Healthy Weight Gain !! Is This An Oxymoron ? By Dr. Leonard Sowah

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As an immigrant from Ghana I have the liberty of blaming all my weight gain on the American diet and a lifestyle with less physical activity. Whilst the kinds of foods we eat play a major role in weight gain physical activity may be a bigger culprit. Over the course of 16 years I have been transformed from a 80 kg guy to 100 kg with a very visible extra collection of fat around my waistline. The science on the health impact of excess body fat has gone back and forth but today most scientists in the field of nutrition metabolism and health agree that fat around ones mid-section or what is now widely referred to as belly fat is very dangerous to your health as compared to fat around your hips. On this note I know that there are a lot of women of color out there cheering with this proclamation because this has always been a great bone of contention with some of my black female patients.

In the US today people of African descent are currently leading the charts on obesity and rates of Type 2 diabetes. Whilst emphasizing health risks of belly fat we should not overlook the deleterious impact of excess body fat on our bodies overall. Our knees carry a big brunt of the damage due to extra body weight irrespective of whether we are talking of belly fat, subcutaneous or fat deposits under our skins or hip and buttock fat.

While we physicians are more conscious of health implications most individuals see overweight and obesity as a aesthetic problem. As a result most advice on weight loss to African and Latino women usually falls on deaf ears. I have patients whose biggest concern when discussing weight loss is that they would lose some hip and booty fat, which they consider as highly favorable attractive assets. This brings up the question, “how much weight gain is okay for aesthetic reasons?”; especially for our women of color who want to still want to maintain some aesthetic assets.  There is no easy answer to this question since the health consequences of being overweight go beyond heart disease. As things stand today women especially women of color are going to continue to say “If I lose weight people are going to think I am sick and only make some half-hearted attempts at addressing excess weight”
Ghanaian model showcasing fashion styles for plus sized women – courtesy of Afrocosmopolitan

The ability to store excess energy in fat cells is a feature that we all inherited from our ancestors who lived in a world where abundance of food sources were seasonal. Researchers believe that an average healthy person stores about 80,000 calories of energy in fat cells in our bodies. This is about a little more than a month of food stores for the lean season. Our ancestors needed this to carry them through the annual season of drought, which corresponds to the winter months in cold climates. Our bodies have evolved over several generations in a world with these cycles of abundance and scarcity and therefore gaining weight by the storage of excess stored body fat is as natural as eating and sleeping. The problem that plagues us is not the weight gain but the utilization of these stores in the lean season. Today especially in US which leads western worlds in obesity rates we actually eat more and are even less active during our lean season leading to more weight gain. All animals in the wild actually have to expend more energy foraging for food in the lean months thus are not affected by the excess accumulation of fat stores.

Deer in a Mid-Western Winter – Courtesy of John Hafner

Clearly as it pertains to our animal neighbors a life closer to nature with less processed foods would be highly beneficial to our health. Unfortunately we are becoming more and more dependent on our electronic devices and spending less time engaging in good interpersonal physical activities. Natural weight gain in pregnancy is becoming a problem for most mothers because less and less women exclusively breastfeed. The biggest problem on this issue is that low income working women are less likely to breastfeed compared to their more affluent women. Thus these stores that the body naturally accumulates to help nourish a woman’s offspring just adds onto her overall weight burden.


Contrary to what most people believe the current obesity epidemic is actually worse in the developing world with the US at # 19 being an obvious outlier in the developed world.  For those concerned about cultural aesthetics though one can safely say that being overweight with body mass index (BMI) from below 30 kg/m2 has not been shown to be associated with increased risk of heart disease however risk of diabetes has been shown to increase as BMI trends upwards.  Also count yourself lucky if the ratio between your waist and hips is < 0.85 for women and 0.9 for men, that suggests a lower risk of heart disease.  And for those with butt implants, please these numbers do not apply to you, you may need to ask your plastic surgeons to advice you on that.

At this point though to move this relentless onslaught of weight gain backwards we must take some simple steps.

  • Try walking to the grocery store if all you need is a few groceries. The unintended benefit is that you do not end up buying a lot of useless stuff that you do not need because there is only so much that you can carry.
  • When it comes to food choices the closer your food products are to their natural state the better they are for you overall. You avoid a lot of unnecessary calories used in food preservation.
  • If you have to go up only 2 or 3 floors climb up the stairs rather than use the elevator.
  • Take a walk round your neighborhood; you actually get to know your neighbors not the cars that they drive.
  • And take up a sport that you enjoy doing, your ancestors chased and killed lions, wild hogs and saber toothed cats with only spears. You need to periodically do stuff like that, the adrenaline and the endorphin rush may challenge some of your best sexual encounters.
  • Talking about sex; there are some specialists who believe that lots of good sex can lead to weight loss. So please get lots of it if you can and remember to be safe whilst getting it because some of us guys and girls carry diseases in our sex organs.


Some of us however do struggle more with weight gain than others.  Overall our bodies are different but we must all learn to work with what we have. One easy way to charge up your weight loss is to increase muscle mass by weight lifting. For our ladies worried about flat butts a few hours on the bike can really do wonders. Muscles tend to use calories more effectively than fat and for that reason men tend to gain weight at slower rates than women.

I must end here though, I really do need to go to the gym now.

Dr. Leonard Sowah is an Internal Medicine Physician in Baltimore, Maryland


A physician providing primary medical care to patients across the lifespan