Fitness or Fatness: Which Influences Our Health More?

Zachary Walston

If you wanted to lose weight today, would you focus on exercise or dieting? Yes, in a perfect world you would nail both. Humor me. Which is more important?

Next question, why do you want to lose weight? It is important to pair the reason and the method together.

People choose to lose weight for a multitude of reasons. Largely they can be classified into one of two buckets: weight control and fitness.

I am not here to focus on the aesthetics piece — how good someone looks in a bathing suit — but rather, I want to focus on the impact weight and fitness have on overall health.

If you want to be healthier, should you focus on losing weight or getting in shape?

Recent research suggests the latter.

The Fitness-Fatness Hypothesis

The fitness-fatness hypothesis suggests a higher level of cardiorespiratory fitness (CRF) will reduce the negative effects of obesity on morbidity and mortality, making obesity less important for health. 

According to research, as a healthcare provider (physical therapy) I should target fitness over fatness to improve the overall health of my patients.

Unfit (using METs to define) individuals have twice the risk of mortality than normal weight-fit individuals regardless of body mass index (BMI) — a ratio of weight to height commonly used in medical and exercise research. Overweight (BMI of 25–29.9) and obese-fit individuals (BMI>30) have similar mortality risks as normal weight-fit individuals.

Overall, the research suggests fitness has a greater influence on the risk of death than thinness. This builds on evidence that supports the overwhelming benefits of moderate and high-intensity activity. Your fitness level can even help fight COVID-19.

The more physically fit someone is, the more resilient and protective their body is. This is great news for individuals who struggle to lose weight but still improve their fitness.

It is easy to become discouraged when the number of the scale remains stagnant. If you are seeing improvements in your performance in the gym then you are building your body’s resilience.

Does this mean obesity doesn’t matter?

The Problems with Obesity

The effects of obesity are frequently researched. Many studies link obesity to all-cause mortality. It has a net negative influence on health across the board.

Research shows sarcopenic obesity — low muscle mass and quality with increased fat mass — is associated with poor physical function and results in additional weight gain. Sarcopenic obesity generates an 8 to 11-fold increase in the risk for three or more physical disabilities.

Obesity can lead to metabolic complications, reducing the structural integrity and functional capacity of a muscle. Obesity also increases inflammation in the body which can impair muscle growth, bone quality, and joint health

Overall, obesity independently increases mortality risk by 20% and 28% in women and men.

Obesity is typically addressed through exercise and nutrition. Tackling obesity is a long-term strategy and requires dietary interventions. 

All Fitness is Not Created Equal

Research shows exercise alone is variable, potentially helping with weight loss. To maximize weight loss goals, a three-pronged approach to managing sleep, exercise, and diet should be used. But as the aforementioned study suggests, exercise can provide protective health benefits regardless of someone’s weight.

To influence CRF, you have to push your body. Walking and other forms of low-intensity activity are fantastic. They improve fitness and bone health — to a point. 

To maximize the protective effects of fitness, moderate and vigorous-intensity resistance and aerobic exercise are needed. There is no magic threshold, but exercise should be regular and challenging.

Prioritize Fitness but Don’t Ignore Your Diet

Being thin has its benefits. This doesn’t have to be an either-or situation. If you are going to focus on one, however, start exercising.

Eat good food to fuel your exercise. Focus on fitness and overall health, not the waistline.

The aesthetics will come over time, but a heavy emphasis on aesthetics, at the expense of fitness, will limit your overall health.

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I am a physical therapist, researcher, and educator whose mission is to challenge health misinformation. You will find articles about health, fitness, medical care, psychology, and professional development on my site. As the husband of a real estate agent, you will also find real estate and housing tips.

Atlanta, GA

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