Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: From their observational data,
Dr Fontaine and colleagues1 concluded that
obesity causes decreased life expectancy. In fact, however, years of life
are lost in association with obesity. Causality has not been adequately established.
A number of studies have shown that fitness is probably a better predictor
of mortality than is body mass index (BMI).2,3 It
may be that obesity and the associated years of life lost are related both
to low physical fitness and to excessive caloric consumption as primary causal
factors, and that obesity is one additional secondary effect, along with hypertension,
glucose intolerance, dyslipidemia, and other factors that are similarly related
to poor health outcomes.
John W. Beasley. Obesity and Years of Life Lost—Reply. JAMA. 2003;289(14):1777. doi:10.1001/jama.289.14.1777-a