Health

Solution to fit vs. fat debate: Exercise more

Two medical studies stress an active lifestyle, as well as eating right, is vital for good health.

How fit you are is a better predictor of whether you will have a heart attack than how fat you are, says a study published in today's Journal of the American Medical Association.

But it's fatness, not fitness, that more accurately predicts whether you will get diabetes, says a second study, also in today's journal.

Which one is right? Is it okay to have that second doughnut? Or to sack out on the couch?

Neither, actually. Scientists say the studies have different results, but a single solution: exercise. Exercise cuts heart attack risk in the first study, and it helps with weight loss, the goal in the second, says Steven Blair, president and CEO of the Cooper Institute and author of an editorial in today's journal about the conflicting results.

"To some extent, the continuing fit vs. fat debate will keep us academics amused for some little while, I expect," he said. "But the important issue is to try to get sedentary people to become active."

Go forth and jog, America.

Over the past year, health officials have sounded off, with increasing alarm, about the nation's obesity epidemic. About 65 percent of American adults are overweight, and 30 percent are obese. But too much of the debate, these scientists say, has focused on food - whether the problem is fat or carbs or the all-you-can-eat fast food fest that is modern America.

"It's been the medical message that obesity is an epidemic," said Dr. Timothy R. Wessel, cardiologist at the University of Florida and lead author of the heart study. "But it seems the general public's interpretation of that is, "Oh, I need to lose weight through Atkins or South Beach,' instead of going out and jogging or Rollerblading. Everybody wants to drop pounds fast."

Blair agrees that obesity has reached epidemic levels. But he thinks people have focused too much on food as the culprit.

"Inactivity tends to play second place when people talk about causes," he said. "It seems much more people want to talk about supersizing ... and people are gluttons, and so on."

Most Americans don't get enough exercise - and national surveys show they haven't for years. But Blair suspects that people also have gotten heavier because they're less active in more subtle ways. Copying a file means pressing a computer key, not walking papers to a copier. Cooking is opening the microwave, not chopping and stirring.

"I think people are simply spending more time sitting than they did 15 or 20 years ago," he said.

Others were more cautious about the effect of activity. Gary Foster, clinical director of the Weight and Eating Disorders Program at the University of Pennyslvania School of Medicine, said Blair "nails" the importance of encouraging fitness.

"We ought to increase our efforts to get people of all sizes, but particularly those who are overweight ... to increase their fitness level," he said.

But Foster said scientists also need to realize how hard it is for people to stick to a new exercise program, and that people generally need to change their diet, not just exercise, to drop lots of pounds.

"If you're looking for weight loss," he said, "physical activity is not going to do it by itself."

Dr. H. James Brownlee, chairman of family medicine at the University of South Florida College of Medicine, wears a pedometer to measure his steps every day so he can show it to patients.

"We've got to get people just using stairs, parking further away," he said. "I tell people, you don't have to do aerobics. Just walk around the block."

But Brownlee, who also started USF's Pre-Diabetes Center, cautioned that activity isn't enough, especially for diabetics.

"It's a puzzle and it's got two sides," he said. "It's got a dietary side and a physical activity side."

Both sides are important to Tampa mother JoEllen Archerd, 47, and daughter Lauren, 20. JoEllen's mother was diagnosed three weeks ago with heart disease, giving the pair extra motivation for a brisk neighborhood walk Tuesday.

"The older I get, the more important it is to me," JoEllen Archerd said of her exercise routine. "I'm watching my parents age, and the problems they're facing, and I want to avoid it if possible."

Both women walk and lift weights. Lauren Archerd runs as well.

Heart health is one reason St. Petersburg resident Mike Wilbur, 26, runs and lifts weights. His grandfather had a heart attack.

"I run to keep my weight down and to stay healthy," he said as he left his gym Tuesday. "A lot of studies say weight (is important), but cardiovascular exercise keeps your vessels clear."

But Wilbur thinks Americans also need to pay more attention to what they eat.

"People eat on the go, eat bad processed foods that aren't good for you," he said.

In the heart study, researchers studied 936 women who already had chest pain or other heart disease symptoms. They measured the women's weight compared to height, or body mass index. They asked questions to measure activity levels, and some women also ran on treadmills.

After four years, 38 percent had further heart problems, ranging from chest pain to heart attacks and death. The overweight women were more likely to have risk factors, such as high blood pressure, for heart disease. But, surprisingly, they were not any more likely to have more heart problems.

However, the women who were less fit had a 46 percent increased risk of heart problems during the study - even if they were not overweight.

Other studies have linked weight to heart disease, Wessel stressed.

"Obesity is an established risk factor," he said. "We're not trying to say that weight is not important."

The second study surveyed more than 37,000 women participating in another ongoing research effort, the Women's Health Study. It evaluated their weight and fitness levels, and followed them for more than six years. Over time, 1,361 women developed diabetes. The heaviest group of women was 14 times more likely to get diabetes. Being more fit decreased the risk but only slightly.

"The message we would like people to take is that physical activity is very important with diabetes prevention, but we should think about physical activity in conjunction with weight loss," said Dr. Amy R. Weinstein, instructor at Harvard Medical School and lead author of the second study.

Although both studies evaluated women, researchers say similar studies indicate the results would apply to men as well.

Federal officials recommend:

ADULTS: Should engage in moderate-intensity physical activities for at least 30 minutes on five or more days of the week. Moderate activities include walking 3 to 41/2 mph, mowing the lawn, recreational swimming or bicycling 5 to 9 mph. Or adults should engage in vigorous-intensity physical activities for at least 20 minutes on three or more days per week. Vigorous activities include walking 5 mph or faster, jogging, aerobic dancing, swimming laps or bicycling 10 mph or faster.

TEENS: Should be physically active daily, or most days, as part of play, games, sports, work or other activities. They should engage in moderate to vigorous activities for at least 20 minutes at a time at least three times a week.

ELEMENTARY SCHOOL CHILDREN: Should accumulate at least 30 to 60 minutes of physical activity on all, or most, days of the week. Accumulating more than 60 minutes, up to several hours per day, is encouraged. Some activities each day should include moderate to vigorous activities lasting 10 to 15 minutes or more, with brief periods of rest. Children should not be sedentary for extended periods.

For more information: www.cdc.gov/nccdphp/dnpa/physical/index.htm

Source: Centers for Disease Control and Prevention

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