and upper-socioeconomic status subjects. The hazard ratio (HR) for an obese or overweight person relative to
established that if currently obese persons were to lose weight or were to
280,184 (range, 236,111-341,153). nonsmokers or never-smokers only. In such an analysis by Stevens et al,45 this way of viewing the burden of obesity showed
healthy group without cancer or cardiovascular disease. The values estimated are not
factors. Knoll Pharmaceutical Co. Meridia patient support pack. Geneva, Switzerland: World Health Organization; 1998. of being in that category, P(CAT), is given as derived from NHANES III data. (range, 236,111-341,153). If we choose a particular year, ie, 1991, we can say, "Of the people
1–5 It has been suggested that obesity is second only to smoking as a preventable cause of death. The cohort was followed for 16 years, and relation of BMI to hazard
"Annual Deaths Attributable to Obesity in the United States" Journal of the American Medical Association October 27, 1999; v.282, n.16; pp.1530-1538. based on this technique. If one is prepared to believe
Mortality Statistics Branch, National Center for Health Statistics. the target population of interest. residual confounding or effect modification is likely, the literature is divided.20,37,43 The results of our
JAMA . 0000003350 00000 n Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. The relationship between body weight and mortality: a quantitative
Of the original 8641 subjects, 3905 (45%) with no missing data who were at
The year 1991 was chosen for analysis because of the availability of
or obese categorization and many possible reference groups. More than 80% of the estimated obesity-attributable deaths occurred among
Hazard ratios also were calculated from data for
disease remained. Adams KF, Schatzkin A, Harris TB, et al. endobj During the NHANES III survey, about
via extraction from published reports (ie, HRs for BMI categories); (3) not
Allison DB, Pi-Sunyer FX. 6928 persons selected in 1965 (response rate, 86%) to represent the noninstitutionalized
and nonsmokers (top part of Table 4). We used the same procedure on the published statistics
Estimates of deaths attributable to obesity in the United States rely on estimates from epidemiological cohorts of the relative risk of mortality associated with obesity. 1960-1994. This, combined with the relative consistency in the estimates from
US civilian noninstitutionalized population and includes all 14,407 persons
endobj 0000121085 00000 n Excess deaths from nine chronic diseases in the United States, 1986. Mathematical expressions for quantities
Methodological factors can
It is important to clarify the quantity
Introduction. Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. (NHEFS) was designed to investigate relationships between clinical, nutritional,
confounding among smokers and effect modification, the best estimates may
mortality rate, however, obesity substantially increases morbidity4 and impairs quality of life.46
Based on published
74 0 obj millions,1 and of great interest to the public. scholarly journals,9-11
individuals with a body mass index of more than 30 kg/m2. Data collection has occurred periodically since then.22,31,32
Leading Causes of Death in the United States in 2000* Cause of Death No. of body mass index. However, in the higher BMI categories, HRs tended to be higher in nonsmokers
O. OBESITY is a complex chronic disease in which abnormal or excessive accumulation of body fat impairs health. the lower BMI limit of the reference group and T2 for its upper
Context Obesity is a major health problem in the United States, but the number of obesity-attributable deaths has not been rigorously estimated.. 1 billion adults and 10% of children are now classified as overweight or obese. and Nutrition Examination Survey I Epidemiologic Follow-up Study) and 1 published
Allison DB, Zannolli R, Narayan KM. at study inception, reported poor health or history of heart attack, stroke,
among US adults. the year had not been obese and if those people had the hazard of those with
in an identical way or at least that the classification into smokers and nonsmokers
in particular. analysis of combined information from existing studies. vital statistics were collected through 1992. mortality, which we have not done in this article. The mean estimate based on analyses of HRs
of estimates among the cohorts examined. 5 cohort studies. then the τ drops out, leaving, © 2021 American Medical Association. (NHANES III). 0000121502 00000 n the average effect of overweight or obesity across both sexes and all adult
HR for a nonobese person also not in the reference category relative to someone
the mean estimate of the annual number of obesity-attributable deaths was
Hence, if cohort age distributions vary, this disparity could
Childhood obesity: future directions and research priorities. First,
Clinical guidelines on the identification, evaluation, and treatment
smoking status, and self-reported height and weight. For simplicity, we refer to this quantity as "the annual number
expectancy, depending on age. of obesity-attributable deaths has not been rigorously estimated. whether residual confounding or effect modification is the more likely explanation. Similar comments apply to exclusion of individuals whose
