Make fitness the focus of weight loss efforts. (Also Prevent Weight Gain).

SAN FRANCISCO -- Weight management efforts should emphasize making patients more fit rather than less fat, Dr. Robert B. Baron said at a conference on women's health sponsored by the University of California, San Francisco.

When patients are ready to consider losing weight, give them three goals, said Dr. Baron, professor of medicine at the university.

The first goal is to become as fit as possible at their current weight. The second is to prevent further weight gain. "And then, if the patient has made some lifestyle changes in moving toward these goals, we can say, 'Let's look at what some of the options are for weight loss.'"

According to the President's Council on Physical Fitness and Sports, moderate daily exercise sufficient to provide measurable health benefits includes activities such as 30 minutes of brisk walking or raking leaves, 15 minutes of running, or 45 minutes of playing volleyball. More benefits accrue with exercise of greater intensity or duration.

This approach focuses on fitness independent of body size and is more attainable for most patients than a standard weight loss regimen, Dr. Baron said.

It also may prevent much of the excess mortality generally associated with obesity. In the Aerobics Center Longitudinal Study, a 14-year observational study of 25,714 men, fitness level mattered more than weight in raising the risk of mortality: Men who were obese but fit, as measured by their performance on a treadmill test, had only a 10% increase in the risk of all-cause mortality over the next 15 years compared with fit, normal-weight men.

In nonfit men of normal weight, the risk of all-cause mortality was doubled, and in nonfit, obese men it was tripled. Fit, obese men had a 60% increase in the risk of death from cardiovascular causes, but if they were nonfit and obese, the risk jumped fivefold. Nonfit, normal-weight men had a threefold increase in the risk of cardiovascular death (JAMA 282[16]:1547-53, 1999).