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Journal of Obesity
Volume 2012 (2012), Article ID 951582, 6 pages
Clinical Study

The Obesity Paradox and Cardiorespiratory Fitness

1Department of Human Performance and Sport Sciences, Winston-Salem State University, C024 Anderson, 601 S Martin Luther King Jr Drive, Winston-Salem, NC 27110, USA
2Department of Physical Therapy, Winston-Salem State University, Winston-Salem, NC 27110, USA
3Department of Cardiology, Division of Cardiovascular Medicine, Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, CA 94304, USA

Received 25 October 2011; Accepted 8 December 2011

Academic Editor: Carl J. Lavie

Copyright © 2012 Paul A. McAuley et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Cardiorespiratory fitness as an explanation for the obesity paradox warrants further examination. We evaluated independent and joint associations of cardiorespiratory fitness and adiposity with all-cause mortality in 811 middle-aged (age, 5 3 . 3 ± 7 . 2 years) male never smokers without documented cardiopulmonary disease or diabetes from the Veterans Exercise Testing Study (VETS). Cardiorespiratory fitness was quantified in metabolic equivalents (METs) using final treadmill speed and grade achieved on a maximal exercise test. Subjects were grouped for analysis by METs: unfit (lowest third) and fit (upper two-thirds); and by body mass index (kg/m2): nonobese (18.5−29.9) and obese (≥30.0). Associations of baseline fitness and adiposity measures with all-cause mortality were determined by Cox proportional hazards analysis adjusted for age, ethnicity, hypertension, hypercholesterolemia, family history of coronary artery disease, and cardiovascular medication use. In multivariate analysis, mortality risk for obese/fit men did not differ significantly from the nonobese/fit reference group. However, compared to the reference group, nonobese and obese unfit men were 2.2 ( 𝑃 = 0 . 0 1 ) and 1.9 ( 𝑃 = 0 . 0 3 ) times more likely to die, respectively. Cardiorespiratory fitness altered the obesity paradox such that mortality risk was lower for both obese and nonobese men who were fit.