Now Reading: The Obesity Paradox – should lack of physical fitness be considered a medical emergency?

My answer to the above is yes. I have told people at the Center for Total Health (@kptotalhealth) that I consider a patient who presents to their doctor without any physical activity a medical emergency. I get looks of surprise when I say this, sometimes a slight chuckle.

In preparation for October’s Mobility Lab (@MobilityLabTeam) Lunch and Learn (see: Health and Transportation Connect During “Lunch At the Lab” — Mobility Lab), I followed up on the wisdom of our Bob Sallis, MD, who has been writing about “The Obesity Paradox.”

Here’s what he’s said recently: Active Voice: The AMA Says Obesity is a Disease; Now We Need to Inform Them How to Best Treat It, and the figure above is what I created for the presentation (which I’ll post about separately).

Bob passed me this paper, which shows, in a study of 14,345 men, assessed over 7 years, that weight was not associated with death. Level of physical activity is, across all weights.

I have believed that lack of physical activity is a medical emergency long before this study. There are several reasons for this. Before I say what those are for me, I’ll see if you agree or what you think of this concept – post in the comments, or on your favorite social network, please…

Slide above adapted for social network clarity, from PPT Slides of All Figures from the study above.


Ted, this is AMAZING and so important.

You seem to clearly be saying that activity is equivalent to fitness. Intuitively that makes sense but could you connect the dots with some evidence? I know I’ll be asked when I quote this (which I will).

I don’t mean to be lazy but you’ve blogged enough on this that it’d be challenging to home in on the specific posts that will answer the question.

Hey Dave,

Sure, the evidence is in the paper linked above. Also check out the editorial that Bob Sallis wrote also above – he references several studies that are linked and he’s a national expert in this.

And also, this just feels better and more human-centric. Being told you are ill with a disease that whose control seems intractable (obesity) vs one that you can control starting almost immediately (becoming active) lends to more empowerment. And it turns out, more health,


Hi Ted – I finally got around to following up on this.

Assuming the paper you mean is the link under the graph, I’m still left with my question.

The conclusion says:

“Maintaining or improving fitness is associated with a lower risk of all-cause and CVD mortality in men. Preventing age-associated fitness loss is important for longevity regardless of BMI change.”

That links fitness (treadmill test) to mortality. But you blogged about *activity*, and I asked if there’s evidence linking *activity* to fitness.

As I said, a link is intuitively obvious, but I always get people asking me about evidence, so I’m askin’.

Hey Dave,

You’re asking a very simple question as a patient that physicians take for granted, which is why we’re all important here :).

The answer is yes. Another way to ask it is, “Is there any other way to maintain your fitness other than physical activity?” Not that I know of.

If it helps you can consult the authors’ earlier study from 1995 where they state:

“Men who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease during follow-up than persistently unfit men. Physicians should encourage unfit men to improve their fitness by starting a physical activity program.”

Go forth and promote physical activity. If anyone doubts that this is good for health, send them our way, always here to support you,


Last night Ginny was watching “NCIS LA” and in a frivolous side plot one character said “Have you see that study? Sitting too much can kill you!”

I’m especially intrigued by the things you’ve posted about the difference between sitting and simply standing!

Ted Eytan, MD