Context Obesity is a major health problem in the United States, but the number
of obesity-attributable deaths has not been rigorously estimated.
Objective To estimate the number of deaths, annually, attributable to obesity
among US adults.
Design Data from 5 prospective cohort studies (the Alameda Community Health
Study, the Framingham Heart Study, the Tecumseh Community Health Study, the
American Cancer Society Cancer Prevention Study I, and the National Health
and Nutrition Examination Survey I Epidemiologic Follow-up Study) and 1 published
study (the Nurses' Health Study) in conjunction with 1991 national statistics
on body mass index distributions, population size, and overall deaths.
Subjects Adults, 18 years or older in 1991, classified by body mass index (kg/m2) as overweight (25-30), obese (30-35), and severely obese (>35).
Main Outcome Measure Relative hazard ratio (HR) of death for obese or overweight persons.
Results The estimated number of annual deaths attributable to obesity varied
with the cohort used to calculate the HRs, but findings were consistent overall.
More than 80% of the estimated obesity-attributable deaths occurred among
individuals with a body mass index of more than 30 kg/m2. When
HRs were estimated for all eligible subjects from all 6 studies, the mean
estimate of deaths attributable to obesity in the United States was 280,184
(range, 236,111-341,153). Hazard ratios also were calculated from data for
nonsmokers or never-smokers only. When these HRs were applied to the entire
population (assuming the HR applied to all individuals), the mean estimate
for obesity-attributable death was 324,940 (range, 262,541-383,410).
Conclusions The estimated number of annual deaths attributable to obesity among
US adults is approximately 280,000 based on HRs from all subjects and 325,000
based on HRs from only nonsmokers and never-smokers.