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The Fat but Fit paradox: what we know and don’t know about it
  1. Francisco B Ortega1,
  2. Jonatan R Ruiz1,
  3. Idoia Labayen2,
  4. Carl J Lavie3,
  5. Steven N Blair4,5
  1. 1 PROFITH ‘PROmoting FITness and Health through physical activity’ Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
  2. 2 Department of Nutrition and Food Science, University of the Basque Country, Universidad del País Vasco/ Euskal Herrico Unibertsitatea (UPV/EHU), Vitoria, Spain
  3. 3 Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
  4. 4 Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
  5. 5 Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
  1. Correspondence to Dr Francisco B Ortega, PROFITH ‘PROmoting FITness and Health through physical activity’ Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Carretera de Alfacar s/n, Granada 18071, Spain. ; ortegaf{at}ugr.es

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What we know about it

In the late 1980s, one of us (SNB) published a study that demonstrated that individuals with a low (below first quintile=20th percentile) cardiorespiratory fitness level had a higher risk of mortality 8 years later, when compared with those who were at least moderately fit.1 Since then, many longitudinal studies have consistently confirmed this notion in men and women, as well as in healthy and diseased individuals, for all-cause mortality, as well as for cardiovascular disease (CVD) mortality.2

Obesity is related to multiple physical and mental comorbidities and it is an incontrovertible risk factor for all-cause and CVD mortality.3 It has been suggested, however, that being fit might attenuate some of the adverse consequences of obesity, independently of some key potential confounders. In this context, in the late 1990s, some studies provided first evidence for what was later known as the Fat but Fit paradox (see review by Ortega et al.3). These studies demonstrated that all-cause and CVD mortality risk in obese individuals, as defined by body mass index (BMI), body fat percentage or waist circumference, who are fit (ie, cardiorespiratory fitness level above the age-specific and sex-specific 20th percentile) is not significantly different from their normal-weight and fit counterparts (ie, the theoretically healthiest group possible) (figure 1).

Figure 1

Illustration of the Fat but Fit paradox in relation with cardiovascular disease (CVD) mortality and all-cause mortality in …

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