The leading causes of death in the United States have been recently reported in a special communication published in the JAMA. Although a small decline in the prevalence of smoking has been observed over recent years, tobacco remains the leading cause of deaths, which is now closely followed by poor lifestyle habits. Indeed, to evaluate the impact of poor diet and sedentarity lifestyle on mortality, the authors have assessed the number of deaths due to overweight. Comparisons of 1991 and 2000 data revealed an increase of 77% in overweight-attributable deaths. With the ongoing increase in the prevalence of overweight/obesity, not only in the US but also all over the world, such devastating statistics clearly indicate that obesity will soon become the leading cause of death.

It is important to keep in mind that the health hazards of obesity were probably underestimated in this report. Indeed, this figure on the deleterious impact of overweight and obesity on health is based on an anthropometric variable, the body mass index, which only provides a crude evaluation of overall adiposity without consideration for the important contribution of regional body fat distribution. It is now well recognized that abdominal fat accumulation is a key determinant of obesity-related metabolic complications. For instance, the abdominal obesity phenotype, as estimated by an elevated waist circumference, is associated with a cluster of abnormalities increasing the risk of type 2 diabetes and cardiovascular disease way beyond total adiposity. Thus, it would be important to quantify the number of deaths related to expanded waistlines in the US. It is likely that the consequences of abdominal obesity as a cause of death would have been even more dramatic than those related to an elevated body mass index.

Therefore, these results clearly emphasize the urgent need to implement strategies aiming at the prevention of weight gain and, when present, to induce weight loss through the reshaping of lifestyle habits (healthier nutritional habits and an increase in physical activity).