Food for Thought

Fit people come in all shapes and sizes
University of South Carolina Arnold School of Public Health Professor Steven Blair has undertaken dozens of studies on joint associations of fitness and fatness to health. These studies show that a normal weight person who is unfit is twice as likely to die in the next decade as a person who is overweight and fit.


Prof. Steven Blair

He writes: ‘I’ve been studying the cause of death in a select group of people for over 30 years and I’ve found that low cardio-respiratory fitness, which is caused by a sedentary lifestyle, accounted for more deaths than anything else. I often tell people that I was short, fat and bald when I started running, but that after running nearly every day for more than 40 years and covering about 70,000 miles ... I am still short, fat, and bald. But I suspect I’m in much better shape than I’d be if I didn’t run.

Most people think that you can tell if someone’s fit, active and healthy just by looking at them. It’s not true! Fit, healthy people come in all sizes and shapes. The same is true of unhealthy people. I know several thin people who are unfit and have serious health problems. Weight isn't everything.

There is now overwhelming evidence that regular physical activity has important and wide-ranging health benefits. These range from reduced risk of chronic diseases such as heart disease, type 2 diabetes, and some cancers to enhanced function and preservation of function with age. As a member of the geriatric set, I am personally delighted that there is strong emerging evidence that activity delays cognitive decline and is good for brain health as well as having extensive benefits for the rest of the body.

For much of my career, I’ve tracked a large group of patients from the Cooper Clinic. Each individual received a medical examination upon entering the study, including measurements of height, weight, body composition and cardio-respiratory fitness. We have followed these patients over the years to see who gets sick, who stays healthy, who lives and who dies. The results are fascinating. Our follow-up has shown that the death rate for women and men who are thin but unfit is at least twice as high as their obese counterparts who are fit. In fact, across every category of body composition, unfit individuals have a much higher death rate than those who are fit. Fitness appears to provide protection against early mortality no matter how much you weigh.

Being fit, as defined in our study, does not require high-level athletic training. It means meeting the consensus public recommendation of accumulating 150 minutes of moderate intensity exercise, such as walking, each week. Doing more brings additional health benefits. Overall, our data show about 50% lower mortality in the moderately fit as compared with the low fit; highly fit individuals lower their risk another 10–15%.

Many people classified as obese by current standards actually have a good health profile. We see that as many as 40% of obese individuals have normal cholesterol and blood pressure, do not smoke and are physically fit. Anyone who struggles with their weight should take this as good news. My recommendation is to focus on good health habits, no matter what number you see on the scale.

• Give fruits, vegetables and whole grains a major place in your daily diet.
• Be moderate about fat and alcohol.
• Don’t smoke.
• Work on managing stress.
• Perhaps most important, get out of your chair and start moving for at least150 minutes/week.’

Blair believes physical inactivity is the biggest public health problem of the 21st century. In 2009, he helped coordinate a special issue of the British Journal of Sports Medicine to focus on the topic. The issue contains 18 articles that provide the background and rationale for giving more attention to physical activity in clinical and public health settings.

To add years to your life and life to your years, you may want to check out Prof Blair’s Fitness After 50 (with Dr Walter Ettinger and Brenda Wright PhD. The book shows you how to get started, stay on track and have some fun as you meet your fitness goals. It’s available from bookshops and Amazon.