Virtually no one asks that question because, by default, most people think they should losing weight. It’s weight loss that has been highlighted over and over in the media, it’s weight loss that most doctors recommend. Exercise takes second place far below that holy grail of weight loss.
But what if focusing on fitness first gave us MUCH better results both in terms of health and looks? I’ll give you 6 reasons this is true at the end of the article. But first, let’s discuss our obsession with weight loss.
I get why we focus on weight loss. First, extra weight is something we can SEE. Fitness is not necessarily something we can detect. Really if I saw you in person right now, I’d probably have no idea how many push-ups you can do, or whether you can walk 1 mile without getting tired. I don’t know if chasing after your kids at the park is true “a walk in the park” or if you get tired after 10 minutes.
But I’ll most probably be able to tell if you carry “extra pounds” or not.
So before we even dig into the research, we know we’re biased in favor of pursuing weight loss rather than fitness. At the end of the day, our senses say so. Your vision is clear you actually see, fitness not so much. To answer “should I losing weight?”
Obesity is linked to multiple conditions, but since heart disease is the Nr. #1 killer in the USA, since it’s about 90% preventable, and since obesity is one of the major risk factors, I’m gonna focus on the link between obesity and heart disease and how fitness changes the picture.
What you already knew: Obesity increases heart disease risk. It’s a major risk factor.
According to the World Health Organization obesity is the fifth leading global risk factor for mortality. Obesity adversely affects hypertension, diabetes Mellitus, metabolic syndrome, atherosclerosis, and CHD events.
Again according to WHO raised BMI increases the risk of cardiovascular disease (mainly heart disease and stroke). The risk for CVD increases with an increase in BMI.
What if the problem is NOT obesity but lack of fitness? Or what if lack of fitness is more to blame than obesity?
Yes, obesity has been linked to cardiovascular disease. But what if obesity is not the problem?
Traditional risk factors for all-cause and cardiovascular disease mortality include hypertension, diabetes, smoking, or obesity. Cardiorespiratory fitness (CRF) is often overlooked, or not measured at all.
So here’s what many studies are missing. Obesity comes for a reason, mainly consuming more calories than what is needed. And one factor responsible for this surplus is a lack of physical activity and living a sedentary lifestyle.
What we know is that fitness has been shown to have a big effect on mortality. According to Lee et al., the protective effect of cardiorespiratory fitness on mortality is independent of age, ethnicity, adiposity, smoking status, alcohol intake, and health conditions.
In the Aerobics Center Longitudinal Study (ACLS), compared with the least fit men and women, the most fit men and women had 43% and 53% lower risk for all-cause mortality, and 47% and 70% lower risk of CVD mortality, respectively.
And it gets better. If you’re fat and think you need to lose weight…
Kodama et al. explained that a 1-MET higher level of CRF is comparable to a 7-cm, 5-mmHg decrement in waist circumference and systolic blood pressure respectively.
MET is a way to measure fitness levels. So getting a bit fitter is equivalent to losing 7 cm from your waist! That’s almost 3 inches!
Researchers recommend focusing on fitness first to reduce risk.
Barry et al. in a meta-analysis of fitness and fatness on all-cause mortality conclude:
Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.
I don’t know what to highlight the most from this conclusion. The fact that fat and fit individuals had similar mortality to normal weight and fit individuals? Or the fact that the researchers suggest focusing on fitness rather than weight?
Ortega et al. set out to discover why some obese people are healthy. Seriously! They investigated the role of fitness:
When adjusting for fitness and other confounders, metabolically healthy but obese individuals had lower risk (30–50%, estimated by hazard ratios) of all-cause mortality, non-fatal and fatal cardiovascular disease, and cancer mortality than their metabolically unhealthy obese peers; while no significant differences were observed between metabolically healthy but obese and metabolically healthy normal-fat participants.
The authors concluded that “the metabolically healthy but obese phenotype is a benign condition.” In other words, if you’re fit, who cares if you’re fat?
