Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Opinion
  • Published:

Disease prevention—should we target obesity or sedentary lifestyle?

Nature Reviews Cardiology volume 7, pages 468–472 (2010)Cite this article

Subjects

Abstract

Obesity is a major health challenge facing the modern world. Some evidence points to obesity itself as the main driver of premature mortality. We propose that this view is oversimplified. For example, high levels of physical activity and cardiorespiratory fitness are associated with lower mortality, even in those who are overweight or obese. To address this issue, we combine epidemiological and physiological evidence in a new paradigm that integrates excess calorie intake, sedentary behavior, and a maladaptive response to stress. Human physiology is optimized to allow large distances to be covered on foot every day in order to find enough food to sustain brain metabolism. Furthermore, when the body is immobilized by an injury, it triggers efficient life-saving metabolic and inflammatory responses. Both these critical adaptations are, however, confounded by a sedentary lifestyle. The implications of these issues for clinical trial design and epidemiologic data analysis are discussed in this article.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Injury and immobilization in a hunter-gatherer.
Figure 2: Effects of a sedentary lifestyle.

Similar content being viewed by others

References

  1. Janssen, I., Katzmarzyk, P. T. & Ross, R. Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J. Am. Geriatr. Soc. 53, 2112–2118 (2005).

    Article  Google Scholar 

  2. Oreopoulos, A. et al. The relationship between body mass index, treatment, and mortality in patients with established coronary artery disease: a report from APPROACH. Eur. Heart J. 30, 2584–2592 (2009).

    Article  Google Scholar 

  3. Kalantar-Zadeh, K., Block, G., Horwich, T. & Fonarow, G. C. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J. Am. Coll. Cardiol. 43, 1439–1444 (2004).

    Article  Google Scholar 

  4. Neubauer, S. The failing heart—an engine out of fuel. N. Engl. J. Med. 356, 1140–1151 (2007).

    Article  Google Scholar 

  5. Kodama, S. et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301, 2024–2035 (2009).

    Article  CAS  Google Scholar 

  6. Byberg, L. et al. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. BMJ 338, b688 (2009).

    Article  Google Scholar 

  7. Kokkinos, P. et al. Exercise capacity and mortality in black and white men. Circulation 117, 614–622 (2008).

    Article  Google Scholar 

  8. Katzmarzyk, P. T., Church, T. S., Janssen, I., Ross, R. & Blair, S. N. Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. Diabetes Care 28, 391–397 (2005).

    Article  Google Scholar 

  9. Gulati, M. et al. Exercise capacity and the risk of death in women: the St James Women Take Heart Project. Circulation 108, 1554–1559 (2003).

    Article  Google Scholar 

  10. Laukkanen, J. A. et al. Determinants of cardiorespiratory fitness in men aged 42 to 60 years with and without cardiovascular disease. Am. J. Cardiol. 103, 1598–1604 (2009).

    Article  Google Scholar 

  11. Blair, S. N. & Church, T. S. The fitness, obesity, and health equation: is physical activity the common denominator? JAMA 292, 1232–1234 (2004).

    Article  CAS  Google Scholar 

  12. Booth, F. W., Laye, M. J., Lees, S. J., Rector, R. S. & Thyfault, J. P. Reduced physical activity and risk of chronic disease: the biology behind the consequences. Eur. J. Appl. Physiol. 102, 381–390 (2008).

    Article  Google Scholar 

  13. Bramble, D. M. & Lieberman, D. E. Endurance running and the evolution of Homo. Nature 432, 345–352 (2004).

    Article  CAS  Google Scholar 

  14. Boulé, N. G. et al. Effects of exercise training on glucose homeostasis: the HERITAGE Family Study. Diabetes Care 28, 108–114 (2005).

    Article  Google Scholar 

  15. Urso, M. L., Scrimgeour, A. G., Chen, Y. W., Thompson, P. D. & Clarkson, P. M. Analysis of human skeletal muscle after 48 h immobilization reveals alterations in mRNA and protein for extracellular matrix components. J. Appl. Physiol. 101, 1136–1148 (2006).

