Physical inactivity at issue: emphasize fitness over weight loss, expert says.(Clinical Rounds)

QUEBEC CITY -- Physical inactivity, more than obesity, is to blame for a large chunk of America's battle with chronic illness, according to Dr. Steven N. Blair president and CEO of the Cooper Institute, a nonprofit research and education center in Dallas, which focuses on the relationship between living habits and health.

"One of my biggest frustrations is that physicians will so often tell their patients to lose weight, but so few of them will say 'Get fit.' And yet research shows that obese individuals who are fit have half the death rate of lean individuals who are inactive," he said at the annual meeting of the American Orthopaedic Society for Sports Medicine.

"I am not saying we should ignore obesity, but we need to recognize that physical inactivity is one of the major public health problems of our time," he told this newspaper. But remedying poor physical fitness will probably do more for a patient's health than simple weight loss.

In a recently published study, Cooper Institute researchers reported that in a group of more than 2,000 men with diabetes, obese, but moderately fit, men had one-third the death rate of normal weight but unfit men (Diabetes Care 27[1]:83-88, 2004). The men were divided into four quartiles according to fitness, then classified as either normal weight, overweight, or obese, according to body mass index (BMI). Risk of mortality was then calculated based on the 275 deaths that occurred over the course of the 25-year follow-up.

The researchers found that BMI was not a significant factor in mortality risk, but physical fitness was. For example, the risk of mortality was 4.5, 2.8, and 1.6 times higher for the lowest, second, and third fitness quartiles, respectively, when compared with the highest fitness quartile-and these risks were independent of BMI.

"For a 45-year-old man in this study, moderate fitness, as opposed to low fitness, means he will live 6 years longer, and attaining a high fitness level would mean he would live 9 years longer," he said.

Another recent study from the Cooper Institute suggests that physicians also can promote physical fitness as a "fountain of youth" (Am. J. Health Promot. 15[1]:1-8, 2000).