initiated in 1959 to investigate health and disease determinants in the rural
denotes time. modification or residual confounding. the number of attributable deaths would have been reduced. through September 1971 (98%) and September 1973 (93%). never become obese, they would not still have a higher mortality rate. Context Obesity is a major health problem in the United States, but the number
proportionality assumption was checked and validated. Similarly, relative to normal-weight persons, there were 42 000 additional deaths for obese men and 70000 additional deaths for obese women. and all-cause mortality reported by Manson et al34
set either the threshold for overweight and the reference category lower,
0000004437 00000 n Sample
Seidell JC, Rissanen AM. measured in nonsmokers or never-smokers was about 325,000 and that found using
who completed the medical examinations at baseline (1971-1975). Get free access to newly published articles. white and middle-class, with an average level of educational attainment higher
0000032247 00000 n The Tecumseh, Michigan community health study. (total population size is N [185,105 441]). All Rights Reserved. 0000031160 00000 n Fontaine KR, Bartlett SJ. Durazo-Arvizu RA, McGee DL, Cooper RS, Liao Y, Luke A. Mortality and optimal body-mass index in a sample of the US population. and it would be interesting to evaluate mortality as a function of BMI changes. %���� Conclusions The estimated number of annual deaths attributable to obesity among
Also, we chose BMI cutoffs for overweight
given in the Appendix and Table 1
A total
the national distribution of adult BMI, and estimates of population size and
risk factors such as hypertension that are partially due to obesity were not
0000005102 00000 n When these HRs were applied to the entire
of variations in BMI on mortality rate in different sex, age, and race groups
considered intermediaries on the causal path from obesity to mortality. The lowest death rates were among women with a BMI of 22.0 to 23.4 and among men with a BMI of 23.5 to 24.9. We analyzed BMI at a single point in time only,
30 kg/m2 ("overweight"), 30 to 35 kg/m2 ("obesity"),
Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. When HRs … in a monotonic (not "U-shaped") manner34 and
the slope between the penultimate and antepenultimate values. Means at each examination and inter-examination variation of specified
the data sets included (1) US source; (2) public availability or availability
%%EOF 0000004874 00000 n Kuczmarski RJ, Carroll MD, Flegal KM, Troiano RP. 1,3 However, these approaches
0000117440 00000 n The top half of Table 4
Hochstim JR. obtained for the 6 sets of analyses. /Encrypt 74 0 R and functional limitation. endobj above a BMI of 25 kg/m2. estimate of deaths attributable to obesity in the United States was 280,184
Using relative hazards associated with elevated BMI in 6 US studies,
does take into account differential effects of obesity by age and sex despite
HRs for obesity calculated on nonsmokers or never-smokers only offer the best
0000020023 00000 n <> Obesity treatment: examining the premises. Eighty-eight percent (8641 persons) of residents participated in the first
sign up for alerts, and more, to access your subscriptions, sign up for alerts, and more, to download free article PDFs, sign up for alerts, customize your interests, and more, to make a comment, download free article PDFs, sign up for alerts and more, Archives of Neurology & Psychiatry (1919-1959), JAMAevidence: The Rational Clinical Examination, JAMAevidence: Users' Guides to the Medical Literature, FDA Approval and Regulation of Pharmaceuticals, 1983-2018, Global Burden of Skin Diseases, 1990-2017, Health Care Spending in the US and Other High-Income Countries, Life Expectancy and Mortality Rates in the United States, 1959-2017, Medical Marketing in the United States, 1997-2016, Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter, US Burden of Cardiovascular Disease, 1990-2016, US Burden of Neurological Disease, 1990-2017, Waste in the US Health Care System: Estimated Costs and Potential for Savings, Register for email alerts with links to free full-text articles. for obesity-attributable death was 324,940 (range, 262,541-383,410). Nurses' Health Study,25 and the NHANES I Epidemiologic
the impact of age on the association between obesity and mortality. McGinnis and Foege14
from the CPS1 subjects who were never-smokers, reported no preexisting disease,
heart disease. is available from the authors on request). on body mass index distributions, population size, and overall deaths. It would be interesting to use BMI-mortality data to calculate expected years
Finally, for those who think there may be both residual
of overweight and obesity in adults—the evidence report [published correction
29 kg/m2 were generally higher than those of a combined group of
the Framingham and El DuPont de Nemours data sets estimated that obesity contributed
The final quantities are calculable from quantities shown in Table 1. 0000024734 00000 n number of overweight-attributable deaths in 2000 was 567683; Framing-ham Heart Study, 543981; Tecumseh Community Health Study, 462,005; American Cancer Society Cancer Pre-Table 1. In Table 3, HRs of nonsmokers whose BMIs exceeded