    Article  CAS  Google Scholar 

  16. Vaidyula, V. R. et al. Effects of hyperglycemia and hyperinsulinemia on circulating tissue factor procoagulant activity and platelet CD40 ligand. Diabetes 55, 202–208 (2006).

    Article  CAS  Google Scholar 

  17. Ross, R. & Bradshaw, A. J. The future of obesity reduction: beyond weight loss. Nat. Rev. Endocrinol. 5, 319–325 (2009).

    Article  Google Scholar 

  18. Pou, K. M. et al. Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation 116, 1234–1241 (2007).

    Article  CAS  Google Scholar 

  19. Björntorp, P. Do stress reactions cause abdominal obesity and comorbidities? Obes. Rev. 2, 73–86 (2001).

    Article  Google Scholar 

  20. Centers for Disease Control and Prevention. Prevalence of regular physical activity among adults—United States, 2001 and 2005. Morb. Mortal. Wkly Rep. 56, 1209–1212 (2007).

  21. Hu, F. B., Li, T. Y., Colditz, G. A., Willett, W. C. & Manson, J. E. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 289, 1785–1791 (2003).

    Article  Google Scholar 

  22. Healy, G. N. et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 31, 661–666 (2008).

    Article  Google Scholar 

  23. Hamilton, M. T., Hamilton, D. G. & Zderic, T. W. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes 56, 2655–2667 (2007).

    Article  CAS  Google Scholar 

  24. Katan, M. B. & Ludwig, D. S. Extra calories cause weight gain—but how much? JAMA 303, 65–66 (2010).

    Article  CAS  Google Scholar 

  25. Kalantar-Zadeh, K. et al. Risk factor paradox in wasting diseases. Curr. Opin. Clin. Nutr. Metab. Care 10, 433–442 (2007).

    Article  Google Scholar 

  26. Unger, R. H. Reinventing type 2 diabetes: pathogenesis, treatment, and prevention. JAMA 299, 1185–1187 (2008).

    Article  CAS  Google Scholar 

  27. Colman, R. J. et al. Caloric restriction delays disease onset and mortality in rhesus monkeys. Science 325, 201–204 (2009).

    Article  CAS  Google Scholar 

  28. Laurier, D., Nguyen, P. C., Cazelles, B. & Segond, P. Estimation of CHD risk in a French working population using a modified Framingham model. The PCV-METRA Group. J. Clin. Epidemiol. 47, 1353–1364 (1994).

    Article  CAS  Google Scholar 

  29. Arsenault, B. J. et al. Physical activity, the Framingham risk score and risk of coronary heart disease in men and women of the EPIC-Norfolk study. Atherosclerosis 209, 261–265 (2010).

    Article  CAS  Google Scholar 

  30. Andersen, L. B., Anderssen, S. A. & Saltin, B. Letter regarding article by Christou et al, “Fatness is a better predictor of cardiovascular disease risk factor profile than aerobic fitness in healthy men”. Circulation 112, e253–e254 (2005).

    Article  Google Scholar 

  31. Johnson, R. K. et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 120, 1011–1020 (2009).

    Article  CAS  Google Scholar 

  32. Malik, V. S., Popkin, B. M., Bray, G. A., Després, J. P. & Hu, F. B. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 121, 1356–1364 (2010).

    Article  Google Scholar 

  33. Caspersen, C. J., Powell, K. E. & Christenson, G. M. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 100, 126–131 (1985).

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Bill Piper for his English language editorial assistance.

Author information

Authors and Affiliations

  1. Department of Cardiology, Centre Hospitalier Sud Francilien, 59 Boulevard Henri Dunant, Corbeil Essonnes, 91108, Cedex, France

    Olivier L. Charansonney

  2. Division of Kinesiology, Department of Social and Preventive Medicine, Université Laval, 2705 Laurier Boulevard, Sainte-Foy, Québec, G1V 4G2, QC, Canada

    Jean-Pierre Després

Authors
  1. Olivier L. Charansonney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Pierre Després
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olivier L. Charansonney.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Charansonney, O., Després, JP. Disease prevention—should we target obesity or sedentary lifestyle?. Nat Rev Cardiol 7, 468–472 (2010). https://doi.org/10.1038/nrcardio.2010.68

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrcardio.2010.68

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing