Fit at Any Size

By Kathleen Kingsbury

Nikki Blonsky is exactly the role model most parents dream of for their kids. She's happy, she's successful, she's overcome obstacles--no wonder her young fans adore her. She's also overweight--by some measures very overweight--in a culture that fetishizes thin.

There was a time when that alone would have been enough to keep the 19-year-old star of the movie Hairspray out of the fan magazines and off the posters decorating grade-schoolers' bedroom walls. But that time may at last be ending. The national obesity epidemic did not happen in a vacuum. It occurred in an era in which fashion models have got thinner and thinner, the tolerance for even a little flab has grown lower and lower, and the rates of eating disorders like anorexia have climbed higher and higher. In that environment, children and adolescents trying to develop a healthy--and realistic--body image have almost no chance at all.

Now they might. Plus-size celebs like Blonsky--or, for that matter, her Hairspray co-stars John Travolta (albeit in a latex fat suit) and Queen Latifah--are increasingly spreading the message that svelte is not the last word in happy. Fit means happy too; so does staying active; so does loving your body no matter its shape. The key is to get that body healthy and keep it that way. The numbers on the scale--pediatricians, nutritionists and psychologists now argue--should start to come second to physical fitness as a gauge for health. After all, says Kelly Brownell, director of Yale University's Rudd Center for Food Policy & Obesity: "If your child experiences shortness of breath walking upstairs, it's problematic whether he's fat or skinny."

More important, at least when it comes to selling that idea to kids, are the other dividends good health pays. "Staying fit gives me the energy to make movies," Blonsky says. "In school, I always made sure to try new sports and was a quick runner. It made me strong against the people trying to hold me back." Not all doctors agree that it's possible to be overweight and fit--or at least, as fit as kids should be--and in that lies a debate. But everyone agrees that the shape so many kids find themselves in today--obese, sedentary and manifestly unfit--is a dangerous one. Changing things even a little makes a lot of children not only happier but a great deal healthier.

Behind the push to get kids fit is the growing recognition that, in many cases, there's just no fighting the natural rhythms or shape of a child's body. Throughout childhood and adolescence, hormones may cause weight to fluctuate dramatically. Plus, nature determines whether we're all going to be stocky, a beanpole or something in between before we're even born. "Most body weights and types for children and adults are genetically determined," says Glenn Gaesser, a professor of exercise physiology at the University of Virginia. "There are a lot of kids who are just naturally heavier than their peers but may be even healthier."

Milwaukee Brewers first baseman Prince Fielder is a good example. He has athletic talents very few people have, but the professional slugger has weighed in at more than 200 lb. since age 12. Scouts frequently labeled the teenage Fielder too heavy to have big-league potential. But, like his father Cecil, another generously proportioned major leaguer, he's proved them all wrong. Now 24, Prince plays with about 270 lb. packed on to his 5-ft. 11-in. frame, but he also led the National League with 50 home runs last year and earned a start at first base in the 2007 All-Star Game. "Prince knows his body type," Brewers manager Ned Yost told reporters in April. "He's on that [stationary] bike and on that treadmill and on that elliptical trainer, making sure he does everything he can to maintain his fitness."

A similar refocusing on fitness over fashion pages can pay other dividends for kids. Difficult as it is to hear that your child is overweight, placing a child on an enforced diet may do more long-term harm than good. Doctors have yet to find a weight-loss program that has proved universally effective and safe, especially for children. More often, dieters will lose weight in the short run only to regain it. Research suggests that the yo-yo cycle can lead to loss in bone density and lean muscle mass, organs and bones, jeopardizing overall health. In fact, at least 15 major studies have shown higher death rates for adults after yo-yo weight cycling. "Research consistently links repeat dieting to increased weights instead of lower ones," says Frances Berg, a nutritionist and author of the book Underage and Overweight. Meanwhile, Berg adds, "Children can suffer nutrient deficiencies, immune suppression and dangerous stress levels."

It's as a result of that stress that the problem of eating disorders can arise. As many as 10 million women and 1 million men in the U.S. suffer from an eating disorder, according to the National Eating Disorder Association (NEDA). Nearly 90% of those afflicted are under the age of 20, and females between the ages of 15 and 24 are 12 times as likely to die from anorexia as any one other cause of death. A 2005 study published in the journal Pediatrics determined that of 10,000 teens surveyed, less than half of the males and about a third of the females were happy with their bodies. "Parents face a complicated situation," Brownell says. "They have to promote healthy weight, but they also don't want to change children into diet-crazed fanatics."

