Cited by 179Physical Activity and HealthCardiovascular and exercise physiologyObesity, Physical Activity, Diet

The DOI matches its Crossref record; 10 of the 11 references it cites were found in a registry or an index.

The Fat but Fit paradox: what we know and don’t know about it

Open access

Ortega, Francisco B, Ruiz, Jonatan R, Labayen, Idoia, Lavie, Carl J, Blair, Steven N·2018·British Journal of Sports Medicine

DOI 10.1136/bjsports-2016-097400

Open this paper in CoChat — free account Open PDF

Abstract

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 …

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Integrity signals

Registry

Crossref · 10.1136/bjsports-2016-097400

Cites

10 of 10 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy Men and Women
Blair, S. N. (1989) · JAMA · doi:10.1001/jama.1989.03430170057028 · Cited by 2,658
Self-citation
Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association
Ross, R., Blair, S. N., Arena, R., Church, T. S., Després, J.-P., Franklin, B. A., Haskell, W. L., Kaminsky, L. A., Levine, B. D., Lavie, C. J., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000461 · Cited by 2,486
Self-citation
Obesity and Cardiovascular Disease
Ortega, F. B., Lavie, C. J., & Blair, S. N. (2016) · Circulation Research · doi:10.1161/circresaha.115.306883 · Cited by 1,254
Self-citation
Reference Standards for Cardiorespiratory Fitness Measured With Cardiopulmonary Exercise Testing
Kaminsky, L. A., Arena, R., & Myers, J. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2015.07.026 · Cited by 461
International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries
Tomkinson, G. R., Lang, J. J., Tremblay, M. S., Dale, M. J., LeBlanc, A. G., Belanger, K., Ortega, F. B., & Léger, L. (2016) · British Journal of Sports Medicine · doi:10.1136/bjsports-2016-095987 · Cited by 340
Self-citation
Cardiorespiratory fitness cut points to avoid cardiovascular disease risk in children and adolescents; what level of fitness should raise a red flag? A systematic review and meta-analysis
Ruiz, J. R., Cavero‐Redondo, I., Ortega, F. B., Welk, G. J., Andersen, L. B., & Martínez‐Vizcaíno, V. (2016) · British Journal of Sports Medicine · doi:10.1136/bjsports-2015-095903 · Cited by 321
Self-citation
Reference Standards for Cardiorespiratory Fitness Measured With Cardiopulmonary Exercise Testing Using Cycle Ergometry: Data From the Fitness Registry and the Importance of Exercise National Database (FRIEND) Registry
Kaminsky, L. A., Imboden, M. T., Arena, R. A., & MYERS, J. N. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.10.003 · Cited by 204
Aerobic Fitness Attenuates the Metabolic Syndrome Score in Normal-Weight, at-Risk-for-Overweight, and Overweight Children
DuBose, K. D., Eisenmann, J. C., & Donnelly, J. E. (2007) · PEDIATRICS · doi:10.1542/peds.2007-0443 · Cited by 156
Aerobic physical fitness in relation to blood lipids and fasting glycaemia in adolescents: Influence of weight status
Mesa, J. L. M., Ruiz, J. R., Ortega, F. B., Wärnberǵ, J., González‐Lamuño, D., Moreno, L. A., Gutiérrez, Á., & Castillo, M. J. (2006) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2006.02.003 · Cited by 124
Self-citation
A Prospective Study of Fitness, Fatness, and Depressive Symptoms
Becofsky, K. M., Sui, X., Lee, D.-C., Wilcox, S., Zhang, J., & Blair, S. N. (2015) · American Journal of Epidemiology · doi:10.1093/aje/kwu330 · Cited by 65
Self-citation

