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Controversy surrounds the relative contributions of changes in weight and fitness to cardiovascular risk. In this longitudinal cohort study, 3148 adults underwent at least three preventive medical examinations over a 27-year period at a single U.S. clinic. Fitness was measured by maximal exercise stress testing; body-mass index and percent body fat were proxies for fatness (a term used by the authors throughout their article). Researchers analyzed the effect of changes in these measures between the first and second examinations on the subsequent development of risk factors.
During a mean follow-up of approximately 6 years after the second examination, 24%, 14%, and 19% of participants developed hypertension, metabolic syndrome, and hyperchol…