Yet if parents are confused, so are physicians and medical researchers. There's little doubt that being obese puts inactive youngsters at a higher risk for several health conditions, including Type 2 diabetes, high blood pressure and heart disease. But almost no studies have been done evaluating the pros and cons of kids being fat yet active. Plus, reports on adults in similar situations have conflicted. Since the 1970s, doctors at the nonprofit Cooper Institute in Dallas have gathered data from more than 100,000 patients who have been weighed, measured and made to run on treadmills while their vital signs are monitored. "We've long concluded that people who are overweight and active can be healthier than those who are thin but sedentary," says Dr. Kenneth Cooper, the institute's director. "There's no reason to believe that conclusion doesn't apply to our children too."

But can overweight kids stay healthy with exercise alone as they age? The jury's still out. For adults, Cooper's theory has recently been challenged. A Harvard-affiliated study released in April showed that being active can lower but does not eliminate heart risks faced by heavy women. Assessing nearly 39,000 middle-aged women over a period of 11 years, researchers determined that the odds for developing heart disease were 54% higher in overweight active women and 87% higher in obese active women compared with normal-weight active women. Women who were normal weight but inactive faced only an 8% increase in risk. "If you're overweight or obese, you can't really get back to that lower risk entirely with physical activity alone," says lead author Dr. Amy Weinstein of Boston's Beth Israel Deaconess Medical Center.

Doctors do know that obese kids nearly always bloom into obese adults. CDC epidemiologist David Freedman evaluated 30-plus years of data and found that of the children who technically qualified as obese, two-thirds grew up to be very obese adults. "Even down to the youngest ages that I've worked with, age 5, overweight kids have maybe a tenfold increased risk of becoming obese adults," Freedman says.

A report, published last year in the New England Journal of Medicine, went further, comparing the medical records of 276,835 Danish citizens born between 1930 and 1976. In that data, scientists found a direct and linear correlation between a higher childhood weight and a greater chance of future heart disease. "Our study shows that even a few excess pounds can damage future health," says co-author Dr. Jennifer Baker of the Center for Health and Society at the Institute of Preventive Medicine in Copenhagen.

Amid all this back-and-forth, however, there is one point that everyone agrees on: exercise definitely improves a child's overall sense of well-being. Cooper, who invented aerobics a generation ago, has been testing the physical fitness of schoolchildren over the past decade and has consistently found that active kids do better academically, have fewer disciplinary issues and maintain better medical histories. "A child doesn't need to be a star athlete or a long-distance runner," Cooper says. "Even taking the stairs instead of an elevator has positive effects."

Parents leading by example will do the most to persuade kids to stop obsessing over weight and start getting fit. "Exercise has to stop being a daily chore," says Dana Schuster, president of the Association for Size Diversity and Health. "Make it about playing and fun again."

Actress KayCee Stroh, a by no means slender star of Disney's hit High School Musical, knows all about that. After gaining nearly 50 lb. following knee surgery, she could not lose the weight with exercise alone. So she turned to a longtime love, dancing. "Riding the elliptical just couldn't motivate me enough," she says. "Dancing was a way to trick myself into being active." Shortly after, Stroh answered a casting call for High School Musical, scoring her part over dozens of other actors. "I am not a size 2, never will be," she says. "I can just be me, and that confidence lets me stand out to directors."

For generations of chubby kids getting teased in school hallways, standing out was something very much to be avoided--at least, if it was because of their size. The idea that size can be not only a liability but also an asset is a true paradigm shift. Says Jennifer Berger, executive director of About Face, a San Francisco--based nonprofit that promotes size acceptance: "The word health has been made to mean skinny, and that has to change." That's especially so since the word happy was too often defined the same way. Blonsky herself admits middle-school classmates' heckling made her dislike her figure. Until, that is, she realized, "I could always keep up with the thin girls, anyway." Actually, she seems to have passed them by.

With reporting by With Reporting by Tiffany Sharples/New York