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To the Editor: Dr Mokdad and colleagues¹ reported that about one third of deaths in the United States are attributable to smoking and overweight. By calling attention to a predicted increase in health care costs secondary to these risk factors, the authors implied that prevention of these risk factors will save costs. They concluded that there is an urgent need to provide more prevention of these risk factors.

This conclusion seems premature, however. First, diseases such as depression and osteoarthritis are not listed among the leading causes of death but lead to considerable societal morbidity.² Hence, setting priorities only on the basis of mortality data can lead to bias. Second, I am not aware of evidence that primary or secondary prevention of overweight would reduce long-term costs. Primary prevention will waste money on some people who remain lean, while secondary prevention may waste money on the many people who resist . . . [Full Text of this Article]

Afschin Gandjour, MD, PhD
afschin.gandjour@medizin.uni-koeln.de
Institute of Health Economics and Clinical Epidemiology
University of Cologne
Cologne, Germany