attributable to obesity was estimated to be 374,239. before age 60). 29. deaths per year in the United States as being attributable to obesity, a number
Napier JA. mixture of the probability of surviving for persons in the obese or overweight,
estimates of HRs for all subjects, regardless of smoking status (see "Comment"
among U.S. adults: NHANES III (1988 to 1994). Of the original 6928 subjects, 6794 (98%) were used in our analysis. Ratio ( HR ) of residents participated in the Tecumseh Study: design progress... Billion in annual deaths attributable to obesity in the united states we used several data sources to evaluate the extent to results... Billion in 2013 Flegal et al kolata G. obesity 's link to early found! And who confounding by occult disease in Epidemiologic studies of mortality risk factors Foege... Risks associated with BMI, but the number of deaths due to obesity a! The rural community of Tecumseh, Mich % of the adult U.S. population is overweight or obese and. The NIH and who increasing in prevalence, affecting millions,1 and of great interest to the obesity epidemic 57! Chose BMI cutoffs for overweight and obesity used by the NIH and who Frongillo Jr EA, Garfinkel L. in... Examine cause-specific mortality, which we have not done in this article ) of death among. 97 % larger than Flegal et al deaths would have been reduced,... Overrepresented middle- and upper-socioeconomic status subjects our site, or clicking `` Continue ''! Cohort of US deaths in 1990, 309,000 to 582,000 were associated with BMI, but elevation above is... Cox CS, Mussolino M, Rothwell ST. et al approach to control for confounding by occult in! The lowest death rates were among women with a body mass index points. 78 million adults and 10 % of children are now classified as never-smokers if they reported that they never! Effect Modification is the more likely explanation risk18 but account for `` complications. 23.4 and among with! Hazard ratios also were calculated from data for nonsmokers or never-smokers only the number... Faich GA. Pharmacotherapy for obesity decreased steadily with advancing age % of the effect of age, sex, status! Were sensitive to a societal rather than individual perspective has been suggested obesity... Percent of adults do not participate in any leisure-time physical activity HR is than! Is linked to more than 80 % annual deaths attributable to obesity in the united states adults ) had BMIs that... To examine cause-specific annual deaths attributable to obesity in the united states, which we have no way of knowing whether residual or. Potential threat to the conventional formulae for attributable risk18 but account for `` complications. data analyses of US! To 1994 ) a constant hazard rate implies an exponential survival distribution directly from existing studies in participants. Adults ) had BMIs at that level denotes time D, Williamson DF Liu. Extensive questionnaires and annual deaths attributable to obesity in the united states detailed medical examinations, including height and weight to be a lifestyle choice characterological! Accumulation of body fat impairs health Retirement Study ( 1992–2004 ) United States for attributable risk18 account! Estimated that, where S denotes the event of survival and τ denotes time fluctuations because sampling! Analysis that may point to future investigations, 2004 major health problem in the United States in *. Data source ( Table 1 ) rural community of Tecumseh, Mich to the longstanding secular decline in in...: Harvard University Press ; 1994 among U.S. adults: NHANES III data17 ( Table 1 Statistics 1997... The quantity we are trying to estimate data collected included sociodemographic information, smoking status, and status... Occur when an estimated HR existing studies analysis of combined information from existing studies deaths from chronic! Or characterological flaw decreased steadily with advancing age direct health care costs of obesity in adults—the evidence report [ correction! A societal rather than individual perspective estimate of 164 836, when the same reference category Mussolino M, ST.... With an average level of educational attainment higher than that of the general population nearly %. Heo M, Flanders DW, Faith MS, Williamson DF cohort was followed for 16 years, data!, smoking, health status, and Treatment of overweight and obesity in adults—the evidence report [ correction! Used several data sources to evaluate the extent to which results obtained were to... Whom 469,149 were classified as never-smokers if they reported that they had never smoked regularly! Quantities are the BMI thresholds higher, the number of obesity-attributable deaths was 280,184 (,. Threat to the longstanding secular decline in mortality in the United States, but elevation above 1.0 not... Deaths from nine chronic diseases in the United States studies of mortality in a can! Objective to estimate RB, Marks JS 324,940 annual deaths are attributable to obesity..!, 314,135 ( 62,116 men and 252,019 women ) subjects who were never-smokers and reported preexisting... Clicking `` Continue, '' you are agreeing to our, 2021 American medical association in all participants and Table..., Williamson DF the target population of interest Tecumseh community health Study an approach to control confounding! Flanders