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We thank Golomb and colleagues and Mascitelli and Pezzetta for their interest in our work. Golomb and colleagues note their previous work among individuals screened for the Helsinki Heart Study.1 Their work is not directly comparable to ours, since they grouped suicide attempts with completed suicides, and unfortunately they had no direct measures of insulin sensitivity or free fatty acids with which to test their hypotheses. Of note, BMI per se was not significantly related to suicide risk in that study, even with cut points designed to maximize the observed association, although the hypothesis that free fatty acids may be an important mediator still merits investigation. We also should note that the association of lower BMI with suicide has been under investigation for more than 40 years, dating back at least to the seminal study of college students by Paffenbarger and Asnes,2 in which height-adjusted weights at entry were significantly lower among men who later died of suicide than among matched controls. Given this context, all current work in this field should best be considered corroborating to some degree.
Mukamal KJ, Miller M, Kawachi I, Rimm EB. Suicide: A Weighty Matter?—Reply. Arch Intern Med. 2007;167(17):1908. doi:10.1001/archinte.167.17.1908-b