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 accessAbstract
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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“which can, at medium to high fitness levels, attenuate the adverse consequences of obesity on health, irrespective of body mass index (BMI). 5 , 6 , 7”
From What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis (2021) · cites this paper as [5]
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Cites
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-citationRoss, 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-citationObesity 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-citationReference 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
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-citationRuiz, 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-citationKaminsky, 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
DuBose, K. D., Eisenmann, J. C., & Donnelly, J. E. (2007) · PEDIATRICS · doi:10.1542/peds.2007-0443 · Cited by 156
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-citationA 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
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An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases
Elagizi, A., Kachur, S. M., Lavie, C. J., Carbone, S., Pandey, A., Ortega, F. B., & Milani, R. V. (2018) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2018.07.003 · Cited by 718
Self-citationTomkinson, G. R., Carver, K. D., Atkinson, F., Daniell, N., Lewis, L. K., Fitzgerald, J. S., Lang, J. J., & Ortega, F. B. (2017) · British Journal of Sports Medicine · doi:10.1136/bjsports-2017-098253 · Cited by 501
Self-citationHealthy Weight and Obesity Prevention
Lavie, C. J., Laddu, D., Arena, R. A., Ortega, F. B., Alpert, M., & Kushner, R. F. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.08.1037 · Cited by 480
“In addition, there is consistent evidence supporting that a sizeable subset of the individuals with obesity can actually have a moderately to high CRF level, the so-called fat but fit paradox, which has consistently shown that being fit counteracts the negative consequences of obesity on CVD (52,53).”
BackgroundSelf-citationObesity and the risk of cardiometabolic diseases
Valenzuela, P. L., Carrera-Bastos, P., Castillo-García, A., Lieberman, D. E., Santos-Lozano, A., & Lucia, A. (2023) · Nature Reviews Cardiology · doi:10.1038/s41569-023-00847-5 · Cited by 452
Exercise in the management of obesity
Petridou, A., Siopi, A., & Mougios, V. (2019) · Metabolism · doi:10.1016/j.metabol.2018.10.009 · Cited by 317
Metadata
- 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
- 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
- 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
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