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BMI: a poor surrogate for diet and exercise in assessing risk of death

International Journal of Obesity volume 30, pages 1173–1175 (2006)Cite this article

The surprising finding by Flegal et al. that overweight (25⩽BMI<30) Americans live longer than those of ‘normal’ weight (18.5<25)1 calls for a reassessment of the premise underlying the results and interpretation of the data presented. In a much quoted article, ‘Actual Causes of Death,’ Mokdad et al.2 estimated that ‘poor diet and physical inactivity’ account for 400 000 US deaths (16.6%) annually. Their article states, ‘Overweight would account for the major impact of poor diet and physical inactivity on mortality.3 Diet may have a minor additional effect on mortality mainly from lack of certain essential nutrients’.4, 5 This commentary will dispute the equating of overweight and obesity with poor diet and physical inactivity – the basis of the recent finding that overweight people live longer than normal weight people.

In acknowledging the limitations of the Flegal analysis, the authors admit that ‘other factors associated with body weight, such as physical activity, body composition, visceral adiposity, physical fitness, or dietary intake, might be responsible for some or all of the apparent associations of weight with mortality’.1 Flegal was not able to prove that the association of BMI with mortality remained after appropriate adjustments for potentially confounding factors, particularly physical activity, physical fitness, dietary intake, age, and sex. Indeed, previous epidemiological studies found that significant correlations of BMI with mortality disappeared after adjusting for other confounding factors.6, 7 The recently published long-term data from the Framingham Heart Study showing that 9 out 10 men and 7 out of 10 women will eventually become overweight or obese8 raises the question of whether Flegal adequately adjusted for age and sex.

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Cundiff, D. BMI: a poor surrogate for diet and exercise in assessing risk of death. Int J Obes 30, 1173–1175 (2006). https://doi.org/10.1038/sj.ijo.0803236

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