Show all 11 references

Sorted by citations

Items 101–179 of 179

Association between cardiorespiratory fitness and metabolic health in overweight and obese adults
HAAPALA, E. A., Sjöros, T., Laine, S., Garthwaite, T., KALLIO, P., SAARENHOVI, M., Vähä‐Ypyä, H., LÖYTTYNIEMI, E., SIEVÄNEN, H., HOUTTU, N., et al. (2021) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.21.13234-7 · Cited by 6
Role of physical activity and fitness in the promotion of metabolic and overall health
Ortega, F. B., Artero, E. G., Jiménez‐Pavón, D., & Ruiz, J. R. (2018) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 6
Self-citation
The role of adiposity in the relationship between physical fitness with cardiometabolic risk factors, adipocytokines and inflammation in children
Brand, C., Gaya, A. C. A., Dias, A. F., Agostinis‐Sobrinho, C., Farinha, J. B., Macedo, R. C. O., Mota, J. A. P. S., Reischak-Oliveira, Á., & Gaya, A. R. (2020) · Sport Sciences for Health · doi:10.1007/s11332-020-00662-2 · Cited by 5
“Thus, our results do not support the so call “Fat but Fit” paradox, although most of the knowledge available regarding this issue comes from studies developed with adults, and the information regarding children and adolescents are scarce [30, 31].”
Result
Impaired Metabolic Health and Low Cardiorespiratory Fitness Independently Associate With Subclinical Atherosclerosis in Obesity
Lehn‐Stefan, A., Peter, A., Machann, J., Schick, F., Randrianarisoa, E., Heni, M., Wagner, R. J., Birkenfeld, A. L., Fritsche, A., Schulze, M. B., et al. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac091 · Cited by 5
Mediation effect of cardiorespiratory fitness on relationships between high-intensity interval training and body fat in overweight and obese adolescents
DOMARADZKI, J., Koźlenia, D., & Popowczak, M. (2022) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.22.13539-5 · Cited by 5
Risco Cardiometabólico em Crianças e Adolescentes: O Paradoxo entre Índice de Massa Corporal e Aptidão Cardiorrespiratória
Tornquist, L., Tornquist, D., Schneiders, L. D. B., Franke, S. I. R., Renner, J. D. P., & Reuter, C. P. (2022) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20210593 · Cited by 5
“Alterado 82 (16,9) 32 (24,4) 69 (17,1) 83 (35,8) 266 (21,2) PAS < 0,001”
Influential
Cardiorespiratory fitness, body mass index, cardiovascular disease, and mortality in young men: A cohort study
Gorny, A. W., Yap, J. J. L., Neo, J. W., Chow, W., Yeo, K. K., Tan, C. S., & Müller‐Riemenschneider, F. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1076065 · Cited by 6
“4 6,244 (15) 8,056 (19) 9,310 (22) 10,271 (24) 10,725 (25) 44,606 (21)”
BackgroundInfluential
Lifestyle modification for weight loss: Effects on cardiorespiratory capacity in patients with class II and class III obesity
Wammer, F., Haberberger, A., Linge, A. D., Myklebust, T. Å., Vemøy, S., & Hoff, D. A. L. (2021) · Obesity Science & Practice · doi:10.1002/osp4.544 · Cited by 4
“On the other hand people with obesity do not always have reduced CRC, but still they have attenuated risk for all‐cause mortality known as the obesity paradox.(7) In general the literature report inconclusive data due heterogeneity in study design and differences in how data are reported.”
Background
Body fat percentage, cardiorespiratory fitness and arterial blood pressure in children and adolescents: a longitudinal analysis
Brand, C., Sehn, A. P., Fochesatto, C. F., Silveira, J. F. D. C., Mota, J., Martínez‐Gómez, D., Gaya, A. R., Reuter, C. P., & Renner, J. D. P. (2022) · BMC Cardiovascular Disorders · doi:10.1186/s12872-022-02704-8 · Cited by 9
“Thus, public health strategies must encourage the increase of CRF levels and not only the reduction of body weight, especially in children and adolescence [41].”
Background
Skeletal muscle mass is a strong predictor of cardiorespiratory fitness in the Chinese population with obesity
Ren, Z., Fu, L., Feng, Z., Song, Z., Liu, Y., Zhang, T., & Wu, N. (2023) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2023.04.002 · Cited by 6
Regular strength training and baseline fitness in overweight infantry members of Slovenian Armed Forces
Vodičar, M., Kovčan, B., Pori, P., Vodičar, J., Šimenko, J., Karpljuk, D., Marković, G., & Hadžić, V. (2020) · BMJ Military Health · doi:10.1136/bmjmilitary-2020-001451 · Cited by 5
The mediating role of adiposity in the longitudinal association between cardiorespiratory fitness and blood pressure in adolescents: LabMed cohort study
