Dr. Abby vs. Dr. South Beach" interview.

NOTE: Some editorial license was used to edit Dr. Agatston’s lengthy answers to my questions. Every effort was made to preserve the integrity of content.

GET A FREE COPY OF THE SOUTH BEACH DIET SUPERCHARGED! Dr. Agatston has graciously provided copies of his bestselling book, now out in paperback. To get your free copy of this insightful and enlightening book, simply become a Diet.com Premium Member today. Be sure to use Coupon Code FREEOFFER66 when completing your enrollment.

Dr. Abby Aronowitz is a psychologist, speaker and coach, who completed work at Columbia University. She holds two master’s degrees and a Ph.D. Previously a consultant to Weight Watchers International, Dr. Abby has been featured on WebMD.com and AOL Diet and Fitness. She is a member of the American Psychological Association and Mensa.

Dr. Abby Aronowitz
Your Final Diet