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April 9, 2003

Obesity and Years of Life Lost—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(14):1777. doi:10.1001/jama.289.14.1777-a

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.

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