Another study exploring the relationship between being fat, being fit, and living longer has found that lower fitness is an independent predictor of all-cause mortality, even after adjustment for adiposity. In the study, obese subjects who were fit had a lower risk of dying than normal-weight subjects who were physically inactive.

"It may be possible to reduce all-cause death rates among older adults, including those who are obese, by promoting regular physical activity on most days of the week which will keep most individuals out of the low-fitness category," the authors, led by Dr Xuemei Sui (University of South Carolina, Columbia), write in the December 5, 2007 issue of the Journal of the American Medical Association.

The study tracked a cohort of 2603 adults aged 60 or over for a mean of 12 years, during which time 450 people died. Adjusted death rates were lowest for people with the lowest body-mass index (BMI), lowest waist circumference, or in the highest quintile for fitness level — this last that held true even in severely obese subjects, who were much less likely to die if their fitness levels were higher. When fitness was factored into the waist circumference analysis and vice versa, fitness predicted mortality risk regardless of smoking, baseline health, BMI, waist circumference, or percent body fat, whereas waist circumference was no longer significantly associated with increased mortality after fitness was considered.

"Normal-weight individuals in our study had greater longevity only if they were physically fit; furthermore, obese individuals who were fit did not have increased mortality," the authors conclude.

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