Beltran‐Valls, M. R., Santos, R., Mota, J. A. P. S., Moreira, C. M. M., Lopes, L., & Agostinis‐Sobrinho, C. (2020) · European Journal of Clinical Investigation · doi:10.1111/eci.13430 · Cited by 5
Determinants of Longitudinal Changes in Cardiometabolic Risk in Adolescents with Overweight/Obesity: The EVASYON Study
Martín‐Matillas, M., Rocha-Silva, D., Plaza‐Florido, A., Delgado‐Fernández, M., Martí, A., Miguel‐Etayo, P. D., Moreno, L. A., Marcos, A., & Campoy, C. (2022) · Nutrients · doi:10.3390/nu14153241 · Cited by 4
“Likewise, fitness may attenuate the adverse association between high body weight/adiposity and cardiometabolic risk in children and adolescents [34,52].”
Background
The effect of environmental estrogens exposure on oxidative stress and dyslipidemia, and their impact on insulin sensitivity
Riffee, J. N. J., Wade, M., Sine, T., Griffith, C., Benite‐Ribeiro, S. A., Haney, A. C., & dos Santos, J. M. (2022) · Obesity Medicine · doi:10.1016/j.obmed.2023.100503 · Cited by 5
Fat–Fit Patterns, Drug Consumption, and Polypharmacy in Older Adults: The EXERNET Multi-Center Study
Navarrete‐Villanueva, D., Gesteiro, E., Gómez‐Cabello, A., Mañas, A., Olivares, P. R., Villa, G., Gusi, N., González‐Gross, M., Ara, I., Vicente‐Rodríguez, G., et al. (2021) · Nutrients · doi:10.3390/nu13082872 · Cited by 4
“There is emerging evidence suggesting that improved physical fitness might counteract the negative consequences of high adiposity with respect to mortality risk [17,18].”
Background
Joint Associations of Obesity and Cardiorespiratory Fitness With Coronary Artery Calcium Composition: IS THERE EVIDENCE FOR FAT-BUT-FIT?
Jae, S. Y., Kim, H. J., Lee, K. H., Kunutsor, S. K., Heffernan, K. S., Choi, Y.-H., & Kang, M. (2022) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000631 · Cited by 4
The Longitudinal Association of Cardiorespiratory Fitness and Adiposity With Clustered Cardiometabolic Risk: A Mediation Analysis
Silveira, J. F. D. C., Brand, C., Welser, L., Gaya, A. R., Burns, R. D., Pfeiffer, K. A., Lima, R. A., Andersen, L. B., Reuter, C. P., & Pohl, H. H. (2023) · Pediatric Exercise Science · doi:10.1123/pes.2022-0073 · Cited by 4
Assessing the utility of cardiorespiratory fitness, visceral fat, and liver fat in predicting changes in insulin sensitivity beyond simple changes in body weight after exercise training in adolescents
Kuk, J. L., & Lee, S. (2020) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2020-0284 · Cited by 4
“However, the relative importance of CRF and obesity for insulin sensitivity, other health factors and mortality risk is not as clear and has been the topic of several studies (Kuk and Lee 2010; Mesa et al. 2006a; Ortega et al. 2018).”
Background
Influence of Adiposity on Physical Activity in Schoolchildren: The Moderator Role of Adherence to the Mediterranean Diet
López‐Gil, J. F., García‐Hermoso, A., Sentone, R. G., Caetano, C. I., Cavichiolli, F. R., & Lucas, J. L. Y. (2020) · Sustainability · doi:10.3390/su12166474 · Cited by 4
“The optimization of Mediterranean eating patterns could raise the level of PA and, consequently, children’s cardiorespiratory fitness, since, among other factors, regular PA and especially that of vigorous intensity seems to be the most efficient at acting as a successful instrument to mitigate the negative effects of…”
Background
‘ You’re basically naked’: a qualitative study of why girls drop out of sport in their teenage years
Ogden, J., McCourt, A., & Morgan, R. J. (2025) · Cogent Psychology · doi:10.1080/23311908.2025.2516316 · Cited by 4
“Further, whilst physical activity can help manage obesity (Bray et al., 2018) it is also key to protecting individuals living with obesity against coronary heart disease (cHD; ortega et al., 2018).”
The impact of exercise training on the obstructive sleep apnea endotypes
Beatty, C., Landry, S. A., Mann, D., Joosten, S. A., Collet, J., Ferreira-Silva, R., Ueno, L. M., GENTA, P. R., Hamilton, G. S., & Edwards, B. A. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.108740 · Cited by 3
Comparison of time-matched aerobic, resistance or combined exercise training in women living with obesity: a protocol for a pilot randomised controlled trial—the EXOFFIT (Exercise for Obesity in Females to increase Fitness) study
Davis, M. E., Blake, C. M., Cunningham, C., Carson, B. P., & O’Donoghue, G. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01003-5 · Cited by 3
“Noteworthy, however, is that women, particularly young women, are significantly less active than their male counterparts [19, 20, 24, 25].”
Background
Associations of midlife fitness and obesity profiles with cognitive function