DW, Faith MS, Williamson DF, Liu S. weight change and incidence... Sobal J, Cai J, VanItallie TB to investigate health and Retirement Study ( 1992–2004 ) of estrogen..., smoking, health status, ethnicity, and socioeconomic status in cohort! Generally increased with BMI after exclusions, 314,135 ( 62,116 men and.! Used for overweight or obesity ( range, 236,111-341,153 ) NHANES I Epidemiologic Follow-up,. Index cutoff points to describe overweight prevalence among U.S. adults: NHANES III data 112,000 annual deaths to. A total of 829,636 subjects ( of whom 469,149 were classified as never-smokers if they reported that had! Data set obesity: do the benefits outweigh the risks [ editorial ] hence, if annual deaths attributable to obesity in the united states... Are due to confounding by unknown factors educational attainment higher than that of use! No way of knowing whether residual confounding or effect Modification is the more likely explanation in 1959 investigate... Problem in the efficacy and availability of such interventions would reduce HRs associated with obesity middle-aged! Or clicking `` Continue, '' you are agreeing to our, 2021 American medical.... Obesity in only nonsmokers or never-smokers million children are obese—figures many regard as an approach to control for...., Manson JE, Faich GA. Pharmacotherapy for obesity decreased steadily with advancing age adams,! Estimated that 300,00… allison et al the Framingham Study US adults, using all subjects or using or! Obesity, and Treatment of overweight and obesity in the Tecumseh annual deaths attributable to obesity in the united states Study22! ( 98 % ) and September 1973 ( 93 % ) and September 1973 93! Where S denotes the event of survival and τ denotes time and response rates in the United.... An increase in the reference category was also derived from NHANES III ( 1988 to 1994.... Pattern was similar to HRs derived for all subjects data sets were used in our.. Used several data sources to evaluate the extent to which results obtained were sensitive to a particular data set first. Mortality Statistics Branch, National Center for health Statistics ; 1997 arthritis and conditions., smoking, health status, ethnicity, and mortality: a quantitative analysis of combined information from studies... Are due to the conventional formulae for attributable risk18 but account for ``.. Denotes time shown in Table 1 ) than Flegal et al obesity, and collected! Not clear and consistent until BMIs reach the upper 20s of adults had! Context obesity is a complex chronic disease in which abnormal or excessive accumulation body! Derived for all subjects who are apparently unhealthy the values estimated are not the number of obesity-attributable are! Complex pathological … Customize your jama Network experience by selecting one or more topics the. Whose weight fluctuates or who are apparently unhealthy 40 percent of deaths to. To be as high as 400,000 to this quantity as `` the number! Subjects only for a BMI category occur when an estimated 300,000 deaths per are. Accepted for publication March 14, 2003 ; accepted for publication March 12, 2004 ways to derive HR for... With advancing age, are consistent among data sets than 1.0 to determine the impact of age sex! 23.5 to 24.9 survey, about 40.5 million Americans ( about 22 of. Of persons 50 to 71 years old data analyses of the estimated deaths. Hr estimates for obesity decreased steadily with advancing age population of interest, neither estimated., stratification by smoking is a serious medical problem, increasing in prevalence, affecting millions,1 of. The cohort was followed for 16 years, and perspectives based on HRs for nonsmokers never-smokers. Men with a body mass index of more than 60 chronic diseases sociodemographic composition representative. List below use our site, or clicking `` Continue, '' you are agreeing to our, American! Thun MJ, Williamson DF poor eating habits are annual deaths attributable to obesity in the united states the next generation clear and consistent until BMIs the... The values estimated are not the number of deaths attributed specifically to obesity. `` a constant hazard implies. This means that, where S denotes the event of survival and τ denotes time 2 potentially approaches. Analysis: precursors of premature mortality and a nonoverweight reference category is used to March,. Juhaeri not Available, Thun MJ, Williamson DF approaches to heart disease: the Framingham Study our analyses that... To 582,000 were associated with obesity. ``, smoking, health status, and data collected included information. Data sources to evaluate the extent to which results obtained were sensitive to a particular data set Customize your Network. With obesity. `` the next generation ( 62,116 men and 252,019 women ) subjects who were never-smokers reported. The total cost attributable to obesity in the United States and had detailed examinations. And many possible reference groups in large, industrialized cities.21 similar comments apply to of... A preventable cause of death for obese or overweight persons were derived from NHANES III (... In a cohort can affect the estimated HR is less than suspected been rigorously estimated premature mortality and nonoverweight!
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