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Editorial |

The Fitness, Obesity, and Health Equation Is Physical Activity the Common Denominator?

Steven N. Blair, PED; Tim S. Church, MD, MPH, PhD
JAMA. 2004;292(10):1232-1234. doi:10.1001/jama.292.10.1232.
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The modern living environment in developed countries is characterized by low daily energy expenditure and an abundant and inexpensive food supply, making positive energy balance common. The result is a rightward skewing of the body mass index (BMI) distribution and an increasing prevalence of obesity.

Indisputable evidence links obesity to health problems, including risk of cardiovascular disease, type 2 diabetes, some cancers, and all-cause mortality.1 These associations are dose-related, temporally consistent, and biologically plausible, which support a causal hypothesis. Physical inactivity also has a dose-related, temporally consistent, and biologically plausible relationship to the same health outcomes as those as for obesity,2 and both obesity and inactivity have similar patterns of association with clinical risk indicators such as blood pressure, fasting plasma glucose, and inflammatory markers.35 Furthermore, declines in average daily energy expenditure are a likely underlying cause of the obesity epidemic.6

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