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This study came out almost two years ago, but it came up in a talk I gave this week, so I thought I’d post about it. CNN ran a headline that said “Fat but fit’ is a myth when it comes to heart health, new study shows.”

The study is Joint Association of Physical Activity and Body Mass Index with Cardiovascular Risk: A Nationwide Population-Based Cross-Sectional Study. In the CNN article Alejandro Lucia who is a professor of exercise physiology and the lead author of the study, was quoted as saying “One cannot be ‘fat but healthy.’ This was the first nationwide analysis to show that being regularly active is not likely to eliminate the detrimental health effects of excess body fat.“

Except that’s not remotely what his study showed, and not just because it was in no way designed to draw that kind of conclusion.

Let’s start with what the study actually did. It looked at self-reported activity data from 527,662 adults from Spain. They grouped the subjects based on BMI (and we already know the use of BMI reflects a lack of scientific rigor but we’ll move past that for now.) Then they classified the activity level into three groups. No activity was considered “inactive,” less than 150 minutes of moderate or 75 minutes of vigorous activity per week was labeled “insufficiently active,” (and since words matter, I would suggest that this label is unnecessarily judgmental and ableist,) and finally, 150 minutes of moderate or 75 minutes of vigorous activity per week or more was labeled “regularly active.”

The study’s goal was to look at the impact of exercise on risk factors for cardiovascular issues, including diabetes, high blood pressure, and high cholesterol. Note that they didn’t look at actual cardiac incidents (like heart attacks or strokes,) they just looked at factors that may raise the risk for such incidents.

So what did they find? Well, to quote their own paper

In summary, increasing PA [physical activity] levels appear to provide benefits in an overall dose-response manner (regularly active > insufficiently active > inactive for the risk of hypertension or diabetes) across BMI categories and should be a priority of health policies

Wait…what? You read that correctly – What they found was that activity provided health benefits to people of all sizes (which is consistent with the findings of (not that these links contain language that pathologizes higher weight bodies varying degrees of weight stigma) and Gaesser and Angadi, Wei et. al. and Matheson et. al, and Barry et. al. which found “Therefore, fit individuals who are overw*ight or obe*e are not automatically at a higher risk for all-cause mortality.” (And as always, a reminder that health is an amorphous concept, is not an obligation, barometer of worthiness, or entirely within our control)

So why are they claiming that you can’t be fat and fit? Well, because they found that fatter people’s risk factors were not mitigated to an equal level with thin people’s risk factors. Their (unsolicit