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Lack of excercise worse than obesity? PDF Print Email

Lack of exercise worse than obesity?

 

According to reports a lack of exercise is “worse for health than being obese”.  Experts believe that being unfit is the root cause of more illness than excess body fat.

 

There have been two opinion pieces published recently by medical experts with opposing views about how to improve public health and reduce the risk of major health problems, such as diabetes and heart disease.  One article suggests that health policy should focus entirely on increasing people’s physical activity rather than worrying about losing weight.  The other article argues that treatment to prevent and reduce obesity is crucial, and that radical changes to diet and lifestyle are needed.

Together, these arguments illustrate the dilemma behind forming public health policy, but they both endorse the fact that staying active and eating healthily are both important health goals for individuals to pursue.

 

The news comes from two opinion-based pieces debating the priorities for public health policies:

• The first is by Dr Richard Weiler, a specialist registrar in sport and exercise medicine at Charing Cross Hospital, London, and colleagues. He maintains that health policy should focus on fitness rather than losing weight.

• The second is by Associate Professor Timothy Gill, principal research fellow at the Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, and colleagues. He argues that health policy should focus on losing weight rather than fitness.

 

The opinion pieces were both published in the same issue of the peer-reviewed British Medical Journal.

In a ‘head to head’, both experts discussed their professional opinions and experiences on whether health policy should focus on increasing physical inactivity or target the prevention and treatment of obesity and provided supporting medical literature.

 

The first paper, by Dr Weiler, proposes that improving physical activity is associated with general improvements in health, even if no weight is lost. A lack of physical activity presents “one of the greatest health threats facing developed nations today”, he believes, particularly as 95% of the UK population do not reach recommended amounts. To support his view, he references several large studies, which found that physical inactivity, rather than obesity, is the cause of many major life-threatening disorders, including cardiovascular disease, stroke, cancer, diabetes, dementia and mental health problems.  He draws particular attention to one set of reviews, which has found that physically active people have a reduced risk of many of these disorders.

Dr Weiler goes on to cite evidence that cardiovascular fitness, which is developed and maintained by regular physical activity, is a better predictor of mortality than obesity. He also cites a Scottish Health Survey, which found that even when BMI (body mass index) is factored in, all types of physical activity are linked to reduced mortality.

He also argues that while drugs and bariatric surgery are now becoming more commonly used for treating obesity, they have serious risks and do not offer the same health benefits as physical activity. Dr Weiler also highlights a report suggesting that since the 1980s we have become less active because of our environment.  He argues that policy makers should look at changing our environment, patterns of land use and transport infrastructure to encourage greater physical activity.

 

In the second paper, Professor Gill argues that although physical activity is important, ignoring the problem of obesity and poor diet is unlikely to bring overall improvements in health. He suggests that lack of excercise is just one marker of a society’s overall “obesogenic lifestyle”. He highlights a report from the World Health Organization in 2003, which he says examined a wide range of evidence and identified poor-quality nutrition as a major contributor to obesity and other health problems, such as tooth decay, high blood pressure and various cancers.

He also cites evidence that the health risks of obesity are associated with more severe chronic disease and early death. He believes that physical activity alone, while able to reverse some of these negative health consequences, is not enough to counteract all of them.

Professor Gill says that obese people need access to high-quality treatment and well-trained professionals, but these facilities are often under-resourced. He says that although previous programmes on obesity have had limited success, there is now evidence that small group- and community-based lifestyle programmes can be effective.

Professor Gill also emphasises the need for improved urban planning – for example, more cycle lanes, improved public transport and increased access to green space. But he also promotes changes in local food production and food pricing strategies as a way of encouraging healthier eating.

 

What are the conclusions?

 

Dr Weiler concludes that for health policy to focus solely on weight loss is “largely misleading” and that health risks can be greatly reduced by increasing physical activity, which leads to improved fitness, even in the absence of weight loss.

Professor Gill says that a focus on reducing obesity through a broad range of actions, including diet and behavioural issues, is likely to be more effective than focusing entirely on physical inactivity.

Interestingly, both specialists agree that there is a need for wider programmes to improve the environment, how are where we live and encourage changes in behaviour.

 

Summary

 

Both physical inactivity and obesity are both major public health problems, which policymakers and professionals must work hard to address. Both authors write convincingly about the subject and provide good references and evidence to support their opinions.  This debate highlights the difficulty in agreeing on the best approach to public health problems, particularly when there is good evidence for different policies.

Both authors were in agreement that reducing the risk factors for major illnesses such as cardiovascular disease, cancer and diabetes is vital to public health, although they disagree about whether the emphasis should be on physical activity alone or whether it should include the prevention and treatment of obesity. They both agree that the wider environment needs to change in order to encourage individual behavioural change.

It is also important to note that this debate is about the merits of different health policies and how to best allocate finite health resources. The articles are not intended to offer advice on individual behaviour or to decide whether a person’s inactivity poses a greater or lesser risk than their obesity. Indeed, there is no reason why individuals cannot tackle both problems by adopting a healthy diet, maintaining a healthy weight and getting 30 minutes of moderate-intensity physical activity every day.

 

The answer, of course, is a combination of both is desirable.