Obesity Paradox and Cardiorespiratory Fitness in 12,417 Male Veterans Aged 40 to 70 Years

Department of Human Performance and Sport Sciences, Winston-Salem State University, 601 S Martin Luther King Jr Dr, Anderson C 24-E, Winston-Salem, NC 27110, USA.
Mayo Clinic Proceedings (Impact Factor: 6.26). 02/2010; 85(2):115-21. DOI: 10.4065/mcp.2009.0562
Source: PubMed

ABSTRACT To evaluate the influence of cardiorespiratory fitness (fitness) on the obesity paradox in middle-aged men with known or suspected coronary artery disease.
This study consists of 12,417 men aged 40 to 70 years (44% African American) who were referred for exercise testing at the Veterans Affairs Medical Centers in Washington, DC, or Palo Alto, CA (between January 1, 1983, and June 30, 2007). Fitness was quantified as metabolic equivalents achieved during a maximal exercise test and was categorized for analysis as low, moderate, and high (defined as <5, 5-10, and >10 metabolic equivalents, respectively). Adiposity was defined by body mass index (BMI) according to standard clinical guidelines. Separate and combined associations of fitness and adiposity with all-cause mortality were assessed by Cox proportional hazards analyses.
We recorded 2801 deaths during a mean+/-SD follow-up of 7.7+/-5.3 years. Multivariate hazard ratios (95% confidence interval) for all-cause mortality, with normal weight (BMI, 18.5-24.9 kg/m2) used as the reference group, were 1.9 (1.5-2.3), 0.7 (0.7-0.8), 0.7 (0.6-0.7), and 1.0 (0.8-1.1) for BMIs of less than 18.5, 25.0 to 29.9, 30.0 to 34.9, and 35.0 or more kg/m2, respectively. Compared with highly fit normal-weight men, underweight men with low fitness had the highest (4.5 [3.1-6.6]) and highly fit overweight men the lowest (0.4 [0.3-0.6]) mortality risk of any subgroup. Overweight and obese men with moderate fitness had mortality rates similar to those of the highly fit normal-weight reference group.
Fitness altered the obesity paradox. Overweight and obese men had increased longevity only if they registered high fitness.

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    • "This may be especially so if the comparator individuals are thin because of severe illnesses (e.g., chronic heart or lung disease, cancer), or because the thinner individuals smoke cigarettes, which would not only reduce body weight, but would also increase CVD risk [71, 72]. Men who are overweight or obese may have reduced mortality only if they are physically fit [73, 74]. Patients with chronic heart failure seem to have no mortality benefit if they have type 2 diabetes mellitus [75]. "
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    ABSTRACT: Among lean populations, cardiovascular disease (CVD) is rare. Among those with increased adiposity, CVD is the commonest cause of worldwide death. The "obesity paradox" describes seemingly contrary relationships between body fat and health/ill-health. Multiple obesity paradoxes exist, and include the anatomic obesity paradox, physiologic obesity paradox, demographic obesity paradox, therapeutic obesity paradox, cardiovascular event/procedure obesity paradox, and obesity treatment paradox. Adiposopathy ("sick fat") is defined as adipocyte/adipose tissue dysfunction caused by positive caloric balance and sedentary lifestyle in genetically and environmentally susceptible individuals. Adiposopathy contributes to the commonest metabolic disorders encountered in clinical practice (high glucose levels, high blood pressure, dyslipidemia, etc.), all major CVD risk factors. Ockham's razor is a principle of parsimony which postulates that among competing theories, the hypothesis with the fewest assumptions is the one best selected. Ockham's razor supports adiposopathy as the primary cause of most cases of adiposity-related metabolic diseases, which in turn helps resolve the obesity paradox.
    Current Atherosclerosis Reports 05/2014; 16(5):409. DOI:10.1007/s11883-014-0409-1 · 3.42 Impact Factor
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    • "This implies that obese persons are considered slothful if they are sedentary, while normal weight persons are not associated with slothfulness even when they are inactive. This is problematic given the 'fitness and fatness' relationship demonstrated by McAuley et al. (2010) and Lyerly et al. (2009). Thus, finding ways to counter such stereotypes and to modify bias towards normal weight yet sedentary persons, in addition to bias towards obese yet active persons, is necessary. "
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    ABSTRACT: Abstract Objective: To change implicit and explicit bias so that active obese people are regarded as more fit and normal weight sedentary people as less fit. Design: Study one created a questionnaire that measured perceptions of active obese persons and sedentary normal weight persons on fitness-related items. Study two used a modified visual probe task to retrain perceptions regarding active obese persons and sedentary normal weight persons. Main Outcome Measures: Self-reported explicit bias was measured with a questionnaire and implicit bias was measured with response times collected during a visual probe task. Results: The questionnaire reliably measured 'fitness and fatness' perceptions. In study two, pairing images of active obese persons with positive activity-related words resulted in active obese persons being explicitly rated more fit; pairing images of normal weight sedentary persons with negative words associated with sedentary lifestyles increased endorsement of normal weight people as unfit. There were no changes in implicit bias. Conclusions: Bias regarding how body weight is thought of relative to fitness can be altered by pairing images of obese persons being active with words such as "health" and "fit". This is evidence that representations of persons of all body weight should be used when promoting physical activity.
    Psychology & Health 01/2014; 29(7). DOI:10.1080/08870446.2014.885024 · 1.95 Impact Factor
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    • "Smoking cessation and physical activity are key aspects of secondary prevention programs (Clark et al., 2005; Smith et al., 2011), although it is unclear if better uptake and adherence to lifestyle advice might partly explain the obesity paradox in CVD patients. Several papers, for example, show that an obesity paradox does not persist in coronary patients with high levels of physical fitness (Goel et al., 2011; McAuley et al., 2010). The aim of this study was to examine the role of self-rated health, behavioral and objectively assessed risk factors, in order to further explore mechanisms that might influence the association between BMI and mortality in a community sample with established CVD. "
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    ABSTRACT: Objective: The obesity paradox in patients with cardiovascular disease (CVD) remains unexplained. We examined the role of self-rated health, behavioral and objectively assessed risk factors, in order to further explore mechanisms that might influence the association between body mass index (BMI) and mortality in CVD patients. Methods: Participants were 4417 community dwelling adults from the Health Survey for England and Scottish Health Survey from 1994-2004 (aged 65.9 ±[Standard deviation (SD) 10.6 yrs], 56.2% men) with clinically diagnosed CVD at baseline. Results: There were 570 CVD and 1441 and all-cause deaths, over an average of 7.3 yrs of follow-up. Overweight and obese patients reported worse self-rated health, more co-morbidities and biological risk factors. However, compared with non-obese participants (BMI<25 kg/m(2)), a lower risk of all-cause mortality was observed in overweight (BMI 25<30 kg/m(2)) (Hazard ratio [HR]=0.73, 95% confidence intervals [CI], 0.64-0.82), and obese (BMI ≥ 30 kg/m(2)) participants (HR=0.84, 95% CI, 0.73-0.97) after adjustment for age, sex, smoking, physical activity, and various co-morbidities. Conclusions: Overweight and obese CVD patients have better prognosis despite reporting worse health, more co-morbidities and risk factors, and poorer adherence to lifestyle advice.
    Preventive Medicine 02/2013; 57(1). DOI:10.1016/j.ypmed.2013.02.012 · 3.09 Impact Factor
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