Fitness Over Thinness for Hearts

[Guest guest]

By Rob Stein

Being fit appears to be far more important than being thin for decreasing

the risk of heart disease, while the opposite seems to be the case for

diabetes, according to two new studies in women.

One study of more than 900 women with chest pain found that those who were

unfit were much more likely to have a heart attack or stroke than those who

were overweight. But the other, a study of more than 37,000 healthy nurses,

found that being fit did little to reduce the huge risk that overweight

women face of developing diabetes.

The new studies, published in today's Journal of the American Medical

Association, rekindled an intense debate over the relative risks and

benefits of being overweight vs. thin, fit vs. unfit.

" The public is going to throw up its hands in exasperation and say: 'I

can't get a straight story from you scientists. You're telling me to lose

weight. You're telling me to exercise. You're telling me that it doesn't

make any difference if I exercise. You're saying it doesn't make any

difference to lose weight,' " said Arthur , an obesity expert at

Washington University. " But no one is really saying that. The real answer

is: 'You should do both.' "

The seemingly conflicting findings may be the result of the different

diseases and populations of women that were studied, with weight perhaps

playing a greater role in diabetes and fitness possibly more important for

heart disease, and others said.

" Although closely linked, they are different diseases, and it may be the

relative importance of different risk factors will vary between them, " said

Lawrence J. Cheskin, director of the s Hopkins Weight Management Center.

" The bottom line still is it would be wisest to assume that both body weight

and body fat distribution and fitness are risk factors for both diabetes and

heart disease. "

With the number of Americans who are overweight and obese increasing

rapidly, public health authorities have been warning that the nation is

facing a major public health crisis. But some researchers have been arguing

that the health risks of being overweight have been exaggerated, and that a

growing body of evidence suggests that being sedentary and unfit is a far

greater problem.

In the first new study, researchers examined 906 women participating in the

Women's Ischemia Syndrome Evaluation (WISE) study.

On average, women who were deemed unfit based on their activity levels were

significantly more likely to have blocked arteries at the beginning of the

study and to go on to suffer a heart attack, stroke or some other serious

cardiovascular problem over the next four years, the researchers found.

Those who were overweight but relatively fit did not have a significantly

elevated risk once researchers accounted for other risk factors, such as

diabetes, high cholesterol or high blood pressure.

" For this group of women, their fitness level was much more important than

their weight, " said R. Wessel of the University of Florida College

of Medicine in Gainesville, who led the research. " We wouldn't say your

weight doesn't matter -- obesity has been established as a known risk factor

for heart disease. But, at least for this group of women, their fitness

level mattered a whole lot more. "

The findings indicate that people who are concerned about their hearts need

to make sure they are physically active, Wessel said.

" You need to be out increasing your fitness level and getting back in

shape, not just dropping pounds, " Wessel said.

Physical activity and fitness may decrease the risk for heart disease

through a variety of mechanisms, including lowering blood pressure and

cholesterol and reducing inflammation inside the body, he said.

In the second study, a team led by Amy R. Weinstein of the Beth Israel

Deaconess Medical Center in Boston and colleagues studied 37,878 women in

the Women's Health Study.

Over an average of seven years, women who were overweight were dramatically

more likely to develop diabetes, with their fitness levels appearing to

affect that risk only minimally, the researchers found.

" For diabetes, it looks like being fit does not counter the increased risk

of being overweight, " Weinstein said.

But proponents of the importance of fitness over fatness said the heart

study supports emphasizing exercise because it is a much more realistic goal

for many people.

" It is far easier to get a fat person fit then it is to get a fat person

thin, " said Glenn A. Gaesser, a professor of exercise physiology at the

University of Virginia. " That is really the bottom line. Trying to lose

weight and keep it off is, if not darn near impossible, then close to it. "