To the Editor: The observational study by Dr Lee and colleagues1 found that relatively high levels of physical activity among overweight or obese women in the Women's Health Study were not associated with protection against long-term weight gain. On the other hand, among white women in the US Diabetes Prevention Program, those exposed to a structured lifestyle intervention (combining exercise, diet, and coping or problem-solving skills) experienced about 8 kg of weight loss during the period of their multidisciplinary, structured support.2 The report from the Women's Health Study, therefore, is consistent with less intensive obesity intervention trials that found little or no weight loss following exercise or dietary treatments.
If preservation of cardiometabolic health is a major objective, these results should not be considered discouraging. A growing body of evidence confirms that adoption of healthy habits can result in reduced abdominal obesity and improved metabolic risk factors despite minimal change in weight.3 A failure to lose weight or prevent weight gain does not prove that exercise (or dietary) interventions were futile. Weight gain under circumstances of high physical activity might reflect accumulation of salutary lean tissue, especially skeletal muscle. And for adults who gain weight as adipose tissue, a predominant increase in subcutaneous fat may serve to safely sequester the excessive calorie burden.4 Subcutaneous lipid sequestration (often in the hips and thighs) may protect such adults from lipotoxic damage to the liver, muscle, heart, and pancreas. Accumulation of intra-abdominal adipose tissue, on the other hand, may indicate increased cardiometabolic risk.
Rather than focus only on weight loss, health promotion programs might alternatively pursue reductions in abdominal obesity, improved lipid indices, or greater cardiorespiratory fitness. Health benefits might be better estimated, for example, as improvements in the lipid accumulation product5 (a continuous variable) or as the reduced population prevalence of a hypertriglyceridemic waist phenotype.
Financial Disclosures: None reported.
Disclaimer: The findings and conclusions in this letter are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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