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To the Editor: To compute the fraction of mortality attributed to specific behaviors relating to poor diet and overweight, Dr Mokdad and colleagues¹ estimated the annual deaths due to overweight. We do not understand the authors' conclusion that the "major impact of poor diet and physical inactivity" would be mediated by overweight, and we are puzzled by why they cited one of our articles² to support this assertion. We have 2 concerns about their approach.

First, the attributable risk of mortality due to poor diet and inactivity should be computed using population prevalence and relative risk data for each of these exposures, rather than using data for overweight as a surrogate indicator of these behaviors. As McGinnis and Foege³ pointed out in their accompanying Editorial, "the 1990 estimate for the impact of poor diet and physical inactivity was drawn from the range of estimates of the proportion of deaths from . . . [Full Text of this Article]

Steven N. Blair, PED
sblair@cooperinst.org

Michael J. LaMonte, PhD, MPH; Milton Z. Nichaman, MD, ScD
The Cooper Institute
Dallas, Tex

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