Addressing Reverse Causation Bias in the Obesity Paradox Is Not “One Size Fits All”
- Deirdre K. Tobias⇑
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Corresponding author: Deirdre K. Tobias, dtobias{at}bwh.harvard.edu.
The obesity epidemic is a global crisis, extending well beyond the U.S. and Western countries. Korea is no exception, with the prevalence of overweight/obesity (BMI ≥23 kg/m2) escalating in recent decades to 61.3% for men and 45.3% for women in 2014 (1).
Despite the overwhelming evidence implicating excess adiposity in the development of several chronic diseases, there has been a prolonged debate surrounding the association between BMI and all-cause mortality. The public health implications of this relationship are not trivial and contribute to the ongoing attention given to this topic.
In this issue of Diabetes Care, Lee et al. (2) report their analysis of 12.8 million adults aged 18–99 years in the National Health Insurance Service of Korea at baseline examinations in 2001, with follow-up through 2013. BMI was evaluated in relation to all-cause mortality, demonstrating a U-shaped association between BMI and all-cause mortality. The authors concluded that the optimal BMI for survival after 10.5 years was 25.0–30.9 kg/m2 for men and 23.5–29.4 kg/m2 for women; thus, maintaining a body weight in the range of overweight and obesity appears ideal for longevity. This controversial finding has been observed by many, …
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