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Both achieved with physical activity, expert notes

Sept. 7, 2004 -- No matter what size you are, your risk of heart disease is lower if you're fit.

That's the news from a U.S. study of middle-aged women who already have some sign of heart disease. The report appears in the Sept. 8 issue of The Journal of the American Medical Association (JAMA).

"These results suggest that fitness may be more important than overweight or obesity for [heart] risk in women," conclude study leader Timothy R. Wessel, MD, of the University of Florida, Gainesville, and colleagues.

But heart disease isn't the only health problem linked to being overweight or obese. Another new JAMA study shows that among otherwise healthy women, obese women have a ninefold greater chance of developing type 2 diabetes. Overweight women have more than a threefold higher risk of type 2 diabetes than normal-weight women.

Being fit helped lower diabetes risk. But not as much as being overweight increased it. The study used body mass index -- BMI, a measure of weight relative to height -- to determine "normal" weight levels. If your BMI is 25 to 29, you're considered overweight. If your BMI is 30 or more, you're considered obese.

"We observed a modest reduction in the risk of diabetes with increasing physical activity level, compared with a large increase in the risk with increasing BMI," conclude study leader Amy R. Weinstein MD, MPH, of Boston's Beth Israel Deaconess Medical Center, and colleagues. "These findings underscore the critical importance of [body fat] as a determinant of type 2 diabetes."

Fitness vs. Fatness

So what's more important, fitness or fatness? For type 2 diabetes, there seems to be something special about extra body fat, especially abdominal fat. People who have or are at high risk for type 2 diabetes need to keep their weight as close to normal as possible.

But a focus merely on weight ignores the many benefits of fitness, argues a JAMA editorial by Steven N. Blair, PED, president and CEO of the Cooper Institute in Dallas.

Blair scolds doctors and policymakers involved in the ongoing debate over which is more important, fitness or fatness. There's no doubt that fitness is extremely important. And there's no doubt that successful weight loss means becoming more physically active.

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