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Cited by 40Physical Activity and HealthObesity, Physical Activity, DietNutrition and Health in Aging

The associations of “fatness,” “fitness,” and physical activity with all‐cause mortality in older adults: A systematic review

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Yerrakalva, Dharani, Mullis, Ricky, Mant, Jonathan·2015·Obesity
DOI 10.1002/oby.21181
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Abstract

Objective: This review explored whether cardiorespiratory fitness or physical activity act as either confounders or effect modifiers of the relationship between adiposity markers and all‐cause mortality in older adults. Methods: Systematic searches were carried out to identify observational studies that examined the association of adiposity markers (BMI, waist circumference, and waist‐hip ratio) with all‐cause mortality in adults aged ≥60 which took into account cardiorespiratory fitness or physical activity. Data from each included study was analyzed to produce a graphical representation of this relationship. Results: Fourteen of the fifteen identified studies found that increasing BMI had a non‐positive association with all‐cause mortality, with persistence of the obesity paradox despite adjustment for physical activity or cardiorespiratory fitness. Physical activity measurement methods were all subjective and often unvalidated. The two studies stratifying for cardiorespiratory fitness did not find that fitness had a significant impact on the relationship between excess adiposity and mortality but found that overweight and fit people had better survival than normal‐weight unfit people, Conclusions: The predominant use of poor physical activity measurement suggests that studies are currently not adequately accounting for possible physical activity confounding. More studies are needed for addressing the modification of the relationship between adiposity markers and mortality by cardiorespiratory fitness.

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  • Fitness level must be considered while assessing the association between body weight and medical outcomes.

    “Termed by some observers as the “fat but fit” paradigm or an “obesity paradox”, better mortality outcomes in persons with overweight or obesity may occur in certain race-ethnicity-sex-age strata [47,48], and fitness level must be considered while assessing the association between body weight and medical outcomes [49].”

    From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [49]

    The Discussion says fitness may be a more important determinant of survival than being overweight in adults aged 60 or over, and the Conclusions call for better fitness measures in studies of adiposity and mortality. But the review addresses all-cause mortality in older adults, not medical outcomes generally; it also reports that the two studies stratifying by fitness found no significant effect on the adiposity–mortality relationship. Thus, “must be considered” is stronger and broader than the evidence presented. (LLM, conf=0.86)

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Cited by

Sorted by citations

Authors
Yerrakalva, D., Mullis, R., & Mant, J.
Affiliations
University of Cambridge (GB)
Corresponding author
Yerrakalva, Dharani
ORCID
Venue
Obesity
Publisher
Wiley
Published
2015-09-04
Volume
23
Issue
10
Pages
1944-1956
ISSN
  • 1930-7381 (ISSN-L)
  • 1930-739X
DOI
10.1002/oby.21181
OpenAlex
W1809143207
Cited by
40
References
9
Citations by year
2026: 2 · 2024: 6 · 2023: 1 · 2022: 5 · 2021: 6 · 2020: 7 · 2018: 5 · 2017: 6 · 2016: 2
FWCI
0.53
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Obesity (publishedVersion)
  • PubMed (publishedVersion)
  • Apollo (University of Cambridge) (acceptedVersion)
Funders
National Institute for Health and Care Research (ACF-2012-14-015)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
all-cause mortality, older adults, adiposity, body mass index, waist circumference, waist-to-hip ratio, cardiorespiratory fitness, physical activity, obesity paradox, confounding, effect modification, physical activity measurement validity
MeSH terms
Aged, Cause of Death, Female, Health Status, Humans, Male, Middle Aged, Motor Activity, Obesity, Obesity, Morbid, Physical Fitness, Body Mass Index, Risk Assessment, Waist-Hip Ratio, Adiposity, Waist Circumference

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