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Johnson et al take issue with our conclusion that men who are overweight or obese and have moderate or higher cardiorespiratory fitness levels have lower CVD mortality risk compared with men who are normal weight and unfit. The age- and examination year–adjusted death rates in Table 3 of our report show a higher mortality rate (79.0 per 10 000 man-years) in men who are normal weight and unfit than in men who are overweight or obese and at least moderately fit.1 Death rates in these latter men are less than 35 per 10 000 man-years (P<.05 for differences with normal weight, unfit men). Mortality risk among unfit men was not significantly different across BMI strata, which suggests an absence of a main effect for BMI as a mortality predictor, an observation that is consistent with the data given in Table 2 of our original report.
Church TS, LaMonte MJ, Barlow CE, Blair SN. Diabetes, Fitness, and Body Mass Index—Reply. Arch Intern Med. 2006;166(12):1326-1327. doi:10.1001/archinte.166.12.1327-a