[Overweight and mortality risk: no connection between overweight in middle and older age groups and increased mortality].

The increasing prevalence rates of overweight and obesity in prosperous areas of the world are causing concern everywhere. Evidence is now available on the excess mortality caused by overweight and obesity. However, in all populations, including that in Asia, the body mass index (BMI) associated with the lowest mortality is in the category 'overweight' (BMI: 25.0-29.9 kg/m2). Cardiovascular mortality has increased, but is balanced by subtle decreases in other causes of death. Even in the category 'mild obesity' (BMI: 30.0-34.9 kg/m2), evidence of increased total mortality is hard to substantiate. Smaller samples from Dutch prospective studies confirm these findings. The epidemiology of overweight and obesity has been changing. BMI is only a rough calculation of adiposity and its relevance may be worse in tall and well-nourished populations. The major cause of obesity-related mortality, cardiovascular diseases, has decreased considerably, partly due to successful cardiovascular risk management. Mortality is lower in 'overweight' than in 'normal weight' BMI's. Overweight and mild obesity are a totally different story to smoking. Smoking is fatal and saves health care costs by killing. Obesity is now a largely non-fatal condition that successfully avoids premature death by effective risk management but with increased health care costs.