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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, MD
Department of Family Medicine (emeritus)
University of Wisconsin School of Medicine
Madison

1. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289:187-193. FREE FULL TEXT 2. Blair SN, Kohl III HW, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA. 1989;262:2395-2401. FREE FULL TEXT 3. Wei M, Kampert JB, Barlow CE, et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA. 1999;282:1547-1553. FREE FULL TEXT

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

JAMA. 2003;289:1777.

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