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Review
. 2021 Sep 20;24(10):102995.
doi: 10.1016/j.isci.2021.102995. eCollection 2021 Oct 22.

Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks

Glenn A Gaesser  1 , Siddhartha S Angadi  2
Affiliations
Review

Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks

Glenn A Gaesser et al. iScience. .

Abstract

We propose a weight-neutral strategy for obesity treatment on the following grounds: (1) the mortality risk associated with obesity is largely attenuated or eliminated by moderate-to-high levels of cardiorespiratory fitness (CRF) or physical activity (PA), (2) most cardiometabolic risk markers associated with obesity can be improved with exercise training independent of weight loss and by a magnitude similar to that observed with weight-loss programs, (3) weight loss, even if intentional, is not consistently associated with lower mortality risk, (4) increases in CRF or PA are consistently associated with greater reductions in mortality risk than is intentional weight loss, and (5) weight cycling is associated with numerous adverse health outcomes including increased mortality. Adherence to PA may improve if health care professionals consider PA and CRF as essential vital signs and consistently emphasize to their patients the myriad benefits of PA and CRF in the absence of weight loss.

Keywords: Nutrition; Obesity medicine; Physical activity.

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Conflict of interest statement

The authors declare no competing interests.

Figures

None
Graphical abstract
Figure 1
Figure 1
Weight loss futile cycle The increased prevalence of obesity during the past 40 years is associated with an increased prevalence of weight loss attempts.
Figure 2
Figure 2
Cardiorespiratory fitness, body mass index, and mortality risk Joint associations between cardiorespiratory fitness (CRF), body mass index (BMI), and all-cause (top) and cardiovascular disease (CVD) (bottom) mortality. Hazard ratios reflect the pooled data from the meta-analyses of Barry et al. for all-cause mortality (Barry et al., 2014) and cardiovascular disease mortality (Barry et al., 2018). For all-cause mortality, the meta-analysis included 6 cohorts of men only, 2 cohorts of women only, and 2 cohorts of both men (~80%) and women. For CVD mortality, the meta-analysis included 8 cohorts of men only and 1 cohort of both men (89%) and women. Vertical lines for each bar represent 95% confidence intervals. Normal weight (BMI = 18.5-<25.0 kg/m2) and Fit is the referent group. Overweight = BMI 25.0-<30.0 kg/m2, and obese = BMI ≥30 kg/m2. “Fit” includes the top 75%–80% of age-adjusted CRF distribution. See text for details.
Figure 3
Figure 3
Intentional weight loss and mortality risk Meta-analyses of the association between intentional weight loss and risk for all-cause mortality (top) and cardiovascular disease (CVD) mortality or major adverse coronary event (MACE) (bottom). Vertical lines for each bar represent 95% confidence intervals. For both top and bottom graphs, the different colored bars identify observational studies (red bars) and randomized control trials (RCTs) (blue bars).
Figure 4
Figure 4
Increases in physical activity are associated with reduced mortality risk Observational studies showing the association between increases in physical activity (PA) and relative risks for all-cause mortality (top) and cardiovascular disease (CVD) mortality or coronary event (bottom). Vertical lines for each bar represent 95% confidence intervals. In studies where confidence intervals were not provided, p values are indicated. For Manson et al. (Manson et al., 1999) the p value represents the trend from lowest PA increase to highest PA increase categories. MVPA = Moderate-to-Vigorous PA.
Figure 5
Figure 5
Increasing cardiorespiratory fitness status is associated with reduced mortality risk Observational studies showing the association between increases in cardiorespiratory fitness (CRF) status and relative risks all-cause mortality (top) and cardiovascular disease (CVD) mortality or stroke (bottom). Vertical lines for each bar represent 95% confidence intervals. Increases in CRF status were generally defined as improving CRF by enough to no longer be in the “least fit” category of CRF.
Figure 6
Figure 6
Increases in cardiorespiratory fitness are associated with reduced mortality risk Observational studies showing the association between increases in cardiorespiratory fitness (CRF) and relative risks of all-cause mortality (top) and cardiovascular disease (CVD) mortality or major adverse coronary event (MACE) (bottom). Vertical lines for each bar represent 95% confidence intervals. For both top and bottom graphs the different colored bars represent risk reduction per 1-MET increase in CRF (orange bars) or per 1 mL/kg/min increase in CRF (green bars). MET = metabolic equivalent of resting metabolism, ~3.5 mL/kg/min.
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