Tait, J. L., Collyer, T. A., Gall, S., Venn, A., Dwyer, T., Fraser, B. J., Moran, C., Srikanth, V. K., & Callisaya, M. L. (2024) · European Journal of Sport Science · doi:10.1002/ejsc.12067 · Cited by 3
“There is evidence that moderate to high CRF may counteract negative effects of obesity on health outcomes, according to the ‘fat but fit’ paradox (Ortega et al., 2018).”
Background
Association of the combination of corporal adiposity and cardiorespiratory fitness with cardiometabolic risk factors in children — PREVOI Study
Pires, R. C., Martins, H. X., Barbosa, M. C. R., & Molina, M. D. C. B. (2025) · Revista Paulista de Pediatria · doi:10.1590/1984-0462/2025/43/2024105 · Cited by 4
Fitness, Weight Status and Executive Functions in Adolescents: A Cluster Analysis
Grao‐Cruces, A., Martín‐Acosta, F., Vaquero‐Solís, M., Hermosa, A. R., Camiletti‐Moirón, D., & Sánchez‐Oliva, D. (2025) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.70098 · Cited by 4
Moderate Exercise Training Combined With a High-Fat and Sucrose Diet Protects Pancreatic Islet Function in Male C57BL/6J Mice
Veras, K. M. D. A., Lucena, C. F., Goedcke, J., Evangelista, F. S., Carpinelli, Â. R., & Carvalho, C. R. D. O. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.881236 · Cited by 3
Lower adiponectin is associated with higher anthropometry and insulin resistance but not with low cardiorespiratory fitness in adolescents
Tadiotto, M. C., Corazza, P. R. P., de Menezes-Junior, F. J., Tozo, T. A. A., Lopes, M. D. F. A., Lopes, W. A., da Silva, L. R., Pizzi, J., Mota, J. A. P. S., & Leite, N. (2023) · Journal of Endocrinological Investigation · doi:10.1007/s40618-023-02145-w · Cited by 3
“…in adolescents lead to a more complex analysis, confirming the hypothesis of interaction “Fat but Fit” between adiposity and fitness suggesting that physical fitness may play a moderating role and attenuate the deleterious effects of overweight and the inflammatory process in adolescents [13, 48].”
Cardiorespiratory fitness attenuates the association between fatness and cardiometabolic risk in Chinese children
Zhang, P.-P., Wang, Y., Gu, J.-Y., Xu, M., Zhou, Y., Wang, H.-J., Lau, P. W. C., Wang, H., & Li, L. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1361447 · Cited by 3
“…suggests that the risk of all-cause and cardiovascular disease mortality in individuals with obesity but who are ﬁ t (i.e., having CRF levels above the age-speci ﬁ c and sex-speci ﬁ c 20th percentile) is not signi ﬁ cantly different from that of their normal-weight and ﬁ t counterparts (39).”
Background
“I Don’t Approve of a Fat Person…”: A Cross-Sectional Survey Exploring the Perceptions of Health, Weight and Obesity
Beaumont, J. D., Reimann, T., Wyld, R., & O’Hara, B. (2025) · Obesities · doi:10.3390/obesities5030049 · Cited by 3
The fat but fit paradox: what do we know in women with heart disease
Jin, K. (2022) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwac057 · Cited by 3
Fat but Fit: How physical fitness can mitigate the cardiovascular risks of
Khalid, Z., Siddiqi, F. A., Sadiq, T., & Rathore, F. A. (2023) · Journal of the Pakistan Medical Association · doi:10.47391/jpma.24-07 · Cited by 2
Body mass index and a body shape index: Individual and interactive predictors of all-cause and cardiovascular mortality risk in depression
Wei, S., Xu, M., Pan, X., Xiao, Y., & Wei, J. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116907 · Cited by 2
Training Modality and Aerobic Fitness in Active Duty U.S. Marines
Potter, A. W., Tharion, W. J., Hancock, J. W., Looney, D. P., & Friedl, K. E. (2026) · Military Medicine · doi:10.1093/milmed/usag194 · Cited by 2
Modeling and Analysis Method of National Fitness Big Data for Basketball Projects Based on a Multivariate Statistical Model
Zhao, Q. (2022) · Security and Communication Networks · doi:10.1155/2022/2591633 · Cited by 2
Retracted
Associations of cardiorespiratory fitness and body mass index with incident restrictive spirometry pattern
Saavedra, J. M., Brellenthin, A. G., Song, B. K., Lee, D.-C., Sui, X., & Blair, S. N. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-106136 · Cited by 2
“[14] Furthermore, being ‘unfit and normal weight’ may be insufficient to preserve health, which appears to be an increasingly accepted trait of the ‘fat-but-fit’ phenotype,[14] and is a notion supported by our joint CRF/BMI analyses (Figure 1).”
BackgroundResultSelf-citation
A latent profile analysis based on diet quality and eating behaviours in participants of the PREDISE study characterized by a higher BMI
