Author Response

      We thank Dr. Kawada for his thoughtful comments on our study and for drawing attention to other factors likely to influence weight gain in the context of prolonged car use for commuting, an instance of sedentary behavior. We concur with his comments that our findings do not provide causal evidence and, like Dr. Kawada, would be concerned if other readers were to infer cause-and-effect relationships from the findings of a prospective epidemiologic study. We also agree that other factors may be contributing to the relationships that we have reported (unmeasured confounding), a number of which have been described by Dr. Kawada.
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      Linked Article

      • Commuting by Car, Lifestyles, and Weight Gain
        American Journal of Preventive MedicineVol. 45Issue 1
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          To the Editor: A study by Sugiyama et al.1 showed that, over a 4-year period, people who used cars daily for commuting tended to gain more weight than those who did not. They used several confounders for the adjustment of linear regression analysis, and a stronger association by trend analysis was observed for subjects with sufficient leisure-time physical activity. I respect their longitudinal study, but I have some concerns on their outcome, in particular with reference to the commuting time.
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