Lee et al. report:
We have found that a moderate to high level of CRF (=cardiovascular fitness) eliminates the higher risk of mortality associated with obesity (Lee et al., 1999). We observed similar findings among older adults aged 60 years or older (Sui et al., 2007). In these ACLS studies, obese individuals who were fit had comparable mortality risk to normal-weight individuals who were unfit. These findings were consistent when using percentage body fat or waist circumference instead of BMI. Recently, the Veterans Exercise Testing Study in men aged 40–70 years also found that overweight and obese men had higher risk of all-cause mortality only if they had a low fitness level (McAuley et al., 2010).
However, in other studies fitness reduced the risks posed by obesity but did not completely eliminate them. At this point, we’re not sure if fitness completely reverses the effects of obesity or not. So we can’t claim that obesity is not a problem.
What we are sure about though is that fitness plays a major role in health and mortality risk. According to Lee et al:
CRF improves insulin sensitivity, blood lipid and lipoprotein profile, body composition, inflammation, and blood pressure and the autonomic nervous system. Insulin resistance is a major determinant of CVD, especially in overweight or obese individuals
Better Than Losing Weight.
6 Reasons why fitness may be a better goal to pursue than Losing Weight
“Should I lose weight?” I’m not saying you shouldn’t. Maybe you should. E.g., if your knees hurt, then by all means do it. But if you’re worried about cardiovascular health, I’d want to encourage you to think strategically:
Do you have to START with focusing on weight loss, or is focusing on FITNESS first a better goal?
Let’s review: Is obesity linked to cardiovascular disease? Yes, it is. Is it bad? Yes, it is. It seems that obesity does have a negative effect, regardless of fitness. We don’t know the extent of this effect. Lack of fitness may or may not play a bigger role than obesity.
But maybe obesity is not that bad, and it just happens that obese people with increased risks were also unfit. Seriously, what if lack of fitness is 2x as severe as having extra pounds? Or what if the effect of obesity is minuscule compared to the effect of being unfit? These are answers that we’ll have to investigate in future research.
1. Getting fit is more fun than being on a diet.
The biggest difference between getting fit and losing weight is that when you get fit you become MORE. When you lose weight you focus on “less,” and most people associate this with restriction.
Now I know people can see getting fit as a restriction too. But generally, it’s easier to start exercising, rather than to focus on restricting yourself, losing weight, and then making sure you don’t get that weight back.
2. We’d have fewer obese people.
If our society paid more attention to fitness rather than weight loss, we’d have fewer obesity incidents. Seriously, if we all talked about how many push-ups we can do, versus getting a “bikini body,” fewer people would get fat because they’d be exercising.
3. It’d be easier to lose weight because people would be exercising.
Getting fit makes weight loss easier. Plus, you’re more likely to NOT gain the weight back.
4. Society is biased against fat people. But if fitness was the holy grail then we wouldn’t automatically assume that fat=unhealthy.
Generally, people think that fat by default means unhealthy, even though in many cases that could not be further from the truth. But if we stopped obsessing about weight loss, our “fat bias” would substantially subside as we’d get involved in more conversations about physical activity rather than the extra pounds we gained and how to lose them quickly.
5. Both fat and thin people would be healthier.
Even if overweight people don’t lose weight, they’d get all the protective benefits of exercise and from a cardiovascular perspective, they may still be fine. Plus all the thin people who think are “fine” just because they’re thin – well, they can do better. Being thin is not an excuse for a lack of fitness.
6. We’d have fewer eating disorders.
If weight loss stops being the holy grail, then why think you need to starve yourself and risk an eating disorder?
As you see it’s not as if you have to pick one. If you choose fitness you may still lose weight (while if you just aim for weight loss without including fitness, well you may lose weight and stay unfit). That’s just one more of the benefits of aiming for fitness first.
So back to the original question: “Should I lose weight, or should I get fit?” Leave a comment below and let me know your thoughts on what you think your goal should be!
References
Lee et al. “Mortality trends in the general population: the importance of cardiorespiratory fitness, Journal of Psychopharmacology.” 2010 Nov; 24(4_supplement): 27–35.
Kodama et al., “Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis.” The Journal of the American Medical Association, 2009 May 20;301(19):2024-35.
Barry et al. “Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis.” Progress in Cardiovascular Diseases, Volume 56, Issue 4, January–February 2014, Pages 382–390
Ortega et al. “The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness.” European Heart Journal, 2012
