• Dr. Doug Pooley

Smokadiabesity’ reaches epidemic proportions. Low fitness still kills more Americans than smoking.


Karim Khan



Smoking, diabetes and obesity are  major public health concerns.  At the same time there is little attention given to the health consequences of missing a day (or a lifetime) of physical activity. Yet low physical fitness kills more Americans than does either smoking, diabetes, or obesity (see Blair).


And, when one looks at it carefully, low fitness kills more Americans than smoking, diabetes and obesity in COMBINATION!! (apologies for red but it deserved it!)


As a nation, an unfit America (that’s where these data exist) dies more from low fitness than from ‘smokadiabesity.’ And low fitness is readily curable.  Do personal, and policy, priorities reflect the real killer? Does our health system reflect this order of importance?



This graph (redrawn from Blair SN, BJSM 2009, pp. 1-2)  compares the population attributable fraction of death for men (left, coloured bar in each set) and women (right, open bar in each set). The low fitness column reflects a greater PAF for deaths than the combined smokadiabesity column.


To learn more, we recommend:

  • As different as Venus and Mars: time to distinguish efficacy (can it work?) from effectiveness (does it work?) Karim M Khan et al., Br J Sports Med, 2011

  • Seven member societies benefit from BJSM's 16 annual issues: add your society for 2013? Karim M Khan et al., Br J Sports Med, 2011

  • Developing healthcare systems to support exercise: exercise as the fifth vital sign. Robert Sallis, Br J Sports Med, 2011

  • Mid-year review: physical inactivity universally accepted as the biggest public health problem of the 21st century, shoulder exam challenges, and progress against the scourges of anterior knee pain and ACL injuries. K M Khan, Br J Sports Med, 2009

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