Does the fat-but-fit paradigm hold true for all-cause mortality when considering the duration of overweight/obesity? Analyzing the WATCH (Weight, Activity and Time Contributes to Health) paradigm

Background: Physical activity has been shown to attenuate the association between overweight/obesity and mortality. Much less is known, however, on how the duration of overweight/obesity potentially alters this association, which was the purpose of this study.

Methods: The 1999-2006 NHANES was used and 11,057 adults (ages 36-85) were evaluated. Eight mutually exclusive groups were created: (1) physically active, normal weight now and 10years ago; (2) physically inactive, normal weight now and 10years ago; (3) physically active, overweight/obese now but normal weight 10years ago; (4) physically inactive, normal weight now but overweight/obese 10years ago; (5) physically active, overweight/obese now but normal weight 10years ago; (6) physically inactive, overweight/obese now but normal weight 10years ago; (7) physically active, overweight/obese now and 10years ago; and (8) physically inactive, overweight/obese now and 10years ago.

Results: After adjustments, only those individuals that were inactive were at a significantly increased risk for all-cause mortality independent of overweight/obesity status (Groups 2, 4, 6, 8).

Conclusion: In alignment with the Exercise is Medicine initiative®, our results provide support for clinicians to perform routine assessments of physical activity, and to further promote physical activity among all individuals regardless of body mass status.