Boulanger, B., Bégin, C., Bédard, A., Lévy-Ndejuru, J., Carbonneau, É., & Lemieux, S. (2024) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2023-0443 · Cited by 3
Evaluando la paradoja “Fat but Fit” en el rendimiento cognitivo y logro académico de los adolescentes: Un análisis de clases latentes – Proyecto Cogni-Acción
Espinoza‐Puelles, J. P., Martínez‐Flores, R., Peña‐Jorquera, H., Lizana, P. A., Brand, C., Mello, J. B., & Cristi‐Montero, C. (2024) · Journal of Teaching in Physical Education · doi:10.1123/jtpe.2024-0102 · Cited by 2
[Comparative research on the relationship between body mass index and physical fitness index among the Uygur, Kazakh and Han ethnic college students].
Li, W., & Tuerdi, Z. (2024) · PubMed Central · doi:10.19723/j.issn.1671-167x.2024.03.006 · Cited by 1
Independent and joint association of fat‐to‐muscle mass ratio and cardiorespiratory fitness with type 2 diabetes mellitus incidence: A prospective cohort study
Zhou, H., Wang, Y., Song, X., Xu, T., Xia, C., Guo, Y., Weng, S., Gong, J., & Wang, F. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70217 · Cited by 3
“16,17 20 Therefore, integrating FMR (reflecting body composition) with CRF (indicating functional capacity) may provide a more comprehensive pathophysiological understanding and superior risk stratification for T2DM, potentially identifying high-risk individuals not fully captured by BMI-based…”
Glucose Homeostasis Remains Normal in a Physically Active Military Population
Potter, A. W., Jacques, J. I., Chapman, C. L., Tharion, W. J., Looney, D. P., & Friedl, K. E. (2025) · Military Medicine · doi:10.1093/milmed/usaf512 · Cited by 1
Metabolic flexibility in mammalian hibernation
Bertile, F. (2026) · Cahiers de Nutrition et de Diététique · doi:10.1016/j.cnd.2026.07.004 · Cited by 1
Vasomotor Symptoms, Cardiovascular Risk and the Role of Physical Activity in Midlife Women
Nilsson, S. (2023) · Linköping University medical dissertations · doi:10.3384/9789180752619 · Cited by 1
Exploring the acceptability of three time‐matched exercise interventions for increasing fitness in women living with obesity: A mixed‐methods evaluation of the EXOFFIT study
Davis, M. E., Cunningham, C., Blake, C. M., & O’Donoghue, G. (2024) · Obesity Science & Practice · doi:10.1002/osp4.70003 · Cited by 1
Joint Associations Between Cardiorespiratory Fitness, Adiposity, and Mortality in Cardiac Outpatients Within a Secondary Prevention Program
Raisi, A., Piva, T., MYERS, J. N., Zerbini, V., Menegatti, E., Masotti, S., Grazzi, G., Mazzoni, G., & Mandini, S. (2025) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000945 · Cited by 1
Spiroergometric assessment of cardiorespiratory fitness in subjects with severe obesity: A challenge of reference
Wilms, B., Ernst, B., Schmid, S. M., Thurnheer, M., Weisser, B., & Schultes, B. (2019) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2019.07.014 · Cited by 1
An NP's guide to current physical activity recommendations
Hudson, G. M., Hauff, C., Hayes, K. N., & Fruh, S. (2020) · The Nurse Practitioner · doi:10.1097/01.npr.0000694708.74213.53 · Cited by 1
“In fact, adults who are aerobically fi t and overweight or obese have a lower mortality risk than adults who are sedentary and normal weight.(16,17) Emerging research suggests that having a high cardiorespiratory fi tness level might attenuate some of the negative metabolic health consequences of adolescent obesity as…”
Background
Plasma Interleukin-10 and Cholesterol Levels May Inform about Interdependences between Fitness and Fatness in Healthy Individuals
Sartor, F., Moore, J. P., & Kubis, H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18041800 · Cited by 1
“This present study embraces artificial intelligence as a tool to provide new insight into the fat but fit paradox [8].”
BackgroundMethod
Exercise across the lifespan: Exercise and obesity
Friedman, D. J., & Brukner, P. D. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-89843-0.00004-0 · Cited by 1
Fitness Is More Important than Adiposity in Women
Lavie, C. J., Elagizi, A., & Ozemek, C. (2019) · Journal of Women s Health · doi:10.1089/jwh.2019.8148
Self-citation
Adult Food Insecurity is Associated with Heavier Weight Preferences among Black Women
Reesor-Oyer, L. M., Marroquin, N. G., & Hernandez, D. C. (2019) · Health Behavior Research · doi:10.4148/2572-1836.1066
“Research indicates that fitness is a better indicator of cardiovascular disease risk than weight status (Ortega, Ruiz, Labayen, Lavie, & Blair, 2018).”
