Unfit and Lean Have Fewer Cardiac Risk Factors Than Fit and Fat

Losing weight may be more important than exercise when it comes to being heart healthy in young adulthood.

Charles Eaton, MD, professor of family medicine at Brown University Medical School in Pawtucket, Rhode Island " said that, it is better to be a normal weight than to be fat and fit." "There is a large population of Americans who are overweight. The question is whether it is better to lose weight or become fit."

Not surprisingly, this study showed that participants who were highly fit and had a normal body mass index (BMI) had the best risk factor profiles for coronary heart disease (CHD), while those with low fitness levels or who were overweight or obese had the worst profiles. However, the researchers also found that low-fit normal weight participants had better risk profiles for CHD than those who were highly fit, but overweight or obese.

Researchers used cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) and studied 2,178 young adults, aged 20 to 49 years, with different levels of fitness. All participants had blood work-ups for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), glucose, insulin, fibrinogen, and homocysteine levels. Blood pressure, height, and weight were recorded using standard protocols. Fitness categories, based on the norms for age and sex, were used to define low, moderate, and high levels of cardiovascular fitness.

The researchers looked at the relationship between BMI level and cardiovascular fitness level to determine whether it is better to be fat and fit or thin and unfit.

While this was a cross-sectional study that measured risk factors at one time point, the findings show that for most markers it was better to be thin and fit than fat and unfit, Dr. Eaton said. "High fitness and normal BMI subjects had the best cardiovascular disease risk factors. Those who were obese and unfit had the worst cardiovascular risk factors."

But, he noted, the study results also suggest that it is better to be normal weight and unfit than obese and fit.

"This study adds to the dialogue that weight is more important than fitness." "If you are overweight it is better to get down to normal weight than be overweight and fit."

Robert Eckel, MD, president of the American Heart Association and professor of medicine at the University of Colorado Health Science Center in Denver said that, “This study raises important questions as to whether or not being fat and fit is okay." "The biomarker report here is not as favorable as that previously reported.

"Being both normal weight and fit remain the best recommendation for prevention of cardiovascular disease and diabetes," he added.

AHA 2005 Scientific Sessions: Abstract 3611. Presented Nov. 13, 2005.

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