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May 22, 1996

Weight Loss vs Exercise to Reduce Coronary Artery Disease Risk Factors-Reply

Author Affiliations

University of Maryland School of Medicine Baltimore

JAMA. 1996;275(20):1546-1547. doi:10.1001/jama.1996.03530440023028

In Reply.  —Dr Greenberg raises an important public health issue concerning recommendations for subjects who are moderately obese. The available data suggest that even moderately obese individuals would improve their CAD risk factor profiles if they lost weight.1 Given that age-associated declines in leisure time physical activity and lean muscle mass adversely impact energy expenditure, in practice it may be difficult for moderately obese, older individuals to lose significant amounts of weight unless they partake in some form of exercise training. Adoption of public health guidelines advocating weight loss to a BMI of less than 22.5 kg/m2 must be tempered by data that demonstrate that the BMI associated with the lowest total mortality may be higher at 26 to 27 kg/m2 in the elderly than in middle-aged populations.2 We agree that large-scale clinical trials will be required to define the role of weight loss and exercise