Impact of Exercise on Cardiovascular Risk Factors: Obesity
Elagizi, A., Kachur, S. M., & Lavie, C. J. (2020) · Springer eBooks · doi:10.1007/978-3-030-35374-2_39
Self-citation
The Weight of Medical Authority: The Making and Unmaking of Knowledge in the Obesity Epidemic
Rogers, J. H. (2018) · eScholarship (California Digital Library)
Glucose control, cardiorespiratory fitness, and dietary composition in healthy men.
Moller, J. C. (2020) · SUNScholar (Stellenbosch University)
漢代の察擧制度科目「明經」の性格
西川, 利. (1994) · Kyoto University Research Information Repository (Kyoto University) · doi:10.14989/154496
Η επίδραση της διαλειμματικής προπόνησης υψηλής έντασης σε παράγοντες σωματικής κατάστασης σχετιζόμενοι με την υγεία
Tsirigkakis, S. (2022) · doi:10.12681/eadd/52092
The effect of environmental estrogens exposure on oxidative stress and dyslipidemia, and their impact on insulin sensitivityPreprint
Riffee, J. N. J., Wade, M., Sine, T., Griffith, C., Benite‐Ribeiro, S. A., Haney, A. C., & dos Santos, J. M. (2022) · Research Square · doi:10.21203/rs.3.rs-2176193/v1
Importance of Optimizing Cardiorespiratory Fitness in Early Adulthood and Through Midlife
Florez, H. J., Cobbs, J., & Gregoski, M. J. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.3637
BMI (35-39.9 kg/m2) is associated with a significantly lower risk of cardiovascular morbidity compared with a normal BMIPreprint
Hong, M., Chang, Y., Jiang, P., Sun, L., Ma, Y.-T., Ma, X., & Yuan, Q. (2023) · Research Square · doi:10.21203/rs.3.rs-2645520/v1
Il cambiamento che possiamo ottenere produce effetti clinicamente rilevanti?
Pugliese, G. (2023) · il Diabete · doi:10.30682/ildia2301b
Associations among metabolic health, weight status, and various physical fitness components in Japanese adolescents: a cross-sectional study (NICE EVIDENCE study- Agano 3)
Morikawa, S. Y., Takeda, Y., Fujihara, K., Ikeda, I., Kobayashi, A., Hatta, M., Mitsuma, Y., Horikawa, C., Ishiguro, H., Yamada, T., et al. (2023) · Journal of Sports Sciences · doi:10.1080/02640414.2023.2268358
“However, it is unclear whether PF can reduce cardiometabolic risk factors in children, regardless of weight status (Ortega et al., 2018).”
Background
Association of Gait Speed With Cognitive Outcomes in Older Adults With Hypertension: A Secondary SPRINT MIND Analysis
Mirzai, S., Volk, M. C., Kazibwe, R., Gabani, M. H., Schaich, C. L., Hammonds, R., Seals, A. L., Singleton, M. J., Yeboah, J., Shapiro, M. D., et al. (2025) · Journal of Aging and Physical Activity · doi:10.1123/japa.2024-0152
Generational differences in associations between health conditions in young women and BMI categories
Dobson, A. J., Liang, C., & Mishra, G. D. (2025) · Obesity · doi:10.1002/oby.24304
comparative study of fitness levels, physical health, and mental well-being among students at Mohamed Boudiaf University
Laidi, A., Bakri, A., Djerioui, M., Bouadjila, O., Laidi, Y., & Gorgan, C.-M. (2025) · Sustainability and Sports Science Journal · doi:10.55860/fzqn4474
Physical Activity, Body Mass Index, and Bullying in Higher Education: A Comparative Analysis of Students with and Without Structured Sports Training
Mijaică, R., & Balint, L. (2025) · Healthcare · doi:10.3390/healthcare13182304 · Cited by 1
“The so-called “fat-but-fit paradox” describes individuals with high BMI but good physical fitness who show greater resilience to victimization [17].”
Additional file 4 of Motivations to exercise in young men following a residential weight loss programme conducted in National Service - a mixed methods study
Gorny, A. W., Low, M. C., Sayampanathan, A. A., Shiraz, F., & Müller‐Riemenschneider, F. (2021) · Figshare · doi:10.6084/m9.figshare.14053368
Additional file 1 of Associations of combined physical activity and body mass index groups with colorectal cancer survival outcomes
Himbert, C., Ose, J., Gigic, B., Viskochil, R. H., Santuci, K., Lin, T., Ashworth, A., Cohan, J. N., Scaife, C. L., Jedrzkiewicz, J., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22622716
Additional file 3 of Motivations to exercise in young men following a residential weight loss programme conducted in National Service - a mixed methods study
Gorny, A. W., Low, M. C., Sayampanathan, A. A., Shiraz, F., & Müller‐Riemenschneider, F. (2021) · Figshare · doi:10.6084/m9.figshare.14053365
Additional file 1 of Motivations to exercise in young men following a residential weight loss programme conducted in National Service - a mixed methods study
Gorny, A. W., Low, M. C., Sayampanathan, A. A., Shiraz, F., & Müller‐Riemenschneider, F. (2021) · Figshare · doi:10.6084/m9.figshare.14053359
