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To the Editor: Dr Mokdad and colleagues¹ attributed 400 000 US deaths to obesity, just below the 435 000 they attributed to tobacco. The estimate for tobacco was achieved² by stratifying by cause of death, sex, and age, then adding up the resulting individual causes. The estimate for obesity does not account for important variables, particularly age and unmodifiable genetic factors.³ Because the risk of dying because of obesity decreases at advanced age,⁴ the authors should have taken this variable into account in the estimations. In addition, the population age distribution is now older than when these studies were performed, so applying unadjusted risk estimates to the current population overestimates the number of deaths.

We are also concerned that the authors provided no justification for adding 15 000 deaths for poor diet and physical inactivity. They provided no evidence to support the assumption that these deaths would occur beyond the direct effects of . . . [Full Text of this Article]

Joaquin Barnoya, MD, MPH; Stanton A. Glantz, PhD
glantz@medicine.ucsf.edu
Center for Tobacco Control Research and Education
University of California
San Francisco

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