Better to Get Fit or Lose Weight?

Both achieved with physical activity, expert notes

Reviewed by Brunilda Nazario, MD on September 16, 2004

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.

"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 active."

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 shapes."

Show Sources

SOURCES: Wessel, T.R. Weinstein, A.R. Blair, S.N. and Church, T.S. Journal of the American Medical Association, Sept. 8, 2004; vol 292: pp 1179-1187, 1188-1194, 1232-1234.

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