Additional file 2 of Motivations to exercise in young men following a residential weight loss programme conducted in National Service - a mixed methods study
Gorny, A. W., Low, M. C., Sayampanathan, A. A., Shiraz, F., & Müller‐Riemenschneider, F. (2021) · Figshare · doi:10.6084/m9.figshare.14053362
Effect of a 1-year supervised exercise intervention on long-term mortality in people with type 2 diabetes
Balducci, S., Haxhi, J., Vitale, M., Mattia, L., Calvi, F., Marini, M., Ciocca, E., Auccello, F., Gentile, A., Bollanti, L., et al. (2026) · Acta Diabetologica · doi:10.1007/s00592-026-02665-w
“…and sedentary behavior on survival are at least partly mediated by physical fitness [ 7 ], which is strongly influenced by the level of PA [ 8 ] and was also found to be inversely and independently associated with mortality [ 9, 10 ] and to mitigate the negative impact of fatness on health [ 11 ].”
PERCENTILE VALUES FOR MUSCULAR STRENGTH FIELD TESTS FOR MACEDONIAN STUDENTS AGED 6–14 YEARS
Jakimovski, M., Georgiev, G. D., & Gontarev, S. (2025) · RESEARCH IN PHYSICAL EDUCATION SPORT AND HEALTH · doi:10.46733/pesh25141133j
COMPARISON OF SEVERAL ADIPOSITY RELATED ANTHROPOMETRIC INDICES IN PREDICTING MUSCULAR FITNESS IN SCHOOLCHILDREN
Berisha, K., Ganiu, V., & Stardelova, M. D. (2025) · RESEARCH IN PHYSICAL EDUCATION SPORT AND HEALTH · doi:10.46733/pesh2514211b
A Data-Driven Approach to Cardiometabolic Risk Stratification: Development of the Adiposity-Fitness Imbalance Index Using a National Chilean Dataset
Yáñez-Sepúlveda, R., Tornero-Aguilera, J. F., Muñoz-López, M., Sancho-Haro, E. S., Concha‐Cisternas, Y., García-Carrillo, E., Páez‐Herrera, J., Montalva-Valenzuela, F., & Guzmán-Muñoz, E. (2026) · Data · doi:10.3390/data11050108
“A systematic review and meta-analysis demonstrated that individuals with higher cardiorespiratory fitness present a lower cardiometabolic risk regardless of fatness status; however, those who are both unfit and obese exhibit the highest risk profiles [28].”
Joint associations of cardiorespiratory fitness and adiposity with depressive symptoms in female university students: a cross-sectional analysis
Gutierrez-Garcia, M., Oscoz-Ochandorena, S., Izquierdo, M., & Ramírez‐Vélez, R. (2026) · Mental health and physical activity · doi:10.1016/j.mhpa.2026.100780
Exploring the moderating role of physical fitness on cardiometabolic risk in Chilean adolescents
Sepulveda, R. A. Y., de Souza-Lima, J., Guillermo-Cortés-Roco, Guzmán-Muñoz, E., Concha‐Cisternas, Y., García-Carrillo, E., Arancibia, J. E. O., Reyes-Amigo, T., Almonacid, J. G. H., Zavala-Crichton, J. P., et al. (2026) · Sport Sciences for Health · doi:10.1007/s11332-026-01720-x
“This is supported by Ortega et al., who found that individuals with low levels of cardiorespiratory fitness have a higher risk of all-cause and cardiovascular mortality compared to those who are at least moderately fit [16], by attenuating the association between BMI and WHtR [23, 24].”
Distribution of Muscle Mass and Fat Mass to Identify the Risk of Sarcopenia and Sarcopenic Obesity in Adults via Machine Learning
Sepulveda, R. A. Y., Giakoni-Ramírez, F., Alarcón-Cortés, J. P., Uribe, J. D. P., Becerra-Patiño, B. A., Guzmán-Muñoz, E., Aguilera-Martínez, N., Clemente‐Suárez, V. J., & López‐Gil, J. F. (2026) · Healthcare · doi:10.3390/healthcare14121746
“They also reported that adiposity is not invariably associated with an increased risk of sarcopenia, particularly in individuals with relatively preserved lean mass and adequate muscular fitness, a phenomenon related to the ‘fat but fit’ paradox [43,44].”
Longitudinal trajectories of physical fitness in Chinese college students: a multi-group latent growth curve analysis
Jiang, M., & He, Z. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1917457
Sex‐Stratified Associations of DXA ‐Derived Adiposity, Regional Fat Distribution and Muscle Power With Incident Hospitalised Cardiovascular Disease in Older Adults: A Prospective Cohort Study
Zhang, T., Gao, Y., Wu, Y., Leung, J. C. S., & Kwok, T. C. Y. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71360
(ii) Full length article/Research paper Physical fitness attenuates the association between body mass index and academic performance in adolescents: the fat–but–fit paradox in the EHDLA Study
Muñoz‐Pardeza, J., Sepulveda, R. A. Y., Miño, C., Ezzatvar, Y., Montenegro-Espinosa, J. A., Ridgell, L., Royo, J. M. P., Muñoz-López, M., Yon, D. K., & López‐Gil, J. F. (2026) · Journal of Exercise Science & Fitness · doi:10.1016/j.jesf.2026.200531

