Better to Get Fit or Lose Weight?
Both achieved with physical activity, expert notes
WebMD News Archive
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
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
"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.
"Physical activity is the common denominator for the clinical treatment
of low fitness and excess weight, making the 'fitness vs. fatness' debate
largely academic," he writes. "Physicians, researchers, and
policymakers should spend less energy debating the relative health importance
of fitness and more time focusing on how to get sedentary individuals to become
Blair spoke with WebMD several weeks ago while working on the editorial.
"After all, we don't have very effective methods for weight loss,"
Blair told WebMD. "Let's focus on what people can do: Eat a
healthy diet, and get fit."
How can a person get fit? Blair has a ready answer.
"If everybody took three 10-minute walks a day, ate better, and consumed
no more than moderate amounts of alcohol, they would be healthier whether they
lost weight or not," he said. "You don't have to be in training for the
Olympics to get health benefits. Three 10-minute walks a day gets you out of
the low-fit category and provides important health benefits. ... Being active
and fit provides a lot of protection to people of all sizes and