The other day, I was reading something in The New York Times about the NBA (I secretly love basketball and follow it closely). The article was about the NBA’s high valuation, and what caught my attention was a point the author made about why professional sports are so valuable. Part of the value is that they’re scarce and something AI cannot replace.
That made me pause. I hadn’t really thought about sports that way, but it made sense. There are some things we simply can’t innovate ourselves out of. Sports, and more broadly, physical fitness are some of those things.
The more I thought about it, the more I started thinking about how often we innovate ourselves into new problems and then work to innovate our way back out of them.
Over the past several decades, we’ve dramatically changed our food environment to solve the challenge of scarcity. We engineered food to be more calorie-dense, palatable, convenient and shelf-stable. We made calories so incredibly abundant that we’ve contributed to rising rates of obesity and other metabolic health problems.
We engineered much of the manual, monotonous and laborious work out of our daily lives through robotic and digital innovation. And that created an environment where many of us can go through an entire day taking less than a few thousand steps.
And now we’ve engineered GLP-1 medications plus a next-generation delivery system where AI bots help identify patients, facilitate prescribing, and deliver medications to patients’ doorsteps with just a few swipes on a phone. While that innovation is helping people change how they eat, lose weight, and manage conditions associated with obesity, it leaves me wondering what unintended consequences await us.
One potential challenge I see on the horizon is the rise of the TOFI problem. For those of you who haven’t heard the term TOFI before, allow me to explain. TOFI is shorthand for “Thin Outside, Fat Inside.” It is sometimes used to describe when someone’s body weight or BMI falls within a “healthy” range and they look lean from the outside while still carrying a disproportionate amount of visceral fat; the fat stored around our internal organs that is metabolically active and linked to greater health risks. And please know, I use the term to illustrate a clinical concept, not as a judgment about someone’s body. It is simply a reminder that body weight and appearance don’t always reflect what’s happening inside.
As we get better at changing the number on the scale, we need to remember that what we see on the outside doesn’t always equate to better function. And we shouldn’t lose sight of what that weight is made of, or whether we’re preserving muscle, strength and physical function.
The reality is that when people lose a significant amount of weight, whether through a low-calorie diet, surgery, or GLP-1s, lean mass often declines as well. That doesn’t mean these medications are bad, but it does mean that preserving muscle and function deserves even greater attention, particularly as we age. That’s how we mitigate the TOFI problem.
Muscle and fitness are insurance. They keep us doing the things we love, help us maintain strength and balance, and protect our independence. And as we get older, strength, balance and physical capacity quickly become the things we wish we had invested in earlier.
Right now, there’s a lot of innovation aimed at addressing some of the challenges that can accompany substantial weight loss and GLP1 use, including growing interest in protein, peptides and other compounds. While these may prove to be helpful building blocks, none of them can work on their own. They can’t substitute for the adaptations that can only happen when we challenge our muscles and cardiovascular system. And this is where I keep coming back to the same conclusion. We can’t replace or out-innovate physical activity.
If we’re trying to preserve muscle, vigor and physical function, the body still has to experience physical demand. Muscles adapt only when we challenge them. Our cardiovascular system adapts when we ask it to do more. Balance and coordination improve when we practice using them. In other words, you have to do the work. And that is the part we haven’t figured out how to innovate around.
Maybe that’s the innovation gap we should be looking to solve. Perhaps the most innovative thing we could do next is use that same next-generation delivery system to deliver something we already know works—a prescription for physical activity.
Physical activity isn’t just another thing we do for our health. It’s part of what makes us feel alive. And maybe that’s also why we love sports. We watch people run faster, jump higher, push the limits of physical effort and endurance, and we can’t outsource that experience to AI or manufacture it with a pill. There’s something deeply human in the effort itself.
Normally I hate the big dollars associated with professional sports, but in this instance, I appreciate the NBA, and their multi-billions. It reminded me of the unique premium value of physical activity. There are still some things technology can’t do for us. Sometimes, the body still has to do the work.
Carolyn Kontos, MS, ACC, Wellness Consultant & Nutrition Coach, is a Professor at Chatham University. She offers Wellness & Nutrition Coaching at the JCC through her Eat Well Programs. For more information, contact Carolyn at [email protected]