Answering questions: Can you be healthy but not fit?

I put some time into recent responses on Quora and figured I'd share them here, too, since I clearly need to work on writing more consistently.

Can you be healthy but not fit?

Yes, but we need to define our terms first.

Americans in the US typically use “fit” to describe physical fitness and athletic capability, whereas other English-speakers in the world may use it to describe people’s appearances and level of attractiveness. The juxtaposition of “healthy and fit” implies the former definition (physical/athletic ability).

“Healthy” has myriad definitions, but I assume the questioner means metabolic health, which includes measures of blood pressure, triglycerides, LDL-cholesterol, HDL-cholesterol, total cholesterol, fasting plasma glucose, etc.

There are, indeed, many people who test in the “normal” and “healthy” ranges on such metabolic measures but who do not exercise regularly and/or may have physical limitations or disabilities that limit fitness endeavors. Metabolic measures are frequently influenced by genetics, so that “health” is not entirely within our control. But those influences can result in good metabolic health or poor metabolic health independently of physical fitness, which takes action and training to achieve.

Physical fitness can influence metabolic health, as metabolic health can influence physical fitness. If a person has naturally high blood pressure, it might not be safe for them to undertake an intense exercise regimen in pursuit of physical fitness. However, researchers have found that “even low levels of physical activity have a beneficial effect on metabolic fitness and the overall health of the individual.” (https://www.ncbi.nlm.nih.gov/pub...)

Many doctors erroneously mistake weight/BMI as a proxy for health. From the article “Weight Science: Evaluating the Evidence for a Paradigm Shift”:

• Yet using BMI as a proxy for health may be more costly than addressing health directly. Consider, for example, the findings of a study which examined the "healthy obese" and the "unhealthy normal weight" populations . The study identified six different risk factors for cardiometabolic health and included subjects in the "unhealthy" group if they had two or more risk factors, making it a more stringent threshold of health than that used in categorizing metabolic syndrome or diabetes. The study found a substantial proportion of the overweight and obese population, at every age, who were healthy and a substantial proportion of the "normal weight" group who were unhealthy.
• Psychologist Deb Burgard examined the costs of overlooking the normal weight people who need treatment and over-treating the obese people who do not. She found that BMI profiling overlooks 16.3 million "normal weight" individuals who are not healthy and identifies 55.4 million overweight and obese people who are not ill as being in need of treatment. When the total population is considered, this means that 31 percent of the population is mis-identified when BMI is used as a proxy for health.

So athleticism, metabolic health, and body size are all different variables, and while any one of them can influence another, none definitely determines or defines another. A person can be healthy and not fit. A person can be fit and have poor metabolic health. And a person can be either of these at any size or weight.

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