The ‘Fat but fit’ debate

Introduction

There has long been a debate as to whether someone can be ‘fat but fit’ (Ref 1). The phrase is blunt, rather than sensitive, but it’s a well known one and it’s a very interesting one to explore. A study was published on January 22nd, 2021, in the European Journal of Preventive Cardiology. It was called “Joint association of physical activity and body mass index with cardiovascular risk: a nationwide population-based cross-sectional study” (Ref 2). It turned out to be just three pages long – a research letter more than a study – but it packed a lot into the few pages with excellent use of one graphic and one table. An accompanying press release was also informative (Ref 3).

The study

The study was Spanish – led by many researchers in Madrid. It used data from 527,662 working adults insured by a large occupational risk prevention company in Spain. The average age of participants was 42 years and 32% were women.

The study aim was simple – to clarify the existence of the ‘fat but fit’ (i.e. higher body mass index (BMI) but active) paradox, in an observational study. The researchers assessed the association (important word) between different BMI categories and Physical Activity levels. The following BMI categories were used – normal (BMI 20-24.9); overweight (BMI 25-29.9) and obese (BMI 30 or above). The World Health Organization recommendations were used for Physical Activity (PA) categories (Ref 4). Participants were categorized as ‘inactive’ (performing neither moderate nor vigorous PA), ‘insufficiently active’ (not meeting World Health Organization (WHO) minimum PA recommendations for adults, i.e. <150min/week and < 75min/week in moderate and vigorous PA, respectively), or ‘regularly active’ (meeting WHO guidelines of ≥ 150min/week of moderate PA or ≥ 75min/week of vigorous PA, or a combination thereof.)

 

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