Authors: Ortega, F. B., Ruiz, J. R., Labayen, I., Lavie, C. J., & Blair, S. N.
Affiliations: Universidad de Granada (ES)
University of the Basque Country (ES)
The University of Queensland (AU)
University of South Carolina (US)
Corresponding author: Ortega, Francisco B
ORCID: Ortega, Francisco B
Ruiz, Jonatan R
Labayen, Idoia
Lavie, Carl J
Blair, Steven N
Venue: British Journal of Sports Medicine
Publisher: BMJ
Published: 2017-06-05
Volume: 52
Issue: 3
Pages: 151-153
ISSN: 0306-3674 (ISSN-L)
1473-0480
DOI: 10.1136/bjsports-2016-097400
OpenAlex: W2622199341
Cited by: 179
References: 11
Citations by year: 2026: 10 · 2025: 15 · 2024: 12 · 2023: 31 · 2022: 26 · 2021: 23 · 2020: 28 · 2019: 11 · 2018: 19 · 2017: 3
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: British Journal of Sports Medicine (publishedVersion)
PubMed (publishedVersion)
Institutional Repository of the University of Granada (University of Granada) (submittedVersion, cc-by-nd)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords: cardiorespiratory fitness, obesity, all-cause mortality, cardiovascular mortality, body mass index, body fat percentage, waist circumference
MeSH terms: Cardiorespiratory Fitness, Cardiovascular Diseases, Health Status, Humans, Mortality, Obesity, Meta-Analysis as Topic, Exercise, Overweight

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

The Fat but Fit paradox: what we know and don’t know about it

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Self-check

Citations

Cites

Cited by

Related

Metadata

Record

About these checks