The overweight debate: Healthy and heavy?

Waist measurement: For women, a waistline of 35 inches or larger is a risk factor for heart disease, no matter how much you weigh or how trim your arms and legs are. And a measurement of 31.5 inches or more indicates an elevated risk of some cancers.

Fitness: Walking briskly for 30 minutes, five days a week, is enough to protect you from disease, no dieting required. "Fitness is achievable, and may do more to improve health than simply losing weight," says Steven Blair, PED, a professor of exercise science at the University of South Carolina and a leading expert on the benefits of exercise among the overweight. In fact, a recent study from the university tracked 2,600 people age 60 and older for a 12-year period, and found that fit overweight people outlive unfit normal-weight people. (Score one for me!) However, if you're overweight and it hurts just to walk up and down stairs, weight loss may be called for; obese women are 4 times more likely to develop knee osteoarthritis than normal-weight women.

Cholesterol and inflammation: A total cholesterol level of 200 mg/dL or more, an HDL reading of less than 40 mg/dL, or triglyceride levels above 150 mg all point to trouble. Being overweight tends to increase cholesterol, and losing weight can help lower total and LDL levels, while raising HDL levels, according to the National Heart, Lung, and Blood Institute. (So can increasing your daily activity if you're sedentary.)

Many experts feel that your rate of systemic inflammation, as defined by the results of a C-reactive protein (CRP) test, is an even stronger indicator of heart disease risk. Being overweight raises your risk of inflammation.

Weighing my options
When I returned home, I did indeed follow up with my doctor. We discussed all of this — my high BMI, cholesterol, low blood pressure, fitness level, and CRP score — and then he calculated my Framingham Risk Score, a measure widely used to assess a 10-year risk of heart attacks. (You can take an online version of this test at prevention.com/links.) Thanks to no smoking, my family history, a good diet, and an active lifestyle, my risk level came up as "very low" at 1 percent. Together, we decided that I could stay, er, voluptuous and still expect to live a reasonably long and healthy life.

I should have felt vindicated, but instead I felt like a quitter. Truth was, I hated that my knees hurt after a walk and that I dreaded bathing suit season. And so I decided to slim down anyway but resolved to go about it as sensibly as I knew how, to follow the most proven weight loss principles available.

First, I dropped my fantasy goal of 130 (last seen before getting pregnant with my now college-bound daughter). Instead, I aimed low — 5 percent of my body weight, or 7 to 8 pounds. (Experts advise shooting for no more than 10 percent at a time.) If you're overweight and have numerous risk factors for chronic disease, even a loss this small can offer some protection. Bigger goals — say, fitting into your wedding dress again — may set you up for regain.

I resolved to lose no more than a pound a week, and not to panic if I lost as little as a pound every 10 days. Researchers are adamant that the changes that bring about small losses — walking 15 minutes more a day, or using fat-free milk instead of cream in coffee — are more likely to become lasting ones. I didn't exactly ban foods like butter, cheese, ice cream, and bacon, but I cut back — switching to reduced-fat alternatives and smaller portions. I also intensified my exercise to at least an hour most days, which is what the U.S. Dietary Guidelines recommend for weight loss. I woke up earlier, dug out my heart-rate monitor, and added jogging intervals to my walking routine. On weekends, I didn't do yoga or go on a hike; I did both.

Is weight loss worth it?
I'm proud to say I lost 7 pounds in 4 months, and I'm fitter and stronger. My back and knees feel better; my cholesterol is a bit lower. Maintenance, though, is a daily struggle, and as the scale number rises and falls, so does my mood. I recalculated my Framingham Risk Score with my new weight — still the same 1 percent risk. Just for fun, I keyed in my dream weight of 130. Maddeningly, no change.

Still, I realized something. Even if it wasn't about my heart health or my "relative risk of mortality," it simply feels good to weigh less. I'm happy I can walk my dogs without pain, slide into my jeans without struggle, and buy a one-piece without cringing. If that's not quality of life, what is?

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