BMI, physical activity, CVD risk relationship complicated
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Increased physical activity may mitigate risk for CVD regardless of BMI, but elevated BMI itself remains a significant CVD risk factor, according to data published in the European Journal of Preventive Cardiology.
“The prevalence of overweight and obesity has reached pandemic proportions, and people with these conditions present with an increased cardiometabolic risk. Some evidence suggests, however, that a high cardiorespiratory fitness might mitigate the detrimental effects of excess body weight on cardiometabolic health, termed the ‘fat but fit’ paradox,” Pedro L. Valenzuela, PhD, of the department of systems biology at the University of Alcalá in Madrid, and colleagues wrote. “It has been proposed that health policies should focus on physical activity-based interventions aimed at improving cardiorespiratory fitness rather than — or at least as much as — on weight-loss strategies, although some controversy remains.”
For this nationwide population-based, cross-sectional study, researchers included 527,662 participants (mean age, 42 years; 32% women) categorized as normal weight (20-24.9 kg/m2), overweight (25-29.9 kg/m2) or obese ( 30 kg/m2) and used self-reported leisure-time physical activity levels to evaluate the existence of the “fitness vs. fatness” paradox of BMI and physical activity levels and their effect on CVD risk factors. Participants were stratified by physical activity as inactive, insufficiently active or regularly active based on WHO guidelines.
Diabetes was present in 3% of participants, hypercholesterolemia in 30% and hypertension in 15%.
Overall, 42% of the cohort had normal weight, 41% were overweight and 18% were obese, whereas 63.5% were inactive, 12.3% were insufficiently active and 24.2% were regularly active.
Researchers found that regular leisure-time physical activity (P = .001) or insufficient active were associated with lower prevalence of CVD risk factors compared with inactivity. This finding was consistent across all categories of BMI and for each subgroup of patients with diabetes, hypercholesterolemia or hypertension.
Although regular and insufficient levels of physical activity showed a protective effect against CVD compared with inactivity, it did not compensate for BMI because individuals who were overweight or obese continued to experience greater CVD risk compared with those of normal weight. This finding persisted when researchers evaluated the overall cohort by sex.
“Our study suggests that, although physical activity mitigates — at least partly — the detrimental effects of overweight/obesity on CVD risk, excess body weight per se is associated with a remarkable increase in the prevalence of major risk factors, as reflected by approximately two-, five- and fourfold higher odds for hypercholesterolemia, hypertension and diabetes among active but obese individuals compared with their inactive peers with normal weight,” the researchers wrote.
“Increasing physical activity levels appear to provide benefits in an overall dose-response manner (regularly active > insufficiently active > inactive for the risk of hypertension or diabetes) across BMI categories and should be a priority of health policies,” the researchers wrote. “However, weight loss per se should remain a primary target for health policies aimed at reducing CVD risk in people with overweight/obesity.”
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