Obesity has long cast a shadow on public health, poised as a significant independent risk factor for cardiovascular diseases (CVD). It’s a condition that’s often mentioned with hushed warnings and somber statistics, frequently highlighting the dire complications and increased mortality rates associated with increased body mass index (BMI). However, a recent article published in the January 2024 edition of the Journal of the Pakistan Medical Association throws a glimmer of hope on this complex subject. In their elucidatory research, Zara Khalid et al. discuss a compelling narrative – the “fat but fit” phenomenon, a paradigm that suggests physical fitness might shield overweight or obese individuals against the cardiovascular risks usually linked to their body mass (1).

This article will dive into the nuances of this paradox, examining how physical fitness can indeed mitigate cardiovascular risks in obesity. It will touch upon the contentious evidence surrounding this concept, the importance of cardiorespiratory fitness, and the implications for clinical practice. DOIs and references will guide the discourse for those looking to explore the topic further.

The Paradox of Being Fat but Fit

The “obesity paradox” and the “fat but fit” paradigm challenge the traditional understanding of obesity-related CVD risks. The widely accepted belief is that a higher BMI invariably escalates the risk of heart disease. Nonetheless, the “fat but fit” concept proposes that superior fitness levels can counterbalance the adverse impact of obesity on heart health. As such, overweight individuals with robust physical fitness might not only resist developing CVD but also potentially enjoy reduced overall mortality rates (1).

This paradoxical notion has sparked debate in the medical and fitness communities, as the evidence to substantiate this claim has been mixed and, at times, conflicting. The article by Khalid et al. underscores the pressing need for more research to fully unravel this complex interaction (1). Understandably, physical fitness and obesity do not exist in a vacuum; they are influenced by myriad individual and environmental factors that make this topic an intricate web of cause and effect.

Cardiorespiratory Fitness: A Cardiovascular Shield?

Delving deeper into the “fat but fit” paradigm, cardiorespiratory fitness emerges as a critical component. Studies suggest that high cardiorespiratory fitness could mitigate or attenuate the negative cardiovascular implications often seen in overweight and obese individuals. This is hypothetically due to the favorable effects of fitness on blood pressure, lipid profiles, inflammation, and insulin sensitivity (1).

By measuring parameters such as VO2 max – the maximum oxygen consumption during intense exercise – researchers can approximate an individual’s cardiorespiratory fitness. It’s theorized that by maintaining or enhancing this aspect of physical health, the obese population might significantly decrease their CVD risks despite elevated BMIs.

The Importance of Fitness Evaluations

Given the multifaceted relationship between physical fitness, obesity, and cardiometabolic health, the authors advocate for fitness evaluations as part of a comprehensive health risk assessment. These assessments could profoundly influence clinical decision-making by distinguishing which patients may benefit from more aggressive lifestyle interventions or medical treatments (1). Therefore, standard health examinations might benefit from incorporating cardiorespiratory fitness tests as part of the routine evaluation for overweight and obese individuals to better predict CVD risks.

Promoting Physical Fitness in the Overweight and Obese

In response to the findings and the questions they raise, strategic health promotion aimed at facilitating the maintenance of physical fitness in overweight and obese populations becomes crucial. Lifestyle interventions, policies, and programs focusing on physical activity, diet, and behavior changes must be tailored to combat both obesity and inactivity, which often play hand-in-hand in exacerbating heart disease risks.


The “fat but fit” phenomenon presents an intriguing conundrum: it challenges the convention that obesity unequivocally equates to higher cardiovascular risk. It offers a hopeful perspective that prioritizes physical fitness as a potentially powerful modifier of health outcomes for the overweight. Still, Khalid et al. remind us that significant work remains to be done in validating this concept through rigorous research (1). Effective strategies to promote and maintain cardiorespiratory fitness among the obese could reshape the approach to mitigating CVD risks, moving towards a more holistic understanding of health and wellness.


1. Khalid Z, Siddiqi FA, Sadiq T, Rathore FA. Fat but Fit: How physical fitness can mitigate the cardiovascular risks of obesity? J Pak Med Assoc. 2024 Jan;74(1):189-191. doi: 10.47391/JPMA.24-07.

DOI: 10.47391/JPMA.24-07


1. Obesity Paradox
2. Fat but Fit Phenomenon
3. Cardiovascular Risks and Obesity
4. Cardiorespiratory Fitness
5. Physical Fitness and Heart Disease

Please note that this article has been constructed from the information provided and by following the standard practices of news article creation; ensuring that information is presented impartially and based on evidence from the references given. The reference numbers in the text are for illustrative purposes and relate to a reference list that would ordinarily be found at the end of an academic news article.