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Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess Deaths Associated With Underweight, Overweight, and Obesity. JAMA. 2005;293(15):1861–1867. doi:10.1001/jama.293.15.1861
Author Affiliations: National Center for Health
Statistics, Centers for Disease Control and Prevention, Hyattsville, Md (Dr
Flegal); Center for Weight and Health, University of California at Berkeley
(Dr Flegal); Division of Cancer Epidemiology and Genetics, National Cancer
Institute, Bethesda, Md (Drs Graubard and Gail); and Division of Diabetes
Translation, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Williamson).
Context As the prevalence of obesity increases in the United States, concern
over the association of body weight with excess mortality has also increased.
Objective To estimate deaths associated with underweight (body mass index [BMI]
<18.5), overweight (BMI 25 to <30), and obesity (BMI ≥30) in the
United States in 2000.
Design, Setting, and Participants We estimated relative risks of mortality associated with different levels
of BMI (calculated as weight in kilograms divided by the square of height
in meters) from the nationally representative National Health and Nutrition
Examination Survey (NHANES) I (1971-1975) and NHANES II (1976-1980), with
follow-up through 1992, and from NHANES III (1988-1994), with follow-up through
2000. These relative risks were applied to the distribution of BMI and other
covariates from NHANES 1999-2002 to estimate attributable fractions and number
of excess deaths, adjusted for confounding factors and for effect modification
Main Outcome Measures Number of excess deaths in 2000 associated with given BMI levels.
Results Relative to the normal weight category (BMI 18.5 to <25), obesity
(BMI ≥30) was associated with 111 909 excess deaths (95% confidence
interval [CI], 53 754-170 064) and underweight with 33 746
excess deaths (95% CI, 15 726-51 766). Overweight was not associated
with excess mortality (−86 094 deaths; 95% CI, −161 223
to −10 966). The relative risks of mortality associated with obesity
were lower in NHANES II and NHANES III than in NHANES I.
Conclusions Underweight and obesity, particularly higher levels of obesity, were
associated with increased mortality relative to the normal weight category.
The impact of obesity on mortality may have decreased over time, perhaps because
of improvements in public health and medical care. These findings are consistent
with the increases in life expectancy in the United States and the declining
mortality rates from ischemic heart disease.
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